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 3 – Adjusted odds ratio of risk factors for severe coronary lesions Independent variable Odds ratio (95%CI) p value Osteopenia or osteoporosis 2.73(1.06–6.13) 0.007 Age 1.24(1.19–2.65) < 0.001 BMI 1.37(0.73-3.57) 0.706 Hypertension 2.31(0.83–5.31) 0.313 Diabetes 3.13(0.96–7.37) 0.082 Hyperlipidemia 1.39(0.57–3.62) 0.431 BMI: body mass index; 95% CI: 95% confidence interval Table 4 – Multiple regression analysis of Gensini score (dependent variable) versus age, diabetes, hypertension, body mass index, hyperlipidemia, and T-score (independent variables). Independent variable β SE p value T-score 0.407 0.151 0.007 Age 0.295 0.132 0.023 Body mass index 0.183 0.203 0.136 Hypertension 0.147 0.134 0.254 Diabetes 0.113 0.179 0.572 Hyperlipidemia 0.053 0.121 0.697 R 2 0.31 β: Values are standardized coefficient; SE: values are standard error of β. R 2 : values are the total explained variance of the model. about the relationship between BMD and severity of coronary lesions. A retrospective study carried out with 55 male patients with CAD, confirmed by coronary angiography, showed that decreased BMD was associated with severe coronary lesions assessed by Gensini score, independent of other cardiovascular risk factors. 13 Similarly, a study involving 74 male CAD patients revealed that the incidence of osteopenia/osteoporosis in severe coronary artery lesions group determined by SYNTAX score was significantly higher than mild coronary artery lesions group. 20 However, most of these studies have been based on male CAD patients while few studies have involved postmenopausal, CAD women patients. In our study, 186 postmenopausal women with CAD patients identified by coronary angiography were divided into two groups by Gensini scoring: mild coronary lesions patients (Gensini score < 25) and severe coronary lesions patients (Gensini score > 25). We found that there was an increase in the osteoporosis/osteopenia rate in the severe coronary lesions group. Multivariable logistic regression analysis showed that osteopenia/osteoporosis at the femoral neck was associated with an increased risk of developing severe coronary lesions. The multiple regression model showed that T-scores were the independent predictors of Gensini score. Most previous research, if not all, including our results indicate that low BMD not only were associated with increased risk of CAD, but also were an independent predictor of severity of coronary lesions in postmenopausal women. Although many hypotheses have been proposed to explain the correlation between osteoporosis and CAD, it has not been thoroughly understood. 16,21,22 In spite of common risk factors of bone metabolism and cardiovascular risk (inflammation, dyslipidemia, menopause, hypertension, smoking, and diabetes mellitus), the possible influence of genetics and vascular calcification also exists. 23,24 Hydroxyapatite, an important part of the mineral phase of bone, is also found in the artery calcified plaque. Moreover, it has been reported that bone matrix proteins such as gla protein, bone morphogenetic protein-2, osteocalcin, and collagen were found in calcified plaques. Studies have suggested that some important gene mutations can lead to the early development of AS and osteoporosis, which indicate the evidence of common genetic basis. 25,26 It’s worth noting that current evidence linking osteoporosis and CAD is far from conclusive. So, further study is needed to explore the relationship between the two common diseases. Limitations The main limitation of our study is that the sample size is relatively small. Further studies involving a larger number of menopausal patients are needed to establish and confirm the relationship between the severity of coronary lesions and osteopenia/osteoporosis. In addition, information on impaired vitamin K status, inflammatory cytokines, gla protein, and osteocalcin, which might be associated with both coronary lesions and osteoporosis, was not available for this study. Also, the fact that the BMD tests were not performed in the same service was another limitation of our study. 214