Stroke mortality in women: Height loss may indicate risk

Medical News Today \ Written by James Kingsland on August 14, 2021 — Fact checked by Alexandra Sanfins, Ph.D.

• Gradual loss of height is normal in both men and women. It begins at about 50 years old and accelerates from around 60 years old onward.
• A study that followed northern European women found that considerable height loss in middle age has associations with a more than twofold increased risk of dying from a stroke.
• The authors propose that doctors could use height loss in early and middle adulthood to identify women at high risk of cardiovascular disease (CVD), including stroke.
• The findings suggest that regular physical activity may help prevent the early onset of height loss.

People tend to maintain their height from the end of puberty until their early 50s when it starts to decline slowly.

Causes of height loss include:

• shrinkage of the discs between the vertebrae of the spinal column
• spinal compression fractures as a result of osteoporosis (loss of bone density)
• changes in posture with aging

Height loss accelerates from around 60 years of age.

Research suggests that people who lose a lot of height are more likely to have low bone mineral density, vertebral fractures, and vitamin D deficiency.

Interestingly, people who live at higher latitudes are more prone to osteoporotic fractures, possibly due to less sunlight exposure.

The skin needs sunlight to make vitamin D, which helps strengthen bones.

Studies have found that rapid height loss — in mixed cohorts of men and women — has associations with a greater overall mortality rate and increased risk of (CVD).

“There appears to be a relationship between cardiovascular disease and osteoporosis,” said Dr. Nieca Goldberg, a cardiologist at New York University (NYU) School of Medicine and medical director of the NYU Women’s Heart Program.

Speaking on behalf of the American Heart Association (AHA), Dr. Goldberg told Medical News Today that the physiological mechanism behind the link is unclear.

“Proposed causes are frailty and decreased endurance as a marker of CVD risk,” she said.

She added that low levels of physical activity increase the risk of CVD, osteoporosis, and muscle weakness, leading to falls and disability.

“A good brisk walk can help to protect our cardiovascular health and prevent bone loss,” she said.

Height loss in middle age

To date, most of the studies into links between height loss and CVD have involved older people, and none has focused exclusively on women.

This is surprising, given that women tend to lose more heightTrusted Source than men and are more likely to develop osteoporosis.

To fill this knowledge gap, scientists at the University of Gothenburg in Sweden set out to determine whether height loss in middle age has links to a greater risk of overall mortality and cardiovascular mortality in women.

They analyzed data from two studies that tracked women’s health in Denmark and Sweden over several decades.

Even after accounting for other factors that affect a person’s risk of CVD, such as weight, smoking, physical activity, alcohol intake, and education, they found unusually large mortality risks associated with height loss.

They associated each centimeter (cm) of lost height with a 14% and 21% greater risk of death from any cause in the Swedish and Danish cohorts, respectively.

When the researchers combined data from the two cohorts, they found that significant height loss — which they defined as more than 2 cm — had associations with a more than a twofold increased risk of stroke.

Crucially, their analysis helps to confirm other research that suggests regular physical activity can guard against height loss in women after menopause.

The new study appears in the journal BMJ Open.

The authors conclude:

“These findings suggest the need for increased attention to height loss to identify individuals at increased CVD risk. Moreover, regular physical activity may be beneficial not only in the prevention of CVD but also in the prevention of height loss and thereby further contributing to CVD prevention.”

How the study worked

The research involved 1,147 women in Sweden who were part of the Prospective Population Study of Women in Göteborg and 1,259 women in Denmark who were part of the MONICATrusted Source (MONItoring trends and determinants of CArdiovascular disease) study.

Researchers measured participants’ height at the start of the studies when they were between 30–60 years old and again 10–13 years later.

The participants lost an average of 0.8 cm during this time, but the amount ranged widely, from 0–14 cm.

For 17–19 years after the second height measurement, researchers recorded deaths among the participants and their possible causes.

After adjustments for other contributory factors, such as lifestyle, those who lost more than 2 cm of their original height were 2.31 times as likely to die from a stroke and 2.14 times as likely to die from any type of CVD.

The authors say that, to their knowledge, this is the first study to find a link between height loss and stroke mortality.

Bones and blood vessels

The researchers believe height loss and CVD are linked via the relationship between bone loss, or osteoporosis, and CVD.

They point to a review of research that found a link between low bone mineral density and fractures and subsequent risk of CVD.

There is a surprisingly close relationship between bone loss and a process called vascular calcificationTrusted Source, which is the buildup of calcium in blood vessels.

Both processes involve inflammation and oxidative stress.

In the new study, researchers indicate that osteoporosis may explain the link between height loss and increased CVD risk.

“Low bone mineral density and osteoporosis, could certainly explain some of the height loss,” said lead author Sofia Klingberg.

“Furthermore, the literature suggests connections between bone loss and CVD through common causes, such as inflammation and oxidative stress,” she told MNT.

She said measuring height could provide a simple, quick early warning sign of increased risk of CVD among female patients.

“Height should be added but not substituted for a CVD risk assessment that includes weight and blood pressure and laboratory testing for cholesterol and glucose,” she added.

She concluded that it is possible to measure people’s vitamin D levels, which is vital for calcium absorption and helps maintain bone mineral density, with a blood test.

Limitations of the study

The authors of the new study emphasize that their research had some limitations.

In particular, they write that the number of deaths due to stroke was relatively low, so people should interpret these results with some caution.

In addition, they say they cannot rule out the possibility that other, unmeasured factors influenced their results, such as physical activity and smoking earlier in life, other diseases, and medical treatments.

However, the study suggests that paying more attention to height loss — particularly in women — might help healthcare professionals identify individuals at increased CVD risk.

• Stroke
• Cardiovascular / Cardiology
• Women’s Health / Gynecology