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Bidirectional association between cardiovascular disease and hip fracture: a systematic review and meta-analysis
Jinyi Wu1,2,3,4, Yan Zhang5, Junwen Wang3,4
1Fudan University School of Public Health, Xuhui, Shanghai, China.
Insights
Cardiovascular diseases (CVD) and hip fractures (HF) show bidirectional links, with conditions like stroke and heart failure increasing HF risk. Hip fractures also elevate risks for stroke, heart failure, and CVD-related death, warranting further research.
Area of Science:
- Gerontology
- Epidemiology
- Cardiology
Background:
- Investigating the complex relationship between cardiovascular disease (CVD) and hip fracture (HF) is crucial for public health.
- Understanding the bidirectional nature of these conditions can inform preventative strategies and patient care.
Approach:
- A systematic review and meta-analysis of 18 cohort and case-control studies involving over 1.8 million individuals.
- Searched multiple databases (PubMed, EMBASE, Web of Science, etc.) and assessed risk of bias using the Newcastle-Ottawa scale.
- Employed random-effects models, subgroup analyses by ethnicity, sensitivity analyses, and evaluated publication bias, adhering to PRISMA and MOOSE guidelines.
Key Points:
- Ischemic heart disease, stroke, heart failure, hypertension, cerebrovascular disease, and arterial diseases are associated with increased hip fracture risk.
- Hip fracture is linked to increased risk of stroke, heart failure, myocardial infarction, and cardiovascular death.
- Subgroup analyses indicated that ischemic heart disease may not significantly increase hip fracture risk in Asian and Caucasian populations.
Conclusions:
- Evidence suggests bidirectional associations between cardiovascular disease and hip fracture.
- High heterogeneity and potential confounding factors necessitate cautious interpretation of findings.
- Further mechanistic studies are required to elucidate the complex interplay between CVD and HF.
Background:
The aim of this study was to comprehensively analyze the bidirectional association between cardiovascular disease (CVD) and hip fracture (HF).
Methods:
We searched PubMed, EMBASE, Web of Sciences, Cochrane Library, ScienceDirect and China National Knowledge Infrastructure for relevant studies. The Newcastle-Ottawa scale was used to evaluate the risk of bias. We conducted random effects model for meta-analysis and subgroup analysis of different ethnic groups. Sensitivity analysis and publication bias of this study were also evaluated. This study followed the PRISMA and MOOSE guidelines for systematic reviews and meta-analyses.
Results:
This research included 18 cohort studies and case-control studies with a total sample of 1,854,441 individuals. The results showed ischemic heart disease might increase the risk of HF (OR = 1.41, 95%CI[1.05, 1.89], I2 = 96%). Stroke might be a risk factor for HF (OR = 2.23, 95%[1.18, 4.19], I2 = 97%), and HF might likewise be a risk factor for Stroke ( OR = 2.22, 95% CI [1.81, 2.71], I2 = 78%). Heart failure might increase the risk of HF (OR = 2.89, 95%CI [1.22, 6.85], I2 = 91%), and HF might increase the risk of heart failure (OR = 2.74, 95%CI [1.27, 5.89], I2 = 92%). Hypertension might increase the risk of HF (OR = 1.55, 95%CI[1.34, 1.8], I2 = 87%), and HF might increase the risk of hypertension (OR = 3.75, 95%CI[3.3, 4.26], I2 = 98%). Cerebrovascular disease (OR = 1.96, 95%CI[1.61, 2.4], I2 = 79%) and diseases of arteries, arterioles, and capillaries (OR = 1.58, 95%CI[1.49, 1.68], I2 = 0%) might increase the risk of HF. HF might increase the risk of myocardial infarction (OR = 2, 95%CI[1.17, 3.41], I2 = 97%) and CVD-related death (OR = 1.78, 95%CI[1.05, 3.02], I2 = 50%). Subgroup analyses showed that among Asians IHD might not raise the risk of HF (OR = 1.33, 95% CI [1.00, 1.78], I2 = 95%). In caucasians, IHD might also not raise HF risk (OR = 1.52, 95%CI [0.64, 4.56], I2 = 95%).
Conclusions:
This study supports possible bidirectional associations between CVD and HF, but more mechanistic studies of CVD and HF were warranted. However, high heterogeneity and potential confounding by unmeasured variables warrant cautious interpretation.
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