Abstract
BackgroundAortic calcification is a major risk factor for death from cardiovascular disease. We investigated the relationship between mortality and the composite markers of number, size, morphology and distribution of calcified plaques in the lumbar aorta.Methods308 postmenopausal women aged 48-76 were followed for 8.3 ± 0.3 years, with deaths related to cardiovascular disease, cancer, or other causes being recorded. From lumbar X-rays at baseline the number (NCD), size, morphology and distribution of aortic calcification lesions were scored and combined into one Morphological Atherosclerotic Calcification Distribution (MACD) index. The hazard ratio for mortality was calculated for the MACD and for three other commonly used predictors: the EU SCORE card, the Framingham Coronary Heart Disease Risk Score (Framingham score), and the gold standard Aortic Calcification Severity score (AC24) developed from the Framingham Heart Study cohorts.ResultsAll four scoring systems showed increasing age, smoking, and raised triglyceride levels were the main predictors of mortality after adjustment for all other metabolic and physical parameters. The SCORE card and the Framingham score resulted in a mortality hazard ratio increase per standard deviation (HR/SD) of 1.8 (1.51-2.13) and 2.6 (1.87-3.71), respectively. Of the morphological x-ray based measures, NCD revealed a HR/SD >2 adjusted for SCORE/Framingham. The MACD index scoring the distribution, size, morphology and number of lesions revealed the best predictive power for identification of patients at risk of mortality, with a hazard ratio of 15.6 (p < 0.001) for the 10% at greatest risk of death.ConclusionsThis study shows that it is not just the extent of aortic calcification that predicts risk of mortality, but also the distribution, shape and size of calcified lesions. The MACD index may provide a more sensitive predictor of mortality from aortic calcification than the commonly used AC24 and SCORE/Framingham point card systems.
Highlights
Aortic calcification is a major risk factor for death from cardiovascular disease
Several interesting findings have been reported on abdominal aortic calcifications as a Cardiovascular diseases (CVD) risk factor: i) Premature parental CVD has been associated with abdominal aortic calcification [7]. ii) Abdominal aortic calcium levels were significantly related to coronary calcium levels independent of the usual risk factors [8,9]. iii) In type II diabetes patients, abdominal aortic calcification was shown to constitute an independent risk factor of clinical vascular disease [10]. iv) An increased total-to-high density lipoprotein (HDL) cholesterol ratio increased the risk of presence of aortic calcification [11]. v) Lumbar aortic calcifications in bone densitometer images have been shown to constitute an independent risk factor of CVD [12]
We evaluated whether each risk included in the composite Morphological Atherosclerotic Calcification Distribution (MACD) marker persisted after correction for generalized risk assessments used in the SCORE card [16], the Framingham score [17] or individual risk factors, such as smoking, cholesterol or triglycerides levels
Summary
Aortic calcification is a major risk factor for death from cardiovascular disease. Cardiovascular diseases (CVD) remain the most common cause of death in the developed world, even though vast epidemiological and interventional studies have demonstrated significant declines in CVD prevalence with adherence to a healthy lifestyle, and the identification and management of risk factors [1]. Iii) In type II diabetes patients, abdominal aortic calcification was shown to constitute an independent risk factor of clinical vascular disease [10]. V) Lumbar aortic calcifications in bone densitometer images have been shown to constitute an independent risk factor of CVD [12]. Abdominal aortic calcification is an important risk factor for CVD
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