• heart disease

Fragility-related fractures and cardiovascular disease are common conditions in old age, both contributing to impaired quality of life and higher risk of death in the elderly. In this issue of Heart, Johansson et al 1 present results suggesting that these conditions may be more closely related than previously considered. The authors hypothesised that cardiovascular autonomic disorder and endothelial dysfunction, as reflected in serum biomarker levels, would be associated with fracture risk. Studying a subset of the Malmö Preventive Project, a population-based prospective cohort, they examined the association of four cardiovascular biomarkers with the risk of incident vertebral, pelvic and extremity fractures in 5415 community-dwelling subjects (mean age, 68.9±6.2 years), followed during 8.1±2.9 years. C-terminal pro-arginine vasopressin (CT-proAVP), C-terminal endothelin-1 precursor fragment (CT-proET-1), the mid-regional fragments of pro-adrenomedullin (MR-proADM) and pro-atrial natriuretic peptide (MR-proANP) were measured in fasting blood samples during re-screening examination in years 2002–2006. Information about fracture diagnoses and the date of death were retrieved from the Swedish National Hospital Discharge Register and the Swedish National Cause of Death Register. Elevated levels of MR-proADM and MR-proANP independently predicted fragility fractures in older adults, with a stronger association in men compared with women. In subjects with levels of all four biomarker in the top quartile, there was a 2- to 3-fold increase in risk of vertebral and femoral fractures. (figure 1)

In the companion editorial, Lewis and Szulc2 point out the strengths …