Low bone mineral density is associated with global coronary atherosclerotic plaque burden in stable angina patients

Figures & data

Table 1 Demographic characteristics of the patients

Parameters	Non-CAD	CAD		P-value
	n=224	One-vessel (n=108)	Multivessel (n=127)
Age (years)	62.03±10.16	65.93±9.16	68.47±8.12	<0.001
Men, n (%)	105 (46.88%)	61 (56.48%)	81 (63.78%)	0.008
BMI (kg/m^2)	24.26±3.35	24.92±3.78	24.36±3.14	0.242
Smoker, n (%)	62 (27.68%)	41 (37.96%)	62 (48.82%)	<0.001
Hypertension, n (%)	139 (62.05%)	82 (75.93%)	107 (84.25%)	<0.001
Diabetes	40 (17.86%)	28 (25.93%)	44 (34.65%)	0.002
Hypercholesterolemia, n (%)	57 (25.45%)	29 (26.85%)	43 (33.86%)	0.229
Cr (μmol/L)	73.56±23.29	78.54±26.33	84.28±40.86	0.005
Modified Gensini score	5.26±1.27	7.93±1.42	12.26±3.62	<0.001
Femoral neck (g/cm^2)	0.86±0.15	0.84±0.15	0.79±0.13	<0.001
Femoral neck T-score (SD)	−1.33±1.08	−1.57±0.99	−2.03±0.93	<0.001
Femoral neck Z-score (SD)	−0.06±0.92	−0.11±0.91	−0.43±0.83	<0.001
Total hip (g/cm^2)	0.95±0.15	0.92±0.16	0.87±0.14	<0.001
Total hip T-score (SD)	−0.75±1.07	−0.99±1.05	−1.43±0.97	<0.001
Total hip Z-score (SD)	0.20±0.93	0.15±0.95	−0.18±0.86	<0.001
Lumbar spine (g/cm^2)	1.04±0.20	1.02±0.22	1.01±0.21	0.567
Lumbar spine T-score (SD)	−1.33±1.61	−1.48±1.73	−1.58±1.65	0.380
Lumbar spine Z-score (SD)	−0.31±1.32	−0.33±1.52	−0.31±1.39	0.992
Minimum T-score (SD)	−1.81±1.20	−2.04±1.20	−2.37±1.01	<0.001
Minimum Z-score (SD)	−0.66±1.01	−0.74±1.09	−0.88±0.87	0.139

Notes: Demographics were analyzed by one-way analysis of variance, and values are presented as means±SD. Percentages do not sum to 100 because of rounding.

Abbreviations: BMI, body mass index; CAD, coronary artery disease; Cr, creatinine.

Table 2 Association between low BMD at various skeletal regions and multivessel CAD

Variables	n	Mean±SD (g/cm^2)	Crude			Adjusted
BMD			OR	95% CI	P-value	OR	95% CI	P-value
Multivessel CAD vs non-multivessel CAD
Femoral neck
Normal (T-score ≥−1.0 SD)	129	1.00±0.10	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	236	0.82±0.06	2.83	1.59–5.07	<0.001	2.84	1.52–5.30	0.001
Osteoporosis (T-score ≤−2.5 SD)	94	0.65±0.07	4.67	2.43–8.99	<0.001	4.34	2.05–9.20	<0.001
Total hip
Normal (T-score ≥−1.0 SD)	234	1.03±0.12	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	182	0.84±0.06	3.03	1.93–4.77	<0.001	2.55	1.56–4.17	<0.001
Osteoporosis (T-score ≤−2.5 SD)	43	0.66±0.05	3.17	1.58–6.38	0.001	2.91	1.29–6.60	0.010
Lumbar spine
Normal (T-score ≥−1.0 SD)	174	1.23±0.14	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	155	0.99±0.07	1.07	0.65–1.74	0.800	1.05	0.61–1.82	0.858
Osteoporosis (T-score ≤−2.5 SD)	130	0.79±0.08	1.27	0.77–2.11	0.346	1.33	0.71–2.48	0.380

Note: Relationship was determined by multivariable logistic regression analysis.

Abbreviations: BMD, bone mineral density; CAD, coronary artery disease.

Table 3 Association between T-score at various skeletal regions and the modified Gensini score

Variables	n	Mean±SD (g/cm^2)	Crude			Adjusted
BMD			β	SE	P-value	β	SE	P-value
Femoral neck T-score (per SD)	459	0.83±0.14	−1.39	0.15	<0.001	−1.13	0.15	<0.001
Total hip T-score (per SD)	459	0.92±0.15	−1.25	0.15	<0.001	−0.96	0.15	<0.001
Lumbar spine T-score (per SD)	459	1.03±0.21	−0.22	0.10	0.036	−0.11	0.11	0.300

Note: Relationship was determined by multivariable linear regression model (adjusted for: age, gender, BMI, smoking, hypertension, diabetes, hypercholesterolemia, and Cr).

Abbreviations: BMD, bone mineral density; BMI, body mass index; Cr, creatinine; SE, standard error.

Table S1 Univariable analysis for multivessel CAD and modified Gensini score

Parameters	Non-CAD	CAD		ANOVA	Multivessel CAD	Modified Gensini score
	n=224	One-vessel (n=108)	Multivessel (n=127)	P-value	Univariable analysis
					P-value	P-value
Age (years)	62.03±10.16	65.93±9.16	68.47±8.12	<0.001	<0.001	<0.001
Men, n (%)	105 (46.88%)	61 (56.48%)	81 (63.78%)	0.008	0.008	0.045
BMI (kg/m^2)	24.26±3.35	24.92±3.78	24.36±3.14	0.242	0.747	0.169
Smoker, n (%)	62 (27.68%)	41 (37.96%)	62 (48.82%)	<0.001	<0.001	0.003
Hypertension, n (%)	139 (62.05%)	82 (75.93%)	107 (84.25%)	<0.001	<0.001	<0.001
Diabetes	40 (17.86%)	28 (25.93%)	44 (34.65%)	0.002	0.002	0.007
Hypercholesterolemia, n (%)	57 (25.45%)	29 (26.85%)	43 (33.86%)	0.229	0.091	0.005
Cr (μmol/L)	73.56±23.29	78.54±26.33	84.28±40.86	0.005	0.008	<0.001
Modified Gensini score	5.26±1.27	7.93±1.42	12.26±3.62	<0.001	NA	NA
Femoral neck (g/cm^2)	0.86±0.15	0.84±0.15	0.79±0.13	<0.001	<0.001	<0.001
Femoral neck T-score (SD)	−1.33±1.08	−1.57±0.99	−2.03±0.93	<0.001	<0.001	<0.001
Total hip (g/cm^2)	0.95±0.15	0.92±0.16	0.87±0.14	<0.001	<0.001	<0.001
Total hip T-score (SD)	−0.75±1.07	−0.99±1.05	−1.43±0.97	<0.001	<0.001	<0.001
Lumbar spine 1–4 (g/cm^2)	1.04±0.20	1.02±0.22	1.01±0.21	0.567	0.347	0.079
Lumbar spine T-score (SD)	−1.33±1.61	−1.48±1.73	−1.58±1.65	0.380	0.246	0.036

Notes: Values are presented as means±SD. Percentages do not sum to 100 because of rounding.

Abbreviations: ANOVA, analysis of variance; BMI, body mass index; CAD, coronary artery disease; Cr, creatinine; NA, not available.

Table S2 Association between low BMD at various skeletal regions and multivessel CAD

Variables	n	Mean±SD (g/cm^2)	Crude			Adjusted
BMD			OR	95% CI	P-value	OR	95% CI	P-value
Multivessel CAD vs non-multivessel CAD
Gender=women
Femoral neck	212	0.78±0.13
Normal (T-score ≥−1.0 SD)	45	0.96±0.05	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	106	0.79±0.05	3.88	1.10–13.66	0.0348	3.67	0.94–14.30	0.0607
Osteoporosis (T-score ≤−2.5 SD)	61	0.63±0.06	6.83	1.88–24.75	0.0034	4.84	1.14–20.43	0.032
Total hip	212	0.86±0.14
Normal (T-score ≥−1.0 SD)	98	0.98±0.09	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	81	0.81±0.06	3.93	1.75–8.80	0.0009	2.70	1.12–6.52	0.0275
Osteoporosis (T-score ≤−2.5 SD)	33	0.65±0.04	4.4	1.66–11.67	0.0029	3.15	0.98–10.15	0.0544
Lumbar spine	212	0.92±0.17
Normal (T-score ≥−1.0 SD)	43	1.18±0.11	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	71	0.96±0.06	1.39	0.45–4.32	0.5659	1.2	0.35–4.05	0.7706
Osteoporosis (T-score ≤−2.5 SD)	98	0.78±0.08	3.35	1.20–9.36	0.0209	2.32	0.75–7.20	0.1453
Gender=men
Femoral neck	247	0.88±0.14
Normal (T-score ≥−1.0 SD)	84	1.02±0.12	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	130	0.84±0.06	2.93	1.49–5.75	0.0018	2.61	1.29–5.28	0.0078
Osteoporosis (T-score ≤−2.5 SD)	33	0.68±0.07	6.79	2.77–16.65	<0.0001	5.08	1.97–13.13	0.0008
Total hip	247	0.97±0.15
Normal (T-score ≥−1.0 SD)	136	1.07±0.12	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	101	0.87±0.05	2.84	1.62–4.99	0.0003	2.46	1.36–4.45	0.0028
Osteoporosis (T-score ≤−2.5 SD)	10	0.70±0.06	5.3	1.40–20.01	0.0139	4.26	1.05–17.37	0.0432
Lumbar spine	247	1.12±0.19
Normal (T-score ≥−1.0 SD)	131	1.25±0.14	1			1
Osteopenia (T-score −1.0 to −2.5 SD)	84	1.02±0.06	1.33	0.75–2.37	0.3331	1.16	0.63–2.15	0.6347
Osteoporosis (T-score ≤−2.5 SD)	32	0.83±0.07	1.03	0.45–2.38	0.9373	0.82	0.33–2.02	0.665

Notes: Relationship was determined by multivariable logistic regression analysis by gender (adjusted for: age, gender, BMI, hypertension, diabetes, hypercholesterolemia, and Cr). Multivessel CAD was defined as luminal stenosis ≥50% in two or more vessels.

Abbreviations: BMD, bone mineral density; BMI, body mass index; CAD, coronary artery disease; Cr, creatinine.

Table S3 Association between T-score at various skeletal regions and the modified Gensini score

Variables	n	Mean±SD (g/cm^2)	Crude			Adjusted
BMD			β	SE	P-value	β	SE	P-value
Gender=women
Femoral neck T-score (per SD)	212	0.78±0.13	−1.31	0.21	<0.0001	−0.82	0.24	0.0006
Total hip T-score (per SD)	212	0.86±0.14	−1.23	0.19	<0.0001	−0.84	0.22	0.0001
Lumbar spine T-score (per SD)	212	0.92±0.17	−0.55	0.16	0.0008	−0.18	0.16	0.2667
Gender=men
Femoral neck T-score (per SD)	247	0.88±0.14	−1.67	0.21	<0.0001	−1.43	0.21	<0.0001
Total hip T-score (per SD)	247	0.97±0.15	−1.43	0.23	<0.0001	−1.25	0.22	<0.0001
Lumbar spine T-score (per SD)	247	1.12±0.19	−0.25	0.16	0.1151	−0.15	0.15	0.3089

Note: Relationship was determined by multivariable linear regression analysis by gender (adjusted for: age, gender, BMI, smoking, hypertension, diabetes, hypercholesterolemia, and Cr).

Abbreviations: BMD, bone mineral density; BMI, body mass index; Cr, creatinine.