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Abstract: FR-PO1049

Use of Bisphosphonates in CKD Is Associated with Incident Cardiovascular Disease (CVD)

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Borghoff, Kathleen, University of Iowa, Coralville, Iowa, United States
  • Zhou, Yunshu, The University of Iowa, Iowa City, Iowa, United States
  • Ounda, Agnes, University of Iowa, Coralville, Iowa, United States
  • Swee, Melissa L., University of Iowa, Coralville, Iowa, United States
  • Ten eyck, Patrick, University of Iowa, Coralville, Iowa, United States
  • Jalal, Diana I., University of Iowa, Coralville, Iowa, United States
  • Jovanovich, Anna Jeanette, Denver VA / University of Colorado, Denver, Colorado, United States
Background


CKD-mineral bone disorder, including vascular calcification, is associated with increased CVD risk. Studies suggest that bisphosphonates, the preferred therapy for osteoporosis, are safe in CKD patients. In animal models, bisphosphonates inhibit vascular calcification. We hypothesized that use of bisphosphonates in CKD is associated with lower incident CVD, CVD mortality, and all-cause mortality.

Methods


2593 Framingham OFFSPRING participants were included. We used propensity score-adjusted Cox regression models to determine the relationship between bisphosphonate use and the following outcomes: time to incident CVD, time to CVD mortality, and time to all-cause mortality. The data were stratified by presence or absence of CKD, defined as eGFR <60 mL/min/1.73m2. The propensity score model included age, sex, hypertension, smoking status, diabetes, total cholesterol, and HDL.

Results


Mean age was 70±9 years and 10% were male. Of the 371 participants using bisphosphonates, 31 had CKD. In the unadjusted analysis, those with CKD who used bisphosphonates had a significant increase in incident CVD [HR 2.061 (95% CI, 0.99-4.29; p=0.05)] compared to those with CKD who did not use bisphosphonates. After adjusting for the propensity score, the HR for incident CVD in participants with CKD who used bisphosphonates increased [HR 2.76 (95% CI, 1.24-6.18; p=0.01)]. There was no significant association between bisphosphonate use and mortality from CVD or all-causes in participants with CKD. In participants without CKD who used bisphosphonates, there was a trend showing a decrease in time to CVD mortality [HR 0.28 (95% CI, 0.07-1.14; p=0.08)] compared to those who did not use bisphosphonates. However, after propensity score adjustment, the HR was attenuated [HR 0.39 (95% CI 0.09-1.67; p=0.21)]. There was no significant association between bisphosphonate use and incident CVD or all-cause mortality in those without CKD.

Conclusion


Contrary to our hypothesis, we show, for the first time, that bisphosphonate use is associated with increased incident CVD in CKD patients. Our analysis was limited by a small sample size. However, future studies in larger cohorts are necessary to confirm these findings and to better understand the mechanisms underlying this association.

Funding

  • Veterans Affairs Support