Atrial Fibrillation and the Risk of Subsequent Fracture - 31/07/20
, Qiuxi Huang, MA b, Douglas P. Kiel, MD, MPH c, d, Emelia J. Benjamin, MD, ScM e, f, g, Ludovic Trinquart, MSc, MPH, PhD b, eAbstract |
Background |
There is conflicting evidence regarding the association between atrial fibrillation and the risk of subsequent fractures.
Methods |
We included participants aged 45 years or older from the Framingham Heart Study Offspring, Third-Generation, New Offspring Spouse, Omni 1, and Omni 2 cohorts. We prespecified analyzing index age 65 years as our primary analysis; we repeated analyses for index ages 45, 55, and 75 years. The primary outcome was any incident bone fracture, except finger, toe, foot, skull, and facial fractures. We assessed the association between time-varying atrial fibrillation and subsequent fractures by an illness-death model that accounted for the competing risk of death. We estimated hazard ratios (HR) adjusted for age, sex, body mass index, smoking, diabetes, alcohol intake, and prior fracture.
Results |
We included 3403 participants (mean age of 68 years, 53.3% female) in the analysis at index age 65 years and above. In all, 525 (15%) participants suffered incident fractures during follow-up (median 12.5 years). The HR between atrial fibrillation and subsequent fracture was 1.37; 95% confidence interval (CI), 1.06-1.79. There was no evidence of effect modification by sex (HR 1.55; 95% CI, 1.06-2.26 in men; HR 1.22; 95% CI, 0.84-1.77 in women; interaction P value .27). Results were consistent at other index ages.
Conclusion |
Atrial fibrillation was associated with increased risk of incident fracture in the community-based Framingham Heart Study.
Le texte complet de cet article est disponible en PDF.Keywords : Atrial fibrillation, Bone fracture, Cohort studies, Epidemiology, Population health, Risk factors
Plan
| Funding: This work is supported by the National Heart, Lung, and Blood Institute's (NHLBI) Framingham Heart Study (HHSN268201500001I; N01-HC 25195). EJB is supported by the National Institutes of Health (NIH)/NHLBI 1R01HL128914; 2R01 HL092577. EJB and LT are supported by the American Heart Association (EJB: 18SFRN34110082; LT: 18SFRN34150007). Both the fracture data collection and DPK were supported by NIH/National Institute of Arthritis and Musculoskeletal and Skin Diseases R01 AR041398 and R01 AR061445. DPK reports funding from Amgen and from Radius Health. |
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| Conflict of Interest: DPK is on the scientific advisory board of Solarea Bio, receives grant funding from Amgen and Radius Health, and receives royalties from his publication on “Falls” in UpToDate—Wolters Kluwer. Starting January 2020, EJB serves as an uncompensated member for the MyHeartLab Steering Committee. The MyHeartLab Study is a principal investigator (PI)-initiated study from the University of California San Francisco: PI, Jeffrey Olgin, MD, through a research grant to the University of California, San Francisco from Samsung. The other authors do not report any conflicts of interest. |
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| Authorship: All authors had access to the data and had a role in writing the manuscript. |
Vol 133 - N° 8
P. 954-960 - août 2020 Retour au numéro
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