Arterial stiffness is not associated with bone parameters in an elderly hyperhomocysteinemic population

Poor Bone Quality is Associated With Greater Arterial Stiffness: Insights From the UK Biobank

Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex. © 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Unraveling the Links Underlying Arterial Stiffness, Bone Demineralization, and Muscle Loss

The effects of elevated arterial stiffness on cardiovascular outcomes are widely studied, whereas the relation to noncardiovascular outcomes relevant to older persons, such as the effect on bones and muscles, is less well established. Arterial stiffness, bone demineralization, and muscle loss are all age-related processes with common risk factors, however, whether these are just parallel age-related alterations or whether these processes share common pathways is not yet understood. In this review, we outline previous literature using different assessments of arterial stiffness in various populations across the world to produce a comprehensive overview. Although there are many studies showing an association between arterial stiffness and loss of bone and muscle, the majority are cross-sectional and there is limited longitudinal evidence to justify causal conclusions. We also give an in-depth review of hypotheses and possible mechanisms which may underlie these associations including hormone dysregulation, impaired glucose metabolism, and inflammation. This narrative review highlights the associations between vessels, bones, and muscles with aging, offering insights into possible shared pathways.

Links between arterial stiffness and bone mineral density in middle-aged and elderly Chinese individuals: a cross-sectional study

OBJECTIVES

To explore whether bone mineral density (BMD) is associated with arterial stiffness in middle-aged and elderly people with an advanced arterial stiffness index as indicated by the cardio-ankle vascular index (CAVI).

DESIGN

A cross-sectional study.

SETTING

This study was conducted from September 2015 to May 2017 at the geriatrics department of a provincial medical centre in China.

PARTICIPANTS

A total of 580 patients aged 50 and over were enrolled in the study. The mean age of the group was 64.82±11.4 years, and 63.1% were male.

PRIMARY OUTCOME MEASURES

Associations of age with CAVI values and BMD. Associations between BMD and CAVI values.

RESULTS

With increasing age, CAVI values gradually increased (p<0.001) and the femoral neck (FN) and total hip (TH) BMD gradually decreased (p<0.001, all). In the bivariate correlation analyses between the covariates and CAVI values, age and CAVI values showed the greatest positive correlation (r=0.631, p<0.001), and CAVI values were negatively correlated with FN BMD (r=-0.229, p<0.001) and TH BMD (r=-0.218, p<0.001). In the linear regression analyses, TH BMD (B=-1.812 (95% CI -2.475 to -1.149), p<0.001) and FN BMD (B=-1.968 (95% CI -2.651 to -1.284), p<0.001) were negatively correlated with CAVI values. After adjusting for age, gender, body mass index, smoking, history of cardiovascular or cerebrovascular disease, history of diabetes mellitus, systolic blood pressure, high-density lipoprotein cholesterol, blood uric acid, fibrinogen and estimated glomerular filtration rate, only TH BMD was still negatively correlated with CAVI values (B=-0.843 (95%CI -1.454 to -0.232), p=0.007). However, there was no consistent and significant correlation between lumbar spine BMD and CAVI values.

CONCLUSION

In this cross-sectional study, a significant correlation between TH BMD and CAVI values was observed in middle-aged and elderly Chinese inpatients. However, our cohort was a small sample of inpatients, and prospective studies from more centres are expected.

The Association between Bone Quality and Atherosclerosis: Results from Two Large Population-Based Studies

OBJECTIVE

It is highly debated whether associations between osteoporosis and atherosclerosis are independent of cardiovascular risk factors. We aimed to explore the associations between quantitative ultrasound (QUS) parameters at the heel with the carotid artery intima-media thickness (IMT), the presence of carotid artery plaques, and the ankle-brachial index (ABI).

METHODS

The study population comprised 5680 men and women aged 20-93 years from two population-based cohort studies: Study of Health in Pomerania (SHIP) and SHIP-Trend. QUS measurements were performed at the heel. The extracranial carotid arteries were examined with B-mode ultrasonography. ABI was measured in a subgroup of 3853 participants. Analyses of variance and linear and logistic regression models were calculated and adjusted for major cardiovascular risk factors.

RESULTS

Men but not women had significantly increased odds for carotid artery plaques with decreasing QUS parameters independent of diabetes mellitus, dyslipidemia, and hypertension. Beyond this, the QUS parameters were not significantly associated with IMT or ABI in fully adjusted models.

CONCLUSIONS

Our data argue against an independent role of bone metabolism in atherosclerotic changes in women. Yet, in men, associations with advanced atherosclerosis, exist. Thus, men presenting with clinical signs of osteoporosis may be at increased risk for atherosclerotic disease.