Cardiovascular risk is increased in patients with Paget's disease of bone: Insights from the CARTaGENE cohort.

Abstract

We aimed to assess whether Paget's disease of bone (PD) increases the risk of major adverse cardiovascular events (MACE) and arterial stiffness in middle-aged men and women. We analyzed data from the CARTaGENE cohort, including individuals aged 40-69 years, recruited in the province of Quebec, Canada in 2009/2010, linked to healthcare administrative databases to identify PD and MACE (both before and after recruitment, 1997-2021). Comorbidities and arterial stiffness parameters (augmentation index, estimated pulse wave velocity) were measured at recruitment. Cardiovascular risk factors were compared in an age-standardized population. MACE was defined as 3-component (myocardial infarction, stroke, cardiovascular death) or 5- component (3-point + heart failure, unstable angina) variables. Time-to-event analyses (from birth) used Cox and Fine-Gray models in a 1:3 propensity-score matched population, and associations with arterial stiffness were tested with linear and logistic regressions. Among 19,990 participants, 101 (0.5%) had PD. PD participants were older (57.5 ± 7.7 vs 54.2 ± 7.9 years) and had a higher prevalence of diabetes (22.4% vs 9.9%) than participants without PD. Ten (10%) MACE-3 and 15 (15%) MACE-5 occurred in the PD group versus 18 (6%) and 24 (8%) in the matched sample (n = 303). Hazard ratios were 1.86 (95%CI 0.80-4.34) for MACE-3 and 2.06 (95%CI 1.06-4.04) for MACE-5. Competing risk models yielded similar results. No significant associations were observed with arterial stiffness parameters. PD was associated with an independently increased risk of MACE, but not with arterial stiffness.