03088nas a2200421 4500008004100000022001400041245010300055210006900158260001300227300001400240490000700254520196800261653000902229653002202238653001602260653001702276653001102293653002202304653001802326653001402344653001102358653001402369653002602383653000902409653002702418653001702445653001602462653001802478100001902496700001802515700001202533700001802545700001502563700001902578700001502597700001802612856003602630 2013 eng d a1433-296500aAlbuminuria is associated with hip fracture risk in older adults: the cardiovascular health study.0 aAlbuminuria is associated with hip fracture risk in older adults c2013 Dec a2993-30000 v243 a

UNLABELLED: The microcirculation plays an important role in bone health. Here, we examine whether albuminuria, a marker of renal microvascular disease, is associated with the risk of hip fracture in older adults (age, 78 years). We find a small independent association in women but not in men.

INTRODUCTION: The microvascular circulation plays an important role in bone physiology. Two studies of middle-aged adults have found that albuminuria (>30 mg albumin/g creatinine), a disorder of the renal microvasculature, is associated with fracture risk. Here, we examine whether albuminuria is related to hip fracture risk and reduced hip bone mineral density (BMD) in older adults with a mean age of 78 years.

METHODS: From the Cardiovascular Health Study (41 % male), 3,110 adults with albuminuria testing were followed up for incident hip fracture for up to 9.5 years. BMD was performed in a subset of 1,208 participants.

RESULTS: There were 313 hip fractures during follow-up (7.7 % of men; 11.7 % of women). The incidence rate for men, with and without albuminuria, was 1.43 and 0.93/100 person-years of follow-up (p = 0.02); for women, 1.84 and 1.33 (p = 0.04). After adjustment for osteoporosis-related factors, frailty and falling, a doubling of albuminuria was significantly associated with hip fracture risk in women (hazard ratio, 1.12, 95 % CI, 1.001-1.25), but not in men. In the subcohort with BMD measurement, increased urine albumin levels were significantly associated with decreased total hip BMD in men (-0.009 g calcium/cm(2) (-0.017, -0.001); p = 0.04), but not in women.

CONCLUSIONS: In older women, albuminuria is associated with a small, but statistically significant, increased risk of hip fracture independent of other explanatory factors. No such risk appears to be present in men, although their total hip BMD is lower in association with albuminuria.

10aAged10aAged, 80 and over10aAlbuminuria10aBone Density10aFemale10aFollow-Up Studies10aHip Fractures10aHip Joint10aHumans10aIncidence10aKaplan-Meier Estimate10aMale10aOsteoporotic Fractures10aRisk Factors10aSex Factors10aUnited States1 aBarzilay, J, I1 aBůžková, P1 aChen, Z1 ade Boer, I, H1 aCarbone, L1 aRassouli, N, N1 aFink, H, A1 aRobbins, J, A uhttps://chs-nhlbi.org/node/605902836nas a2200277 4500008004100000022001400041245007000055210006900125260001600194520207400210100001102284700001602295700001602311700002002327700001802347700001702365700001802382700001502400700002002415700001602435700001802451700001502469700002002484700001802504856003602522 2016 eng d a1464-549100aBrain natriuretic peptide and insulin resistance in older adults.0 aBrain natriuretic peptide and insulin resistance in older adults c2016 Apr 213 a

AIMS: Higher levels of brain natriuretic peptide (BNP) have been associated with a decreased risk of diabetes in adults, but whether BNP is related to insulin resistance in older adults has not been established.

METHODS: N-Terminal (NT)-proBNP was measured among Cardiovascular Health Study participants at the 1989-1990, 1992-1993 and 1996-1997 examinations. We calculated measures of insulin resistance [homeostatic model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), Gutt index, Matsuda index] from fasting and 2-h concentrations of glucose and insulin among 3318 individuals with at least one measure of NT-proBNP and free of heart failure, coronary heart disease and chronic kidney disease, and not taking diabetes medication. We used generalized estimating equations to assess the cross-sectional association of NT-proBNP with measures of insulin resistance. Instrumental variable analysis with an allele score derived from nine genetic variants (single nucleotide polymorphisms) within or near the NPPA and NPPB loci was used to estimate an un-confounded association of NT-proBNP levels on insulin resistance.

RESULTS: Lower NT-proBNP levels were associated with higher insulin resistance even after adjustment for BMI, waist circumference and other risk factors (P < 0.001 for all four indices). Although the genetic score was strongly related to measured NT-proBNP levels amongst European Americans (F statistic = 71.08), we observed no association of genetically determined NT-proBNP with insulin resistance (P = 0.38; P = 0.01 for comparison with the association of measured levels of NT-proBNP).

CONCLUSIONS: In older adults, lower NT-proBNP is associated with higher insulin resistance, even after adjustment for traditional risk factors. Because related genetic variants were not associated with insulin resistance, the causal nature of this association will require future study. This article is protected by copyright. All rights reserved.

1 aKim, F1 aBiggs, M, L1 aKizer, J, R1 aBrutsaert, E, F1 ade Fillipi, C1 aNewman, A, B1 aKronmal, R, A1 aTracy, R P1 aGottdiener, J S1 aDjoussé, L1 ade Boer, I, H1 aPsaty, B M1 aSiscovick, D, S1 aMukamal, K, J uhttps://chs-nhlbi.org/node/7124