The Relationship Between Bone Mineral Density And Left Ventricular Diastolic Function In Elderly Hypertension Patients

Objective: To investigate the relationship between bone mineral density and left ventricular diastolic function in elderly hypertension patients.Methods:Retrospective analysis was performed in 1002 consecutive hypertension patients, aged over 60, who were admitted to the second affiliated hospital of Dalian Medical University from December 2013 to February 2015.Bone mineral density(BMD) was measured by dual X-ray absorptiometry and detected results were shown by T scores for all four parts. All cases were divided into three groups based on T scores: Normal bone mass group(n=269):T≥-1.0; Osteopenia group(n=433):-2.5<T<-1.0; and Osteoporosis group(n=300):T≤-2.5. In order to evaluate the left ventricular diastolic function in patients, the echocardiogram was used to measure LVEF, the early diastolic transmitral inflow peak velocity(E) and mitral annulus peak velocity, and then calculate the E/e ratio.E/e>15 and LVEF≥50% represent left ventricular diastolic dysfunction(LVDD),which can be used to assess the changes in LVDD and to evaluate the relationship with BMD,ANOVA was applied to analyze the mean of the E/e ratio and Chi-square test was used to compare LVDD incidence among the indicated three groups. All cases were divided into two groups based on E/e ratio. Normal left ventricular diastolic function group(n=506), E/e≤15;left ventricular diastolic dysfunction group(n=496),E/e>15.Chi-square test was used to compare abnormal incidence of BMD between the two groups.Factors including age, sex, body mass index(BMI), smoking,drinking alcohol,,history of hypertension and diabetes,systolic pressure, diastolic pressure, BMD of the femoral neck, trochanter major, Ward’s area and lumbar spine,LVEF,glycosylated hemoglobin, creatinine, cystatin, fasting plasma glucose,triglycerides, total cholesterol, high density lipoprotein cholesterol, et al,were also analyzed in this study. Simple linear correlation was used to analyze the correlation of E/e ratio with each factor. Multiple linear regression analysis was applied to analyze the independent factors of E/e ratio. P<0.05 was considered statistically significant.Results:1.The incidence of LVDD of Osteoporosis group(56.3%) was significantly higher than that of Normal bone mass group(44.2%) as well as Osteopenia group(48%)(p<0.05). And there was no significant difference between Osteopenia group and Normal bone mass group(p>0.05). The abnormal incidence of BMD of LVDD group(76%) was higher than normal left ventricular diastolic function group(p<0.05).2.Simple linear correlation analysis showed that the negative linear correlations were found between E/e ratio and glycosylated hemoglobin(r=-0.066, p=0.046), BMD of the lumbar spine(r=-0.083, p=0.009), BMD of the femoral neck(r=-0.11,p=0.002),BMD of the Ward’s area(r=-0.138,p=0.001) as well as BMD of the trochanter major(r=-0.091, p=0.004), but not total cholesterol(r=0.072, p=0.022),which showed a positive one instead. Reduced BMD of the Ward’s area(r=-0.12,p=0.025) and increased total cholesterol(r=-0.047, p=0.038) both were recognized as independent variables of left ventricular diastolic function in multinomial regression analysis.Conclusion:1.The incidence of LVDD of Osteoporosis group is significantly higher than that of Normal bone mass group.The abnormal incidence of BMD of LVDD in elderly hypertension patients is higher than that of normal left ventricular diastolic function.2.Reduced BMD of the Ward’s area and increased total cholesterol both are recognized as independent variables of left ventricular diastolic function, which can be referred to be important predictive factors in assessment and evaluation of cardiovascular events.