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Study Reveals Link Between Hip Fractures and Cardiovascular Events, Highlights Need for Personalized Care

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A research team from the Department of Pharmacology and Pharmacy at the LKS Faculty of Medicine, University of Hong Kong (HKUMed), has discovered that hip fractures not only cause physical and psychological harm but can also lead to serious cardiovascular events. The study, which utilized big data and artificial intelligence (AI), revealed that hip fracture patients with pre-existing heart conditions face a significantly higher risk of cardiovascular events (CVEs) and mortality, poorer prognosis, and increased use of health services. The research analyzed electronic health records from over 100,000 hip fracture patients in Hong Kong and the United Kingdom (UK). The findings, published in Nature Communications, could improve the management of hip fracture patients and offer insights into precision medicine.



Professor Cheung Ching-lung & his team
Led by Professor Cheung Ching-lung (left), the HKUMed research team finds that hip fracture may induce cardiovascular events, and hip fracture patients with pre-existing heart failure face a five-fold increased risk of cardiovascular events and approximately doubled mortality risk compared to relatively healthy patients.


Background

The all-cause mortality rate for hip fracture patients in Hong Kong is about 17%, higher than that for breast, thyroid, and prostate cancer patients. CVEs are the leading cause of death among hip fracture patients, accounting for 33% of fatalities. Current research has shown a link between hip fractures and an increased risk of CVEs, such as heart failure and myocardial infarction. However, managing CVE risk in hip fracture care is often overlooked.

Hip fractures frequently require surgery and can lead to postoperative cardiac complications. Even after accounting for these complications, there is an immediate increased risk of CVEs following hip fractures. The mechanisms behind this temporal association are complex and remain largely unexplored due to the diverse clinical characteristics of hip fracture patients.


Hip Fractures and Cardiovascular Research Findings and Significance

The HKUMed research team used AI to identify distinct clusters or subphenotypes of hip fracture patients based on their clinical profiles. In the Hong Kong cohort, three clusters were identified: relatively healthy individuals (66%), those with metabolic-related diseases (21.4%), and those with a history of congestive heart failure or arrhythmia (12.6%).

The relatively healthy cluster had a lower risk of CVEs compared to the other two clusters. The cluster with metabolic-related diseases had about twice the risk of major adverse cardiovascular events (MACEs) hospitalization within 180 days of hip fracture. The cluster with a history of congestive heart failure or arrhythmia had a five-fold increased risk of MACE hospitalization in the same period. Additionally, this cluster had twice the all-cause mortality risk and unplanned hospital visits of healthy individuals with fractures, along with longer hospital stays.


Professor Cheung Ching-lung & his team
HKUMed research underscores the importance of cardiovascular event risk management in hip fracture care, particularly for patients with congestive heart failure or arrhythmia.

The findings emphasize the importance of managing CVE risk in hip fracture care, particularly for patients with congestive heart failure or arrhythmia. The study suggests a need for personalized management strategies, including close monitoring, timely interventions, and prioritizing healthcare resources for high-risk patients. This approach is crucial for improving the prognosis of hip fracture patients.

The team also found a 93% increase in the risk of MACEs within 60 days after a hip fracture using the self-controlled case series method. This indicates that hip fractures alone can contribute to a short-term increased risk of MACE, which is further heightened by pre-existing cardiac conditions and other comorbidities. The risk decreased during the subsequent post-hip fracture period of 61–180 days. Similar findings were observed in the UK cohort.


Expert Commentary

Professor Cheung Ching-lung, Associate Professor in the Department of Pharmacology and Pharmacy, HKUMed, commented, "Vascular calcification is a known risk factor for CVEs. Bones serve as a vital calcium repository in the body; the sudden increase in blood calcium after fractures may raise the risk of stroke and cardiovascular disease. Therefore, prompt management of CVE risk following a hip fracture is very important."


"Many people are unaware of the serious complications and mortality risks associated with fractures," added Professor Cheung. "Our research shows that hip fractures may trigger or worsen CVEs. By using AI, we categorized the subphenotypes of hip fracture patients and found that individuals with a history of congestive heart failure or arrhythmia are at higher risk of experiencing CVEs following hip fractures. These findings can help introduce tailored treatments for hip fracture patients, reducing the likelihood of post-fracture complications and mortality. They also pave the way for more precise and fitting clinical strategies for hip fracture patients in the future."


About the Research Team

The research was led by Professor Cheung Ching-lung, Associate Professor from the Department of Pharmacology and Pharmacy, HKUMed. PhD students Warrington Hsu Wenqiang and Zhang Xiaowen from the same department were the co-first authors. Other co-authors from HKUMed included Dr. Sing Chor-wing, Professor Ian Wong Chi-kei, and Dr. Wallis Lau Cheuk-yin from the Department of Pharmacology and Pharmacy, and Professor Kathryn Tan Choon-beng from the Department of Medicine of the School of Clinical Medicine.


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