ABC | Volume 110, Nº3, March 2018

Original Article Xu et al Association of severity of coronary lesions with BMD Arq Bras Cardiol. 2018; 110(3):211-216 Table 1 – Characteristics of the study population (n = 122) Age (years) 64.31 ± 4.71 Body mass index (kg/m 2 ) 26.19 ± 2.49 Hypertension, n (%) 48 (39.3%) Diabetes, n (%) 47 (38.5%) Hyperlipidemia, n (%) 38 (31.1%) T-score –1.24 ± 1.27 Gensini score 43.46 (17.5, 73) osteoporosis, n (%) 24 (19.6%) osteopenia, n (%) 51 (41.8%) osteoporosis or osteopenia, n (%) 75 (61.5%) Continuous variables with a Gaussian distribution are presented as mean ± SD, and those with a non-Gaussian distribution are presented as median values with corresponding 25th and 75th percentiles. Categorical data are expressed as absolute numbers with (percentages). Table 2 – Comparison of clinical parameters between the groups with mild coronary lesions and severe coronary lesions Parameter Mild coronary lesions group Severe coronary lesions group p value Gensini score < 25 Gensini score ≥ 25 n = 37 n = 85 Age (years) 62.33 ± 5.65 65.17 ± 4.43 0.003 Body mass index (kg/m 2 ) 26.23 ± 2.53 26.17 ± 2.47 0.872 Hypertension, n (%) 13 (35.1%) 35(41.2%) 0.530 Diabetes, n (%) 9 (24.3%) 38 (44.7%) 0.034 Hyperlipidemia, n (%) 11 (29.7%) 27(31.8%) 0.824 T-score −0.84 ± 1.01 −1.42 ± 1.39 0.024 osteoporosis, n (%) 3(8.1%) 21 (24.7%) 0.034 osteopenia, n (%) 10 (27.0%) 41 (48.2%) 0.029 osteoporosis or osteopenia, n (%) 13 (35.1%) 62 (72.9%) 0.000 Continuous variables with non-Gaussian distribution (except for those expressed as median) were compared using t-tests. For values expressed as median (25th and 75th percentiles), P values were determined by Mann-Whitney U test. Categorical variables were compared by chi-square test, except for osteoporosis, which were compared by Fisher’s exact test (expected frequencies of ≤ 5). Corresponding to these findings, multivariate logistic regression analysis was used to detect the association between osteoporosis/osteopenia and risk of severe coronary lesions. After adjusting for confounding factors such as age, hypertension, diabetes, and hyperlipidemia, the osteoporosis /osteopenia remained the risk factors for severe coronary lesions (OR = 2.73, 95% CI, 1.06–6.13, p = 0.007, Table 3). When Gensini score was considered as the dependent variable in a linear regression model, T-score ( β = −0.407, SE = 0.151, p = 0.007) and age ( β = 0.295, SE = 0.132, P  = 0.023), but not diabetes, hypertension, BMI, and hyperlipidemia, were the independent predictors of Gensini score. In a linear regression analysiswithGensini score as a dependent variable and age, T-score, diabetes, hypertension, BMI, and hyperlipidemia as independent variables (Table 4), only T-score ( β = −0.407, SE = 0.151, p = 0.007) and age ( β = 0.295, SE = 0.132, p = 0.023) correlated with Gensini score. Discussion In our study, postmenopausal women with severe coronary lesions are more likely to have osteopenia/osteoporosis compared with mild coronary lesions group, independent of other risk factors. This suggests that postmenopausal women with osteopenia/osteoporosis may have a higher risk of developing severe coronary lesions. Our findings are in accordance with previous studies demonstrating the relationship between BMD and CAD that concluded that BMD is a promising marker of severity of CAD. Both osteopenia and AS are serious public health problems that can threaten people's health and quality of life. 14,15 Previous studies have proved a clear link between AS and BMD. In a retrospective study including 1,335 elderly patients, the incidence of CAD increased in low BMD patients, compared with patients with normal BMD. Multiple logistic regression analysis confirmed that low BMD is associated with CAD, after adjustment for diabetes mellitus, hypertension, smoking, and age. 16 Another study with 252 postmenopausal women showed that osteopenia/osteoporosis at the lumbar spine or femoral neck was associated with coronary AS assessed by 64-row multidetector computed tomography. 17 Our previous study showed that another measure of AS, coronary artery calcification, was associated with BMD of the lumbar spine in healthy postmenopausal women. The odds for coronary artery calcification in osteoporotic women were over three-fold higher compared with those in women with a normal BMD. 11 Gensini score is an important angiographic scoring system used to assess the extent, severity, and complexity of CAD. CAD patients with high Gensini score are more likely to report major adverse cardiac events. Therefore, identifying CAD patients with high Gensini scores is critical for reducing CAD-related disability and death. 18,19 There are a few studies 213