Байкальский медицинский журнал (Sep 2023)
CARDIOVACULAR PATHOLOGY AND FRACTURE PREDICTION IN MEN OVER 45
Abstract
Introduction. The combination of cardiovascular pathology with osteoporosis and fractures in men, especially at a younger age, requires the study of the causes and risk factors for the strategy of early diagnosis, treatment and prevention.Target. To study the clinical and pathogenetic relationships of cardiovascular pathology with the risk of fractures in men over 45 years of age.Materials and methods: 201 men over the age of 45 were examined, mean age 51.1 [46.1; 56.3]. The accuracy and statistical significance of the distribution of groups was assessed using discriminant analysis. High values of canonical correlation (Canonic.R=0.941) and chi-square test (χ²=630.4) with zero probability of not rejecting the null hypothesis (p=0.000) and coincidence of the results of discrimination and cluster analysis in 95% of cases made it possible to assume the reliability of the model , built on the basis of the proposed variables.Results. The frequency of risk factors in the examined patients was: smoking - 107 people. (53.2%), abdominal obesity 74 people. (36.8%); arterial hypertension - 75 people. (37.3%), hypercholesterolemia (total cholesterol> 5.0 mmol / l) - 39 people. (19.4%), increased low-density lipoprotein cholesterol (LDL cholesterol)> 3.0 mmol / l - 32 people. (15.9%), hypertriglyceridemia (TG> 1.7 mmol / l) - 27 people. (13.4%); fasting glycemia or diabetes mellitus - 28 people. (13.9%). Among patients with fractures, men with an increased body mass index (26.5±3.3 kg/m² and 24.1±4.5 kg/m² p=0.008) and abdominal obesity (104.1±7.0 and 100.1±6.2 cm, p=0.004), vitamin D deficiency or insufficiency (37 (18.4%) versus 4 (1.9%) p=0.000) and androgen deficiency (15 (7 .4%) and 7 (3.4%) p=0.048). Fractures were significantly more often associated with diabetes mellitus (19 (9.4%) and 4 (1.9%) p=0.029), respectively. Based on the identified factors, the discriminant analysis made it possible to build a mathematical model for predicting fractures in men over 45 years of age. The canonical correlation coefficient R was 0.841. Wilkson's lambda statistics values of 0.292 indicate good discrimination (with χ² - 223.7 p<0.01). The established most significant signs were assigned gradations (X1 - 6) and numerical values, where: X1 - history of fractures: no - 0, yes - 1; Х2 – age of the first fracture older than 50 years: no – 0, yes – 1; smoking: no - 0, yes - 1; diabetes mellitus: no - 0, yes - 1; walking less than 1 hour a day: no - 0, yes - 1; X6 - osteoporosis or osteopenia: no - 0, yes - 1. X1-X6 values are standardized initial data calculated by the formula: Z = (X I - X) / s, where Z - initial distribution values, X I - results dimensions of the distribution with the original dimension. The values of the constants F1 and F2 are determined: F1 = -5.99; F2 = -4.54. Having established the gradations and numerical values of the risk factors, the predictive coefficients F1 and F2 are determined according to the following formulas: F1= -5.99–0.854×X1–0.192×X2+0.855×X3–0.179×X4+8.755×X5+3.904×X6. F2= –4.54+1.24×X1+ 2.94×X2+2.165×X3+1.60×X4–0.77×X5+5.75×X6. With an absolute value of F2 greater than the absolute value of F1, a high risk is predicted, and with an F2 value less than F1, a low risk of fractures in comorbid men is predicted.Conclusions. Among men in a random sample over 45 years of age, a high incidence of cardiovascular risk factors was established. A third of the examined men had bone fractures of various localization. The mathematical model makes it possible to predict the development of fractures in men over 45 years of age, the risk of which increases in the presence of the following risk factors: a history of fractures before the age of 50, physical inactivity, smoking, the presence of diabetes mellitus and osteoporosis according to x-ray osteodensitometry.
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