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Orthostatic Hypotension and Elevated Resting Heart Rate Predict Low-Energy Fractures in the Population : The Malmö Preventive Project

Hamrefors, Viktor LU ; Härstedt, Maria LU ; Holmberg, Anna LU ; Rogmark, Cecilia LU ; Sutton, Richard; Melander, Olle LU and Fedorowski, Artur LU (2016) In PLoS ONE 11(4). p.0154249-0154249
Abstract

BACKGROUND: Autonomic disorders of the cardiovascular system, such as orthostatic hypotension and elevated resting heart rate, predict mortality and cardiovascular events in the population. Low-energy-fractures constitute a substantial clinical problem that may represent an additional risk related to such autonomic dysfunction.

AIMS: To test the association between orthostatic hypotension, resting heart rate and incidence of low-energy-fractures in the general population.

METHODS AND RESULTS: Using multivariable-adjusted Cox regression models we investigated the association between orthostatic blood pressure response, resting heart rate and first incident low-energy-fracture in a population-based, middle-aged cohort of 33... (More)

BACKGROUND: Autonomic disorders of the cardiovascular system, such as orthostatic hypotension and elevated resting heart rate, predict mortality and cardiovascular events in the population. Low-energy-fractures constitute a substantial clinical problem that may represent an additional risk related to such autonomic dysfunction.

AIMS: To test the association between orthostatic hypotension, resting heart rate and incidence of low-energy-fractures in the general population.

METHODS AND RESULTS: Using multivariable-adjusted Cox regression models we investigated the association between orthostatic blood pressure response, resting heart rate and first incident low-energy-fracture in a population-based, middle-aged cohort of 33 000 individuals over 25 years follow-up. The median follow-up time from baseline to first incident fracture among the subjects that experienced a low energy fracture was 15.0 years. A 10 mmHg orthostatic decrease in systolic blood pressure at baseline was associated with 5% increased risk of low-energy-fractures (95% confidence interval 1.01-1.10) during follow-up, whereas the resting heart rate predicted low-energy-fractures with an effect size of 8% increased risk per 10 beats-per-minute (1.05-1.12), independently of the orthostatic response. Subjects with a resting heart rate exceeding 68 beats-per-minute had 18% (1.10-1.26) increased risk of low-energy-fractures during follow-up compared with subjects with a resting heart rate below 68 beats-per-minute. When combining the orthostatic response and resting heart rate, there was a 30% risk increase (1.08-1.57) of low-energy-fractures between the extremes, i.e. between subjects in the fourth compared with the first quartiles of both resting heart rate and systolic blood pressure-decrease.

CONCLUSION: Orthostatic blood pressure decline and elevated resting heart rate independently predict low-energy fractures in a middle-aged population. These two measures of subclinical cardiovascular dysautonomia may herald increased risks many years in advance, even if symptoms may not be detectable. Although the effect sizes are moderate, the easily accessible clinical parameters of orthostatic blood pressure response and resting heart rate deserve consideration as new risk predictors to yield more accurate decisions on primary prevention of low-energy fractures.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
longitudinal study, Heart Rate, Hypotension, Orthostatic
in
PLoS ONE
volume
11
issue
4
pages
0154249 - 0154249
publisher
Public Library of Science
external identifiers
  • scopus:85015356238
  • wos:000375211700060
ISSN
1932-6203
DOI
10.1371/journal.pone.0154249
language
English
LU publication?
yes
id
16ce6566-d9cd-4bc9-b26b-dc81fe5a4b5a
date added to LUP
2017-04-10 16:33:32
date last changed
2017-09-18 13:32:00
@article{16ce6566-d9cd-4bc9-b26b-dc81fe5a4b5a,
  abstract     = {<p>BACKGROUND: Autonomic disorders of the cardiovascular system, such as orthostatic hypotension and elevated resting heart rate, predict mortality and cardiovascular events in the population. Low-energy-fractures constitute a substantial clinical problem that may represent an additional risk related to such autonomic dysfunction.</p><p>AIMS: To test the association between orthostatic hypotension, resting heart rate and incidence of low-energy-fractures in the general population.</p><p>METHODS AND RESULTS: Using multivariable-adjusted Cox regression models we investigated the association between orthostatic blood pressure response, resting heart rate and first incident low-energy-fracture in a population-based, middle-aged cohort of 33 000 individuals over 25 years follow-up. The median follow-up time from baseline to first incident fracture among the subjects that experienced a low energy fracture was 15.0 years. A 10 mmHg orthostatic decrease in systolic blood pressure at baseline was associated with 5% increased risk of low-energy-fractures (95% confidence interval 1.01-1.10) during follow-up, whereas the resting heart rate predicted low-energy-fractures with an effect size of 8% increased risk per 10 beats-per-minute (1.05-1.12), independently of the orthostatic response. Subjects with a resting heart rate exceeding 68 beats-per-minute had 18% (1.10-1.26) increased risk of low-energy-fractures during follow-up compared with subjects with a resting heart rate below 68 beats-per-minute. When combining the orthostatic response and resting heart rate, there was a 30% risk increase (1.08-1.57) of low-energy-fractures between the extremes, i.e. between subjects in the fourth compared with the first quartiles of both resting heart rate and systolic blood pressure-decrease.</p><p>CONCLUSION: Orthostatic blood pressure decline and elevated resting heart rate independently predict low-energy fractures in a middle-aged population. These two measures of subclinical cardiovascular dysautonomia may herald increased risks many years in advance, even if symptoms may not be detectable. Although the effect sizes are moderate, the easily accessible clinical parameters of orthostatic blood pressure response and resting heart rate deserve consideration as new risk predictors to yield more accurate decisions on primary prevention of low-energy fractures.</p>},
  author       = {Hamrefors, Viktor and Härstedt, Maria and Holmberg, Anna and Rogmark, Cecilia and Sutton, Richard and Melander, Olle and Fedorowski, Artur},
  issn         = {1932-6203},
  keyword      = {longitudinal study,Heart Rate,Hypotension,Orthostatic},
  language     = {eng},
  number       = {4},
  pages        = {0154249--0154249},
  publisher    = {Public Library of Science},
  series       = {PLoS ONE},
  title        = {Orthostatic Hypotension and Elevated Resting Heart Rate Predict Low-Energy Fractures in the Population : The Malmö Preventive Project},
  url          = {http://dx.doi.org/10.1371/journal.pone.0154249},
  volume       = {11},
  year         = {2016},
}