title: Increased risk for coronary heart disease after avascular necrosis of femoral head: A 3-year follow-up study.
abstract: BACKGROUND
  Although pathomechanisms of avascular necrosis (AVN) of the femoral head are not well-known, vascular and coagulation abnormalities have been proposed as hypotheses. We propose that the pathomechanisms of AVN could also involve the cardiovascular system. This study explores the risk of coronary heart disease (CHD) after AVN, through a population-based case-control approach.
  
  
  METHODS
  We identified 1,450 patients with AVN as the study group and randomly selected 7,250 patients as the comparison group. Each patient was individually tracked for 3 years to identify all who developed CHD during the follow-up period. Cox proportional hazards regressions were performed to calculate the hazard ratios (HRs) of CHD for the 2 groups.
  
  
  RESULTS
  In total, 90 patients (6.21%) from the study group and 295 patients (4.07%) from the comparison group developed CHD during the follow-up period. Compared with patients in the comparison group, the HR for CHD among patients with AVN was 1.43 (95% CI 1.10-1.86, P = .002), after adjusting for geographic variables and cardiovascular risk factors. Among males, the adjusted HR for CHD was 1.65 (95% CI 1.20-2.27, P < .001). For patients <65 years old with AVN, the adjusted HR for CHD was 1.42 (95% CI 1.02-1.98, P = .021). There was no significant difference in the HR for CHD among females with AVN and patients > or =65 years old.
  
  
  CONCLUSIONS
  The incidence of CHD in the 3 years after AVN is significantly higher than in the general population.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taiwan.
authors.forename: Jiunn-Horng
authors.initials: JH
authors.lastname: Kang
authors.forename: Herng-Ching
authors.initials: HC
authors.lastname: Lin
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003327:Coronary Disease / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D005260:Female; D005271:Femur Head Necrosis / Q000150:complications* / Q000503:physiopathology; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors