ABC | Volume 110, Nº3, March 2018

Original Article Association of Severity of Coronary Lesions with Bone Mineral Density in Postmenopausal Women Rui Xu, *1 Xin-Chun Cheng, *1,2 Yuan Zhang, 1 Hong-Mei Lai, 3 Hong-Ni Yang 1 Gerontology Center - People’s Hospital of Xinjiang Uygur Autonomous Region, China 1 Department of Pacing and Electrophysiological - The First Affiliated Hospital of Xinjiang Medical University, China 2 Department of Cardiology - People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China 3 * Equally contributed to the work Mailing Address: Hong-Ni Yang • N°. 91 Tianchi Road, Tianshan Disztrict, Urumqi, Xinjiang, China. 830001, Tianshan Disztrict, Urumqi, Xinjiang – China E-mail: xjddddd@126.com Manuscript received April 02, 2017, revised manuscript June 13, 2017, accepted August 23, 2017 DOI: 10.5935/abc.20180035 Abstract Background: Coronary artery disease (CAD) and osteoporosis (OP) are common diseases in postmenopausal women. In both cross-sectional and longitudinal epidemiologic studies, low bone mass has been related to increased frequency of CAD. However, available data on the relationship between bone mineral density (BMD) and severity of coronary lesions is limited. Objective: To investigate association between the BMD and severity of coronary lesions assessed by Gensini score in postmenopausal women. Methods: This study included 122 postmenopausal women who were diagnosed with CAD. These patients were divided into two groups according to the severity of coronary lesions assessed by the Gensini score – patients with mild coronary lesions (Gensini score < 25) and patients with severe coronary lesions (Gensini score ≥ 25). Femoral neck mineral density was measured with dual energy X-ray absorptiometry (DXA). Results: The study included postmenopausal women aged 64.31 ± 4.71 years, 85 of whom (69.7%) exhibited severe coronary lesions. Participants with severe coronary lesions had a significantly higher T score than did those with mild coronary lesions at the femoral neck (p < 0.05). The mean T-score was −0.84 ± 1.01 in mild coronary lesions group, −1.42 ± 1.39 in severe coronary lesions group (p < 0.05). Multivariable logistic regression analysis showed that osteopenia-osteoporosis at the Femoral neck (odds ratio 2.73; 95% confidence interval 1.06 to 6.13) was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores ( β = −0.407, SE = 0.151, p=0.007) were the independent predictors of Gensini score. Conclusion: The relationship between severity of coronary lesions and BMD was significant in postmenopausal women. BMD, a low-cost technique involving minimal radiation exposure, widely used for osteoporosis screening, is a promising marker of severity of coronary lesions. (Arq Bras Cardiol. 2018; 110(3):211-216) Keywords: Coronary ArteryDisease;Osteoporosis, Postmenopausal; BoneDensity; Stroke;Morbidity; BoneDiseases,Metabolic. Introduction Atherosclerosis (AS) is one of the most common diseases in elderly people, especially in postmenopausal women. The complications of AS, like coronary artery disease (CAD) and cerebrovascular diseases reduce quality of life and lead to excess morbidity. 1 Epidemiology studies found that the CAD morbidity and mortality rates were significantly higher in postmenopausal women comparedwith premenopausal women. 2 Unlike younger women, the risk of CAD in older women is higher when there is a decrease in estrogen production, marking the end of the protective effect of endogenous estrogens against CAD. 3-5 Therefore, identifying the risk factors associated with CAD in postmenopausal women is critical for improving patients' survival rate and life quality. Recently, increasing evidence has accumulated to support the correlation between low bone mineral density (BMD) and AS. 6-8 AS and osteopenia-osteoporosis syndrome share some risk factors, among which are parathyroid hormone, lack of estrogen, homocysteine, inflammatory process, vitamins D and K, lipid oxidation products, molecular pathways involved in bone and vascular mineralization, and calcification mechanisms that seem to be similar in vascular structure and bone. 9,10 We have previously reported that coronary artery calcium scores, an earlier sign of coronary artery AS, were significantly higher in the osteopenia/osteoporosis groups compared to normal BMD groups, and that these values were negatively associated with T-scores. These findings indicate that decreased BMD may increase the risk of CAD. 11 However, little is known about the association between decreased BMD and severity of coronary lesions in postmenopausal woman. Therefore, the aim of this cross-sectional study was to examine the associations between BMD and coronary lesions assessed by Gensini score in postmenopausal women who attended our Laboratory and who had their BMD measured and grouped by the severity of CAD. 211