Abdominal Aortic Calcification Score Research Articles

It’s time for a practical method quantifying vascular calcification

It’s time for a practical method quantifying vascular calcification

Abdominal Aortic Calcification in Patient’s Infected by the Human Immunodeficiency Virus

In countries where highly active antiretroviral therapy (HAART) is available, cardiovascular disease is a major cause of morbidity and mortality in patients infected by the human immunodeficiency virus (HIV). Vascular calcification is used as subclinical marker of atherosclerosis. As vascular calcification is now considered to be an active, inflammatory process, its evaluation in HIV-infected patients may thus be clinically relevant. The primary objective of the present study was to determine and compare the prevalence of abdominal aortic calcification (using the multislice spiral computed tomography) in HIV-positive patients receiving HAART and in HIV-negative control subjects. The secondary objective was to determine the risk factors associated with the presence of abdominal aortic calcification in HIV-positive patients. Seventy-seven HIV-positive patients and 77 HIV-negative controls were included in the study. We found that the prevalence of abdominal aortic calcification was similar in the two groups. Furthermore, the mean abdominal aortic calcification score was not significantly higher in HIV-positive patients than in controls. The following parameters were correlated with the aortic calcification score: age (p<0.0001), total cholesterol (p=0.004), low density lipoprotein cholesterol (p=0.007), estimated creatinine clearance (p=0.039), low viral load (p=0.02) and time since the diagnosis of HIV infection (p=0.005). However, in a multivariate analysis, only age was independently associated with the aortic calcification score (p=0.007). In conclusion, abdominal aortic calcification is neither more frequent nor more severe in HIV-positive patients than in HIV-negative controls, and seems only to be affected by independent HIV factors (such as age) in the patients. It remains to be established whether the progression of abdominal aortic calcification is independent of HIV status (in contrast to what has been observed for coronary calcification).

Severe Abdominal Aortic Calcification in Older Men Is Negatively Associated With DKK1 Serum Levels: The STRAMBO Study

Experimental data show that dickkopf-1 (DKK1) may be involved in the regulation of arterial calcification. However, clinical data on the association between serum DKK1 levels and severity of abdominal aortic calcification (AAC) are scarce. Our aim was to determine the association between serum DKK1 concentration and AAC severity in men. This is a cross-sectional analysis in the STRAMBO cohort. The cohort was recruited from the general population. We examined 1139 male volunteers aged 20 to 87 years. No specific exclusion criteria were used. We collected blood samples and assessed AAC severity on the lateral spine scans obtained by a Discovery A Hologic device using the semiquantitative Kauppila score. We tested the hypothesis that low DKK1 levels are associated with AAC severity in men. In men aged 20 to 60 years, serum DKK1 levels were not associated with other variables. In men aged 60 years and older, lower DKK1 levels were associated with higher odds of severe AAC (AAC score >5). After adjustment for confounders, odds of severe AAC increased with decreasing DKK1 levels (odds ratio = 1.42, 95% confidence interval = 1.13-1.79, P < .005) and was higher below vs above the median DKK1 level (odds ratio = 2.19, 95% confidence interval = 1.37-3.49, P < .005). Heavy smoking, hypertension, ischemic heart disease, and elevated levels of fibroblast growth factor 23 were associated with severe AAC significantly, independently of DKK1 and additively with low DKK1 levels. In older men, lower serum DKK1 levels are associated with severe AAC regardless of age and other potential confounders.

Clinical and Radiological Characteristics of Concomitant Peripheral Arterial Obstructive Disease in Patients with Lumbar Spinal Stenosis

Background: Intermittent claudication is a typical symptom of lumbar spinal stenosis (LSS) and peripheral arterial obstructive disease (PAD). Because both LSS and PAD are predominantly associated with degenerative conditions, concomitant conditions are not uncommon. However, few reports of the demographic, clinical, and radiological characteristics of concomitant LSS and PAD (LSSPAD) have been published. Objective: To identify the demographic, clinical, and radiological risk factors for concomitant PAD in LSS. Study Design: A retrospective matched-control study. Methods: This study involved a retrospective cohort of 43 consecutive patients with LSSPAD and a control cohort of 45 age- and gender-matched patients diagnosed with LSS without PAD. Each patient in both groups underwent plain lumbar radiographs, magnetic resonance imaging of the lumbar spine, and ankle-brachial index (ABI) measurement. Demographic and clinical parameters were obtained. The abdominal aorta calcification score (AACS) was evaluated on the lateral lumbar radiographs. Computed tomographic angiography (CTA) of the lower limb was performed to confirm PAD. Results: The mean age of the LSSPAD group was 67.7 ± 10.7 years (52 – 88 years). The prevalence of diabetes mellitus (DM) was significantly higher in the LSSPAD group than in the LSS group (P = 0.022). The mean ABI was 0.71 ± 0.22 (0.32 – 0.91) for the LSSPAD group and 0.96 ± 0.18 (0.83 – 1.10) for LSS group (P &lt; 0.001). The prevalence of aortic calcification was significantly higher in the LSSPAD group than in the LSS group (P &lt; 0.001). The mean AACS was 10.2 ± 3.2 (2 – 18) for the LSSPAD group and 3.4 ± 4.1 (0 – 14) for the LSS group (P &lt; 0.001). Limitations: Retrospective design. Conclusion: We found that concomitant PAD in patients with LSS is associated with old age, DM, the presence of aortic calcification, and ABI &lt; 0.9. When these risk factors exist, further work up is needed to exclude the concomitant PAD. Key words: Claudication, lumbar spinal stenosis, peripheral arterial obstructive disease, aortic calcification, ankle-brachial index

High hip fracture risk in men with severe aortic calcification: MrOS study

A significant link between cardiovascular disease and osteoporosis is established in postmenopausal women, but data for men are scarce. We tested the hypothesis that greater severity of abdominal aortic calcification (AAC) was associated with an increased risk of nonspine fracture in 5994 men aged ≥ 65 years. AAC was assessed on 5400 baseline lateral thoracolumbar radiographs using a validated visual semiquantitative score. Total hip bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry. Incident nonspine fractures were centrally adjudicated. After adjustment for age, body mass index (BMI), total hip BMD, fall history, prior fracture, smoking status, comorbidities, race, and clinical center, the risk of nonspine fracture (n=805) was increased among men with higher AAC (hazard ratio [HR] quartile 4 [Q4] [AAC score ≥ 9] versus quartile 1 [Q1] [0-1], 1.36; 96% confidence interval [CI], 1.10-1.68). This association was due to an increased risk of hip fracture (n=178) among men with higher AAC (HR Q4 versus Q1, 2.33; 95% CI, 1.41-3.87). By contrast, the association between AAC and the risk of nonspine, nonhip fracture was weaker and not significant (HR Q4 versus Q1, 1.22; 95% CI, 0.96-1.55). The findings regarding higher AAC and increased risk of fracture were not altered in additional analyses accounting for degree of trauma, estimated glomerular filtration rate, presence of lumbar vertebral fractures (which may bias AAC assessment), preexisting cardiovascular disease, ankle brachial index, or competing risk of death. Thus, in this large cohort of elderly men, greater AAC was independently associated with an increased risk of hip fracture, but not with other nonspine fractures. These findings suggest that AAC assessment may be a useful method for identification of older men at high risk of hip fracture.

Role of 8-isoprostane, Matrix Gla Protein (MGP) and Bone Morphogenetic Protein-2 (BMP-2) in Vascular Calcification in Chronic Kidney Disease

BACKGROUND: Vascular calcification may be an important risk factor of cardiovascular disease in Chronic Kidney Disease (CKD). The pathobiology of vascular calcification in CKD is complex and involves some factors including inflammation, oxidative stress and balancing of calcification regulators. The aim of the study was to investigate the interaction between 8-isoprostane with calcification regulators such as matrix gla protein (MGP) and bone morphogenetic protein (BMP)-2 with vascular calciication in CKD.METHODS: A cross-sectional study was performed on 63 subjects undergoing haemodialysis maintenance for more than 3 months. Abdominal aortic calcification (AAC) was measured using a lateral abdominal X-ray for calcification in abdominal aorta, which is related to severity of calcific deposits at lumbar vertebral segment (L)1-L4. Serum levels of 8-isoprostane, MGP and BMP-2 were measured by enzyme-linked immunosorbent assay method.RESULTS: Results showed that 8-isoprostane levels were correlated with BMP-2 (r=0.266, p=0.018) and MGP levels (r=0.410, p≤0.001). MGP/BMP-2 levels ratio was correlated with AAC score (r=0.279, p=0.013). Subjects were then stratified into 3 groups based on AAC score: 0, 1-6 and ≥7. The highest mean of MGP levels was in AAC score 1-6 group, and the highest mean of 8-isoprostane levels was in AAC score ≥7. In the group of AAC score 0, 8-isoprostane levels were correlated with MGP levels (r=0.499, p=0.001) and MGP/BMP-2 levels ratio (r=0.291, p=0.034). In AAC score 1-6 group, 8-isoprostane levels were correlated with BMP-2 (r=0.661, p=0.005) and MGP levels (r=0.569, p=0.017). In AAC score ≥7 group, MGP levels were positively correlated with AAC score (r=0.608, p=0.041). With multivariate logistic regression analyses, we identified that increased MGP/BMP-2 levels ratio (OR=12.436; 95% CI=1.595-96.971) was an independent predictor in aortic calcification event.CONCLUSION: We concluded that regulators of calcification including calcification inhibitor and promoter related to oxidative stress, were associated with vascular calcification in CKD. MGP levels were increased in the early of calcification and MGP/BMP-2 levels ratio was a strong predictor for vascular calcification in CKD.KEYWORDS: vascular calcification, CKD, oxidative stress, 8-isoprostane, MGP, BMP-2

Radiographic Assessment of Vascular Calcification, Aortic Pulse Wave Velocity, Ankle‐Brachial Index and Fibroblast Growth Factor‐23 in Chronic Hemodialysis Patients

Vascular calcification is a frequent complication of chronic kidney disease and end stage renal disease. In both the general population and patients with end stage renal disease, vascular calcification is related to arterial stiffness and is a predictor of cardiovascular morbidity and mortality. Various diagnostic methods are currently used to assess vascular calcification. There is a preference for simple, reliable methods that can be used in daily practice. Therefore, several imaging and laboratory methods are investigated. Twenty-eight patients with mean age of 62 years on chronic hemodialysis were enrolled in the study. The mean duration of hemodialysis treatment was 70 months (range 3 to 350 months). Vascular calcification was assessed with coronary computed tomography and lateral lumbar, pelvic and hand radiographs. Vascular stiffness was evaluated using aortic pulse wave velocity and ankle-brachial index measurements, and finally serum levels of fibroblast growth factor-23 were followed. A statistically significant correlation was demonstrated between all the following parameters: coronary artery calcification score, aortic pulse wave velocity, abdominal aortic calcification score, simple vascular calcification scores in pelvis and hand. A statistically significant correlation of ankle-brachial index >1.3 to coronary artery calcification score was found. There was no correlation between the previous parameters and fibroblast growth factor-23. The results of our study indicate that simple imaging methods could provide confident vascular damage assessment and therefore potentially guide therapy adjustments. An association between fibroblast growth factor-23 and the other diagnostic modalities in our study was not found.

Cardiovascular Significance of Abdominal Aortic Calcification on Dual-Energy X-ray Absorptiometry in Middle-aged Men

Background:Abdominal aortic calcification (AAC)measured on spine X-rays is an established cardiovascular risk factor, though the significance of its presence on dualenergy X-ray absorptiometry (DEXA) is less certain. We set out to determine whether AAC on DEXA is associated with cardiovascular variables, including coronary calcium score and events, in middle-aged men. Methods: Men over 40 years of age from a local randomised trial of calcium supplementation were studied. DEXA was performed at baseline and two-year followup for retrospective AAC assessment using the AAC-8 score. Coronary and aortic calcium scores were assessed by computed tomography (CT). Vascular events including myocardial infarction (MI), stroke (CVA) and sudden death were independently adjudicated. Results: AAC (AAC-8> 0) was present at baseline in 17.2% (57/320) of subjects, and significantly increased to 26%at two years (P< 0.001). Agewas the only independent predictor of baselineAAC (OR=1.06, P< 0.001).Meanpredicted five-year cardiovascular risk (5y-CV) was higher in presence ofAAC (2.5%vs. 1.7%,P< 0.001). AACwas significantly associated with higher CT coronary (P= 0.03) and aortic calcium (P= 0.003) scores. In linear regression models, AAC and coronary calcium score accounted for 8.5% and 19.9%, respectively of the variance of 5y-CV. AACwas significantly associated with MI using survival analysis (HR 5.32, P= 0.04), though did not remain an independent predictor after adjusting for 5y-CV. Conclusion: AAC assessed by DEXA was significantly associated with higher CT coronary and aortic calcium scores and incident myocardial infarction in middleaged men, and therefore can add valuable information regarding cardiovascular risk in this population.

Isolated Aortic Valve Replacement in Octogenarians and Septuagenarians: Five-Year Cohort Study

Background:Abdominal aortic calcification (AAC)measured on spine X-rays is an established cardiovascular risk factor, though the significance of its presence on dualenergy X-ray absorptiometry (DEXA) is less certain. We set out to determine whether AAC on DEXA is associated with cardiovascular variables, including coronary calcium score and events, in middle-aged men. Methods: Men over 40 years of age from a local randomised trial of calcium supplementation were studied. DEXA was performed at baseline and two-year followup for retrospective AAC assessment using the AAC-8 score. Coronary and aortic calcium scores were assessed by computed tomography (CT). Vascular events including myocardial infarction (MI), stroke (CVA) and sudden death were independently adjudicated. Results: AAC (AAC-8> 0) was present at baseline in 17.2% (57/320) of subjects, and significantly increased to 26%at two years (P< 0.001). Agewas the only independent predictor of baselineAAC (OR=1.06, P< 0.001).Meanpredicted five-year cardiovascular risk (5y-CV) was higher in presence ofAAC (2.5%vs. 1.7%,P< 0.001). AACwas significantly associated with higher CT coronary (P= 0.03) and aortic calcium (P= 0.003) scores. In linear regression models, AAC and coronary calcium score accounted for 8.5% and 19.9%, respectively of the variance of 5y-CV. AACwas significantly associated with MI using survival analysis (HR 5.32, P= 0.04), though did not remain an independent predictor after adjusting for 5y-CV. Conclusion: AAC assessed by DEXA was significantly associated with higher CT coronary and aortic calcium scores and incident myocardial infarction in middleaged men, and therefore can add valuable information regarding cardiovascular risk in this population.

Prevalence and predictors of abdominal aortic calcification in healthy living kidney donors

Vascular calcification (VC) is common and is both a marker and a cause of increased cardiovascular morbidity and mortality, especially so in chronic kidney disease (CKD) patients. Renal transplantation is the cornerstone of the successful long-term management of CKD, and in order to satisfy transplantation needs, more use is made now of living kidney donors (LKD). Prior to selection for transplantation, much screening of potential LKD takes place, including for cardiovascular issues. It is not known; however, how much these potentially healthy LKD may be prone to clinically silent VC. We identified 103 living kidney donors from 2011 renal transplant records. Abdominal aortic calcification (AAC) was assessed using existing abdominal CT imaging using multi-channel CT aortograms (used primarily to assess renal vascular anatomy). Using these CT scans, manual calcium scoring was undertaken to calculate total aortic calcium load (AAC severity score). The prevalence, severity and associations of AAC between calcified and non-calcified donors were then compared. A total of 103 donors were identified from records. Ninety three of these had detailed clinical records to complement their CT scans. Fifty of ninety-three donors were male, and the mean age was 45.9 ± 1.8 years. Mean MDRD eGFR was 88.73 ± 2.97 ml/min/1.73 m(2). 7.14 ± 3.07 % of the aorta in these donors was calcified with a mean AAC severity score of 0.98 ± 0.56. In kidney donors >50 years of age, there was significantly more AAC than in those <50: 2.47 ± 1.56 versus 0.31 ± 0.29, p < 0.001. There was no relationship between the presence or severity of aortic VC and donor GFR, systolic blood pressure, pulse pressure, calcium-phosphate product or smoking. AAC prevalence, patterns and severity in this important donor population have not previously been described in the literature. There was relatively little VC in what would be regarded as a "healthy" donor population. VC was more common with age, but the other possible risk factors for the presence or severity of VC did not impact on overall AAC scores. VC did not influence vascular stiffness as represented by pulse pressure. Following the evolution of AAC over time in those who have donated a kidney, and lost some global renal function as a consequence, would be of considerable interest.

Vertebral fractures and abdominal aortic calcification in postmenopausal women. A cohort study

IntroductionVertebral fracture assessment (VFA) imaging with a bone densitometer can simultaneously detect prevalent vertebral fractures (VFs) and abdominal aortic calcification (AAC). ObjectiveTo study the relation between the prevalence of VFs using VFA in asymptomatic women and the prevalence and severity of AAC. DesignThis is a cross-sectional study. SettingsSubjects were recruited in a third care center from asymptomatic women selected from the general population. ParticipantsWe enrolled 908 post-menopausal women with a mean age of 60.9years±7.7 (50 to 91) with no prior known diagnosis of osteoporosis or taking medication interfering with bone metabolism. Primary and secondary outcome measuresLateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of Genant semiquantitative (SQ) approach and morphometry. VFA images were scored for AAC using a validated 24 point scale. ResultsVFA images showed that 179 of the participants (19.7%) had at least one grade 2/3 VF, 81% did not have any detectable AAC whereas the prevalence of significant atherosclerotic burden, defined as AAC score of 5 or higher, was 12%. The group of women with 2/3 VFs had a statistically significant higher AAC score and higher proportion of subjects with extended AAC, and lower weight, height, and lumbar spine and hip BMD and T-scores than those without VFA-identified VFs. Multiple regression analysis showed that the presence of grade 2/3 VFs was significantly associated with age, BMI, history of peripheral fracture, AAC score≥5 and densitometric osteoporosis. ConclusionIn post-menopausal women, extended AAC is independently associated with prevalent VFs regardless of age, BMI, history of fractures, and BMD.

The relationship between inhibitors of the Wnt signalling pathway (Dickkopf-1(DKK1) and sclerostin), bone mineral density, vascular calcification and arterial stiffness in post-menopausal women

Epidemiological studies have shown an association between bone loss/osteoporosis and vascular calcification (VC). Recent studies have implicated the Wnt signalling pathway in the pathogenesis of VC. We investigated the association between circulating concentrations of Wnt inhibitors; DKK1 and sclerostin with bone mineral density (BMD), abdominal aortic calcification (AAC) and arterial stiffness in post-menopausal women. One hundred and forty six post-menopausal women aged (mean [SD]) 61.5[6.5] years were studied. Sclerostin and DKK1 were measured in serum. BMD was measured at the lumbar spine (LS), femoral neck (FN), total hip (TH). AAC was detected by Vertebral Fracture Assessment (VFA) imaging and quantified using an 8- and 24- point scoring methods. Arterial stiffness was determined by aortic pulse wave velocity (PWV). A significant positive correlation was observed between sclerostin and BMD at the FN (r=0.166, p=0.043) and TH (r=0.165, p=0.044). The association remained significant at the FN (p=0.045) and TH (p=0.026) following adjustment for confounders. No significant correlation was observed between DKK1 and BMD. In contrast, there was a significant negative correlation between log DKK1 and AAC (24-point score: r=−0.25, p=0.008 and 8-point score: r=−0.21, p=0.024). Subjects with AAC score of 1 or less had significantly higher DKK1 (p=0.01). The association between DKK1 and AAC remained significant following correction for age, blood pressure, cholesterol (24-point score: p=0.017, 8-point score: p=0.044). In adjusted linear regression analysis, sclerostin was positively associated with AAC (24-point score: p=0.048, 8-point score: p=0.031). Subjects with a PWV>9m/s had significantly higher sclerostin than those with PWV <9m/s: 23.8[12.3], vs 29.7 [14] pmol/l, p=0.03). No association was observed between DKK1 and PWV. The opposite association between AAC and the 2 Wnt signaling inhibitors is of interest and merits further investigations. Future longitudinal studies are needed to establish the precise role of sclerostin and DKK1 in the pathogenesis of VC.

Serum osteocalcin levels are inversely associated with abdominal aortic calcification in men with type 2 diabetes mellitus

We found that serum osteocalcin (OC) and undercarboxylated OC (ucOC) levels were negatively associated with abdominal aortic calcification in type 2 diabetes mellitus (T2DM) men. This finding suggests that circulating OC and ucOC are not only related to glucose or fat metabolism but also to arteriosclerosis. Recent studies revealed that serum osteocalcin levels were associated with not only bone metabolism but also glucose and fat metabolism. However, the relationship between serum OC levels and arteriosclerosis remains controversial. We examined whether or not bone metabolic markers including OC are associated with abdominal aortic calcification in patients with type 2 diabetes mellitus. We recruited 118 men and 100 postmenopausal women with T2DM. We evaluated the abdominal aortic calcification score (ACS) on a lateral lumbar radiograph and examined the association between serum OC or undercarboxylated OC levels and ACS. The ACS of 3 and greater, which corresponded well to the highest quartile, was significantly and negatively associated with serum OC and ucOC levels in men by logistic regression analyses after adjusting for age, BMI, serum levels of creatinine and LDL cholesterol, radial bone mineral density, smoking, duration of DM, hemoglobin A1c, and the index of insulin resistance [odds ratio (OR) 0.36, 95 % confidence interval (CI) 0.19-0.70, P < 0.005, and OR 0.28, 95 % CI 0.12-0.69, P < 0.01, per standard deviation increase in OC and ucOC, respectively]. These observations were still significant after an additional adjustment for other bone markers. In contrast, there were no significant relationships with serum OC or ucOC levels and ACS in women. These findings suggest that serum OC and ucOC levels are associated with not only bone metabolism but also arteriosclerosis in men, but not in women with type 2 diabetes mellitus.

Higher Serum Osteocalcin Is Associated With Lower Abdominal Aortic Calcification Progression and Longer 10-Year Survival in Elderly Men of the MINOS Cohort

Abdominal aortic calcification (AAC) is an indicator of cardiovascular risk, especially in the diseases characterized by insulin resistance such as type 2 diabetes. Osteocalcin is a bone-secreted hormone that favors insulin sensitivity and insulin secretion. We investigated whether total serum osteocalcin level at baseline is associated with AAC progression and 10-year all-cause mortality in elderly men. We assessed 774 men aged 51-85 years from the MINOS cohort who had osteocalcin measurement and lumbar spine radiographs at baseline. They were followed-up prospectively for 10 years. Among them, 615 patients had a follow-up radiograph at 3.5 or 7 years. Serum total osteocalcin was measured with an immunoradiometric assay on morning fasting serum collected at baseline. Kauppila's AAC score was assessed from lumbar spine radiographs. AAC progression rate was calculated as the difference between AAC on the last available radiograph and AAC at baseline divided by the follow-up time. Death status was collected over 10 years. In multivariate analysis, higher baseline total osteocalcin was associated with lower AAC progression rate (odds ratio = 0.74 [0.57-0.97] per 10 ng/mL variation; P = 0.029). At the 10-year follow-up, there were 599 men alive (77%), 181 dead (23%), and 2 lost to follow-up. Higher osteocalcin was associated with lower 10-year all-cause mortality (hazard ratio = 0.62 [0.44-0.86] per 10 ng/mL variation; P = 0.005). Higher baseline total osteocalcin concentrations were associated with lower AAC progression rate and lower mortality. These data suggest that osteocalcin level might be an independent indicator of cardiovascular risk and global health in elderly Caucasian men.

Associations between Pulse Wave Velocity, Aortic Vascular Calcification, and Bone Mineral Density in Chronic Hemodialysis Patients and General Population

The aims of this study were to compare PWV, vascular calcification (VC), and bone mineral density (BMD) in chronic hemodialysis patients (CHP) with those of the general population patients (GPP). We evaluated 60 GPP (aged 57.5 ± 10.9) compared with 80 CHP (aged 59.3±11.8). PWV was determined from time diversity propagation of the carotid and femoral artery by Doppler ultrasound. Lateral lumbar radiography (LLR) of the abdominal aorta was used to determine the overall abdominal aortic calcification (AAC) score. BMD of the hip and the spine was assessed by dual energy X-ray absorptiometry (DEXA). Biochemical parameters (PTH, Ca2+, P, albumin, CRP, etc.) were determined in all participants according to standard laboratory procedures. The mean PWV was 9.2±2.0 m/s in the GPP and 12.5±2.0 m/s in the CHP. The mean AAC score was as follows: GPP: 2.2±2.69, CHP: 7.98±5.65. The mean BMD at hip was as follow: GPP: 0.875±0.159 (g/cm2), CHP: 0.729±0.147 (g/cm2). In the GPP, PWV correlate with VC (P&lt;0.001), BMD (P&lt;0.001), albumin (P&lt;0.001), and CRP (P=0.004). In the CHP, PWV correlates with VC (P&lt;0.001), BMD (P&lt;0.098), albumin (P&lt;0.094), and CRP (P=0.004). There is a strong inverse correlation between PWV and BMD and between VC and BMD. There is a positive correlation between PWV and VC.

Serum phosphate and hip bone mineral density as additional factors for high vascular calcification scores in a community-dwelling: The São Paulo Ageing & Health Study (SPAH)

ObjectiveTo analyze the association between abdominal aortic calcification scores (AACS) and bone metabolism parameters in a well-characterized general population of older adults. BackgroundSeveral studies suggest a link between bone mineral metabolism disorders and vascular calcification; although only few of them analyze bone mineral density(BMD), laboratory bone markers and cardiovascular parameters at the same time and none were done in a miscegenated population. MethodsThis cross-sectional study included 815 subjects ≥65years old. The risk factors for osteoporosis and cardiovascular disease as well as a wide array of demographic and lifestyle characteristics were collected using a standardized questionnaire. BMD was measured by DXA. Kauppila's method was used to quantify the AAC score (AACS) by spine X-rays. Laboratory analyses were also performed. ResultsAAC was observed in 63.2% of subjects with a median AACS of 2 (IQR: 0–7). AACS were categorized in quartiles and the highest quartile of AACS (>7) were compared with the three lower quartiles of AACS (≤7). Logistic regression analysis was performed using parameters with statistical significance in the univariate analysis. The best logistic regression model revealed that AACS>7 was negatively associated with femoral neck BMD and positively associated with phosphorus, adjusted by age, current smoking, LDL, and arterial hypertension in the elderly community-dwelling population. ConclusionsWe identified that higher serum phosphate levels and lower hip BMD are independent bone variables that are associated with elevated vascular calcification scores, supporting the search for effective prevention and treatment strategies that may simultaneously reduce these modifiable risk factors in older subjects.

Serum myostatin levels are negatively associated with abdominal aortic calcification in older men: the STRAMBO study

To assess the association between abdominal aortic calcification (AAC) and serum levels of myostatin, a negative regulator of skeletal muscle mass, which has been implicated in the development of atherosclerotic lesions in mice. We assessed AAC semiquantitatively from the lateral spine scans obtained using dual energy X-ray absorptiometry in 1071 men aged 20-87 years. Serum myostatin levels were measured by an immunoassay that detects all myostatin forms. Total myostatin serum levels did not differ between men with or without self-reported ischemic heart disease, hypertension, or diabetes mellitus. Total serum myostatin levels were higher in men with higher serum calcium levels and lower in men with higher serum concentrations of highly sensitive C-reactive protein. Men with AAC had lower myostatin levels compared with men without AAC. Prevalence of AAC (AAC score > 0) was lower in the highest myostatin quartile compared with the three lower quartiles (P < 0.05). After adjustment for confounders, odds of AAC (AAC score > 0) were lower (OR=0.62; 95% confidence interval (95% CI), 0.45-0.85; P< 0.005) for the fourth myostatin quartile vs the three lower quartiles combined. In the sub-analysis of 745 men aged 60 years, the results were similar: AAC prevalence was lower in the highest myostatin quartile compared with the three lower quartiles combined (OR=0.54; 95% CI, 0.38-0.78; P<0.001). In older men, total myostatin serum levels are inversely correlated with AAC. Further studies are needed to investigate mechanisms underlying this association and to assess utility of myostatin as a cardiovascular marker.

Vascular calcification in South African dialysis patients: Ethnic variation, prevalence, detection and haemodynamic correlates

Studies from the US have shown little effect of ethnicity on vascular calcification in dialysis patients. This has not been examined in the multi-ethnic population of South Africa where genetic and environmental differences may exist. We assessed the extent and severity of vascular calcification in South African dialysis patients according to race and known risk factors. We further evaluated the association of abdominal aorta calcification with coronary artery calcification. Seventy-five CKD-5D patients and 20 healthy controls were enrolled consecutively. All subjects underwent chest computed tomography for coronary calcium score and abdominal X-ray for abdominal aorta calcium score. Ambulatory blood pressure monitoring was generated via radial artery applanation tonometry. Coronary calcification was present in 38.6% of patients and was associated with age and prior cardiovascular disease on multivariate analyses. The median coronary calcium score in black patients was 0 (IQR 0) and 66 in non-Blacks (IQR 383, P < 0.001); controls had a coronary calcium score of 0 (IQR 0). Black race remained a significant negative predictor for coronary calcification after adjustment, prevalence ratio = 0.14 and 95% confidence interval (CI): 0.0-0.53. Vascular calcification was not associated with any ambulatory blood pressure parameter. Using receiver operator characteristic curves, an abdominal aorta calcification score of ≥1 showed an area under the curve of 0.83 to predict a coronary calcium score ≥ 10. Black race appears to protect from vascular calcification in South African CKD-5D patients and this warrants further study regarding the underlying mechanism. The abdominal X-ray is a useful screening tool for coronary calcification.

Abdominal Aortic Calcification is an Independent Predictor of Cardiovascular Events in Peritoneal Dialysis Patients

Abdominal aortic calcification (AAC) is reported as a predictor for cardiovascular events in general population and in hemodialysis patients. At present, there are no AAC data in peritoneal dialysis. The purpose of this study was to evaluate the prognostic role of AAC score on cardiovascular events in peritoneal dialysis patients. Seventy-four peritoneal dialysis patients were enrolled. AAC was measured on baseline lateral abdomen radiographs by the semi-quantitative method as described by Kauppila. The other cardiovascular risk factors were obtained from patient history and blood examination. The Kaplan-Meier method was used to evaluate freedom from cardiovascular events, and differences were assessed with the log-rank statistic. Multivariate Cox regression models addressed time to cardiovascular events. The median period of follow-up was 30.5months (IQR 19.4-32.7). During follow-up, there were 29 cardiovascular events (39.2%). In univariable analysis, patient's age (HR=1.050; P=0.001), urine output (HR=0.999; P=0.02), and AAC stratified by tertiles (overall P-value<0.001) were significantly associated with cardiovascular events. In multivariable regression analysis, AAC score stratified by tertiles was the only independent predictor for cardiovascular events (overall P-value<0.001). To our knowledge, we have shown for the first time that AAC score is an independent predictor of cardiovascular events in peritoneal dialysis patients. Risk stratification by assessment of AAC score may provide important information for the management of cardiovascular disease in peritoneal dialysis patients without any additional expense, because these patients have several abdominal X-ray scans to evaluate the catheter position.

Relationship between vertebral fracture prevalence and abdominal aortic calcification in men

To study the relationship between the prevalence of vertebral fractures (VFs) using VF assessment (VFA) in asymptomatic men and the prevalence and severity of abdominal aortic calcification (AAC). We enrolled 709 men with mean (s.d.) age 62.4 (8.6) (range 45-89) years. Lateral VFA images and scans of the lumbar spine and proximal femur were obtained using a GE Healthcare Lunar Prodigy densitometer. VFs were defined using a combination of the Genant semi-quantitative (SQ) approach and morphometry. VFA images were scored for AAC using a validated 24-point scale. VFA images showed that 68 (14.2%) of the participants had at least one grade 2/3 VF, 82% did not have any detectable AAC, whereas the prevalence of significant atherosclerotic burden, defined as an AAC score of ≥5, was 2.8%. The group of men with grade 2/3 VFs had a statistically significant higher AAC score and higher proportion of subjects with extended AAC, and lower weight, height and lumbar spine and hip BMD and T-scores than those without a VFA-identified VF. Multiple regression analysis showed that the presence of grade 2/3 VFs was significantly associated with BMI [odds ratio (OR 0.915; 95% CI 0.589, 0.975; P = 0.006], AAC score ≥5 (OR 4.509; 95% CI 1.505, 13.504; P = 0.007) and osteoporosis in any site (OR 5.159; 95% CI 3.116, 8.540; P ≤ 0.0001). In elderly men, extended AAC is an indicator of the increased risk for prevalent VFs regardless of age, BMI, history of fractures, smoking and BMD.