Abstract P235: Superior Mesenteric Artery Calcification is Associated with Cardiovascular Risk Factors, Systemic Calcified Atherosclerosis and Mortality in Asymptomatic Adults

Abstract

Arterial calcification is a hallmark of atherosclerosis and can be detected by computed tomography (CT). There are few epidemiological data regarding the superior mesenteric artery, the atherosclerotic occlusion of which contributes to mesenteric ischemia that may, in turn, lead to increased morbidity or mortality. This study tested the hypothesis that superior mesenteric artery calcification (SMAC) is associated with cardiovascular disease (CVD) risk factors, systemic calcified atherosclerosis, and both cardiovascular and all-cause mortality. The presence and amount of arterial calcification was evaluated by CT in 4302 adults with no known CVD who were physician- or self-referred to obtain preventative health testing at a university-affiliated outpatient center. Laboratory data and medical histories were obtained concomitantly. A multiple logistic regression model was used to determine risk factor associations for SMAC presence, adjusted for calcification in five other arterial beds. In a separate logistic regression model adjusted for CVD risk factors, SMAC presence was used as a predictor for systemic calcified atherosclerosis, represented as having calcification in all five other arterial beds. Cox models, adjusted for CVD risk factors and calcification in other arterial beds, were used to examine the association of SMAC presence and amount (expressed as log[Agatston score+1]) with cardiovascular and all-cause mortality. In the study sample, the average age was 56 years, 43.7% (1879 of 4302) were women, and 6.7% (290 of 4302) had SMAC. Age (OR=1.08, 95%CI [1.06 to 1.10]), male sex (OR=1.97, 95%CI [1.43 to 2.71]), dyslipidemia (OR=1.38, 95% CI [1.01 to 1.88]) and any smoking (OR=1.60, 95% CI [1.20 to 2.14]) were associated with SMAC presence. Moreover, SMAC presence was associated with higher odds for calcification in all five other arterial beds (OR=5.96, 95%CI [3.72-9.54]). Over a median follow-up time of 9.4 years, there were 234 (5.4%) deaths, 76 of which were CVD-related. SMAC presence (HR=1.57, 95%CI [0.93-2.68]) and amount (HR=1.30 per unit increase in log[Agatston score+1], 95%CI [1.00-1.68]) were each associated with a greater risk for CVD mortality. Similarly, SMAC presence (HR=1.52, 95%CI [1.10-2.12]) and amount (HR=1.25, 95%CI [1.06-1.48]) were each associated with a greater risk for all-cause mortality. In conclusion, age, male sex, dyslipidemia, and any smoking were significant risk factors for the presence of SMAC. The association of SMAC presence with greatly increased odds for calcification in all other vascular beds suggests that calcification of the superior mesenteric artery occurs with subclinical, yet widely-manifest, systemic atherosclerosis. Finally, SMAC amount was significantly associated with incident cardiovascular mortality, while both SMAC presence and amount were significantly associated with all-cause mortality.