Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

Background Emerging evidence showed that bone metabolism and cardiovascular disease (CVD) are closely related. We previously observed a potential immediate risk of cardiovascular mortality after hip fracture. However, whether there is an immediate risk of cardiovascular events after hip fracture is unclear. The aim of this study was to evaluate the risk for major adverse cardiovascular events (MACEs) between patients having experienced falls with and without hip fracture. Methods This retrospective population-based cohort study used data from a centralized electronic health record database managed by Hong Kong Hospital Authority. Patients having experienced falls with and without hip fracture were matched by propensity score (PS) at a 1:1 ratio. Adjusted associations between hip fracture and risk of MACEs were evaluated using competing risk regression after accounting for competing risk of death. Results Competing risk regression showed that hip fracture was associated with increased 1-year risk of MACEs (hazard ratio [HR], 1.27; 95% confidence interval [CI], 1.21-1.33; p < .001), with a 1-year cumulative incidence difference of 2.40% (1.94%-2.87%). The HR was the highest in the first 90-days after hip fracture (HR of 1.32), and such an estimate was continuously reduced in 180 days, 270 days, and 1 year after hip fracture. Conclusions Hip fracture was associated with increased immediate risk of MACEs. This study suggested that a prompt evaluation of MACE among older adults aged 65 years and older who are diagnosed with hip fracture irrespectively of cardiovascular risk factors may be important, as early management may reduce subsequent risk of MACE.