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History of cardiovascular disease and cardiovascular biomarkers are associated with 30-day mortality in patients with hip fracture

  • D. Norring-AgerskovEmail author
  • C. M. Madsen
  • L. Bathum
  • O. B. Pedersen
  • J. B. Lauritzen
  • N. R. Jørgensen
  • H. L. Jørgensen
Original Article

Abstract

Summary

Hip fractures are associated with increased mortality and it is important to identify risk factors. This study demonstrates that preexisting cardiovascular disease as well as cardiovascular biomarkers that are associated with increased 30-day mortality. These findings can be used to identify high-risk patients who might benefit from specialized care.

Introduction

This study investigates the association between cardiovascular disease (CVD), cardiovascular biomarkers, and 30-day mortality following a hip fracture.

Methods

The Danish National Patient Registry was used to investigate the association between CVD and mortality following hip fracture in a nationwide population-based cohort study. In a subset of the included patients (n = 355), blood samples were available from a local biobank. These samples were used for analyzing the association between specific biochemical markers and mortality. The primary outcome was 30-day mortality.

Results

A total of 113,211 patients were included in the population-based cohort study. Among these, heart failure was present in 9.4%, ischemic heart disease in 15.9%, and ischemic stroke in 12.0%. Within 30 days after the hip fracture, 11,488 patients died, resulting in an overall 30-day mortality of 10.1%. The 30-day mortality was significantly increased in individuals with preexisting CVD with multivariably adjusted odds ratios of 1.69 (95% confidence interval, 1.60–1.78) for heart failure, 1.23 (1.17–1.29) for ischemic heart disease, and 1.06 (1.00–1.12) for ischemic stroke. In the local database including 355 patients, 41 (11.5%) died within 30 days. The multivariably adjusted odds ratio for 30-day mortality increased with increasing NT-proBNP (2.36 [1.53–3.64] per quartile) and decreased with increasing HDL cholesterol (0.58 [0.41–0.82] per quartile). On this basis, we established a model for predicting the probability of death based on the biochemical markers.

Conclusion

Preexisting CVD was associated with increased 30-day mortality after a hip fracture. Furthermore, high levels of NT-proBNP and low levels of HDL cholesterol were associated with increased 30-day mortality.

Keywords

HDL-C Heart failure Ischemic heart disease Ischemic stroke NT-proBNP 

Notes

Authors’ contributions

All authors have contributed significantly to the manuscript. Study design: All authors. Processing and preparation of raw data for subsequent analyses: HLJ. Preparation of biobank material: DNA. Data analysis: DNA, CMM, and HLJ. Interpretation of data: All authors. Drafting of the manuscript: DNA. Critical review of the manuscript for intellectual content and approval of the final version: All authors. Guarantor: DNA.

Compliance with ethical standards

This study was approved by the Danish Data Protection Agency (2012-58-0004)/local number BBH-2014-050, by Statistics Denmark (project number 704670) and by the ethics committee of the Capital Region of Denmark (H-B-2007-103 / 61361).

Conflicts of interest

None.

Human and animal rights and informed consent

Most of the data is derived from registers and the data was anonymized prior to our use. In this case, informed consent from the individual patients is not required according to Danish law. Informed consent was obtained for all the patients included in the biobank. Animals were not used in this study.

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Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2019

Authors and Affiliations

  1. 1.Department of Clinical BiochemistryHvidovre HospitalHvidovreDenmark
  2. 2.Open Patient Data Explorative NetworkUniversity of Southern Denmark and Odense University HospitalOdense CDenmark
  3. 3.Department of Clinical BiochemistryHerlev og Gentofte HospitalHerlevDenmark
  4. 4.Department of Clinical ImmunologyNæstved SygehusNæstvedDenmark
  5. 5.Department of Clinical MedicineUniversity of CopenhagenCopenhagen NDenmark
  6. 6.Department of Orthopedic SurgeryBispebjerg HospitalCopenhagen NVDenmark
  7. 7.Department of Clinical BiochemistryRigshospitaletGlostrupDenmark

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