Presence Of Abdominal Aortic Calcification Research Articles

A cross-sectional study investigating the relationship between urinary albumin creatinine ratio and abdominal aortic calcification in adults.

The presence of abdominal aortic calcification (AAC) is strongly linked to the development of atherosclerosis and the incidence of morbidity and mortality related to cardiovascular diseases (CVD). Urinary albumin creatinine ratio (UACR) was found related with the increased risk of CVD. The aim of this study is to explore the relationship between the UACR and severe AAC (SAAC). This study included a total of 2,379 individuals aged over 40 years, and their information was obtained from the National Health and Nutrition Examination Survey conducted (NHANES) in 2013-2014. The measurement of AAC was conducted through dual-energy x-ray absorptiometry and assessed using the Kauppila scoring system. SAAC was characterized by a Kauppila score of 6 or higher. Multivariate regression models were used to analyze the relationship between UACR level and SAAC, with covariate adjustment. In the completely adapted model, the top third subgroup exhibits increased likelihood of SAAC (odds ratio 1.50; 95%CI: 0.98, 2.29; p = 0.030) in contrast to the bottom third subgroup. The subgroup analyses revealed a more pronounced correlation among the older participants (p-value for interaction = 0.013). In the United States, SAAC was more likely to occur in adults who had a higher probability of UACR. The use of UACR has the potential to be a valuable method for forecasting the likelihood of SAAC.

Abstract 18786: The Association Between Aortic Abdomen Calcification, Systemic Immune Inflammation Index, Estimated Pulse Wave Velocity, Atherogenic Index of Plasma and Triglyceride-Glucose Index Among Non-Diabetic Patients: A NHANES 2013-2014 Cross Sectional Study

Background: Not enough studies showed the predictive value of systemic immune inflammation (SII) index, estimated pulse wave velocity (EPWV) index, atherogenic index of plasma (AIP) and triglyceride glucose (TyG) index for developing abdominal aortic calcification (AAC). This study assesses the relationship between the previous indexes and the risk of AAC. Methods: National Health and Nutrition Examination Survey (NHANES) data was utilized. The study included data from 2013 to 2014. We included non-diabetic participants aged 18 years or older. All studied indexes were divided into four quartiles, except AIP, into two categories. SPSS was used for the analysis. The sensitivity and specificity of the included indexes in predicting AAC were calculated by receiver operating characteristic (ROC) analysis. We performed univariate and multivariate logistic regression to analyze the associated factors with higher values of studied indexes. Results: The analysis included 1315 non-diabetic patients, of which 324 had AAC, and 74 had severe AAC. Except for SII index, all indexes showed a statistically significant association with the presence of AAC (P < 0.05). AAC was more prevalent among patients in the third and fourth quartiles of all Triglyceride-Glucose Index models, p-value<0.05. Participants in the second quartile of the AIP were more likely to be affected by AAC, p-value<0.05. In addition, all unadjusted regression models showed that higher values of the inquired indexes were significantly associated with the risk of abdominal aortic calcification. The areas under the curve (AUC) for TyG index, AIP, and EPWV were 0.558 (95% CI 0.52-0.59), 0.551(95% CI 0.51- 0.58), 0.692 (95% CI 0.65- 0.72) (p-value ≤ 0.05), respectively. Conclusion: Among all involved indexes, the estimated pulse wave velocity index was the best indicator for abdominal aortic calcification.

Abdominal aortic calcification assessed on standard lateral lumbar radiographs as a screening tool for impaired bone status in spine surgery.

The aim of this study was to determine whether the presence of abdominal aortic calcification (AAC) can predict patient bone status, represented by volumetric bone mineral density (vBMD) assessed with quantitative computed tomography (QCT). Patients undergoing lumbar fusion surgery at a tertiary care center between 2014 and 2021, with a preoperative lumbar CT-scan and lateral lumbar radiographs were retrospectively reviewed. A semi-quantitative measurement method for AAC (AAC 4, 8 and 24) was performed. QCT measurements were made for L1 and L2. Patients were divided into two groups depending on whether AAC was present. A one-way analysis of covariance was conducted to adjust for age. A multiple linear regression model was used to test if age, sex, BMI, diabetes, hypertension, smoking and presence of AAC could predict the vBMD. A receiver operating characteristic (ROC) analysis was conducted for predicting impaired bone status. 267 patients with a median age of 65.1years and BMI of 29.8kg/m2 were analyzed, 59.6% of patients had AAC. The group comparison showed that vBMD was significantly lower in patients with the presence of AAC (97.8mg/cm3 vs. 121.5mg/cm3). Age (β = - 0.360; p < 0.001) and presence of AAC (β = -0.206; p = 0.005) significantly predict vBMD as independent variables. Impaired bone status could be discriminated using AAC 4, 8 and 24 (cut off value 0.5) with a sensitivity of 70.1% and a specificity of 60.2%. The presence of AAC may identify patients at risk for impaired bone status. Preoperative evaluation of standard lumbar radiographs could be used as a potential diagnostic tool in assessing bone status.

Association between healthy eating index-2015 and abdominal aortic calcification among US Adults.

To evaluate the relationship of the healthy eating index-2015 (HEI-2015) with abdominal aortic calcification (AAC) in US adults. We conducted a cross-sectional study with data extracted from the National Health and Nutrition Examination Survey (NHANES). AAC score was measured using the scoring system of Kauppila (AAC-24) and Schousboe (AAC-8). HEI-2015, which was used for evaluating compliance with Dietary Guidelines for Americans (DGA), was calculated through two rounds of 24-h recall interviews. HEI-2015 was categorized as inadequate (<50), average (50~70), and optimal (≥70) groups for analysis, while the AAC-24 score was grouped by whether the score was >0. Weighted multiple regression analyses were conducted to estimate the association of HEI-2015 with AAC score and the presence of AAC. Moreover, smooth curve fittings, based on a generalized additive model (GAM), were applied to evaluate a possible non-linear relationship. Sensitivity analysis and subgroup analysis were performed to provide more supporting information. A total of 2,704 participants were included in the study (mean age, 57.61 ± 11.40 years; 51.78% were women). The mean score of HEI-2015 was 56.09 ± 13.40 (41.33 ± 6.28, 59.44 ± 5.54, and 76.90 ± 5.37 for inadequate, average, and optimal groups, respectively). After adjusting for covariates, higher HEI-2015 was associated with decreased AAC score (AAC-24: β = -0.121, 95% CI: -0.214, -0.028, P = 0.010; AAC-8: β= -0.054, 95% CI: -0.088, -0.019, P = 0.003) and lower risk of AAC (OR = 0.921, 95% CI: 0.855, 0.993, P = 0.031). Among the components of HEI-2015, a higher intake of fruits, greens, and beans was associated with a lower AAC score. Subgroup analysis showed that an inverse association of HEI-2015 with AAC score existed among different groups. The study presented that higher HEI-2015 was related to a lower AAC score and decreased risk of having AAC, indicating that greater compliance with 2015-2020 DGA, assessed by HEI-2015, might be beneficial for preventing vascular calcification and CVD among US adults.

Impact of obesity on vascular calcification in patients with chronic kidney disease.

The aim of this study was to compare vascular calcification (VC) in obese and non-obese chronic kidney disease (CKD) patients, using three methods for measuring VC. The study included 168 consecutive patients with CKD. Patients were divided into two groups by body mass index (BMI) - group 1 (BMI ≥ 30 kg/m2) and group 2 (BMI < 30 kg/m2), and according to estimated glomerular filtration rate (eGFR) - subgroup A (eGFR < 45 mL/min/1.73m2) and subgroup B (eGFR < 45 mL/min/1.73m2). VC was assessed by measuring abdominal aortic calcification (AAC), ankle-brachial index (ABI) and echocardiography. Group 1 patients were older (p=0.03). There was a relatively low number of diabetics in our study cohort: 41 patients, (24%). The number of diabetics was similar in both groups. The presence of AAC was more common in 1B and 2B than in 1A and 2A groups (p=0.005 and p=0.02) and in 1B group compared to 2B group (p = 0.05). In both groups, ABI ≥ 1.3 and ABI < 0.9 were more common in B subgroups. The presence of heart valvular lesions was very high in both groups. Spearman rank-order analysis of every cohort demonstrated significant correlation between AAC and heart valve lesions (Spearman R=0.3; p=0.01) and also between AAC and LVH (Spearman R=0.3; p=0.004). Analysis of variance of every cohort showed that in patients with ABI ≥ 1.3 and heart valve lesions, Kauppila score was significantly higher than in those with normal heart valves. Our study shows that obesity is not an independent predictor of VC in CKD patients. VC, assessed by three different methods, was more pronounced in obese patients with lower kidney function.

Association between aortic calcification and the presence of kidney stones: calcium oxalate calculi in focus

PurposeThe current research is aimed at analyzing the relationship between kidney stone (KS) and abdominal aortic calcification (AAC) and the relationship between KS components and AAC.MethodsThis is a retrospective, case–control study. Kidney stone formers (KSFs) were treated at the Department of Urology, West China Hospital, Sichuan University for urological calculus disease from January 2014 to January 2020. Matched non-stone formers (non-SFs) were drawn from the same hospital for routine health examination from January 2018 to February 2019. Research-related information was collected and reviewed retrospectively from the hospital’s computerized records. AAC were evaluated using available results of computed tomography imaging and abdominal vascular ultrasound. The relationships of AAC between KSFs and non-SFs were compared. The composition of renal calculi was analyzed by Fourier-transform infrared spectrophotometer. KSFs were divided into AAC groups and non-AAC based on AAC. The relationship of the composition of renal calculi between AAC and non-AAC were compared. The independent-sample t test, the chi-squared test and binary logistics regression were performed.ResultsAltogether, 4516 people were included, with 1027 KSFs and 3489 non-SFs. There were no significant differences in the laboratory parameters between KSFs and non-SFs. The association between the presence of AAC and KS was significant in multivariable model 2 [adjusting hypertension, diabetes mellitus, fasting blood glucose, uric acid, serum triglyceride (TG), serum calcium, and urine pH] (OR 5.756, 95% CI 4.616–7.177, p < 0.001). The result of KSFs showed that calcium oxalate calculi (CaOx) was significantly associated with AAC in multivariable model 3 (adjusting age, hypertension, diabetes mellitus, drinking history, smoking history, and TG) (OR 1.351, 95% CI 1.002–1.822, p = 0.048).ConclusionsThe current study pioneered the revelation of the relationship between CaOx and AAC. Through an elimination of the confounding factors, the study demonstrated that KS and AAC were connected.

MO709ASSOCIATION BETWEEN SERUM ELASTIN-DERIVED PEPTIDES AND ABDOMINAL AORTIC CALCIFICATION IN PERITONEAL DIALYSIS PATIENTS: A CROSS-SECTIONAL STUDY

Abstract Background and Aims Peritoneal dialysis (PD) patients experience accelerated arterial aging, which is characterized by elastin degradation. Although elastin-derived peptides (EDPs) have been reported to be associated with vascular diseases, studies on the association between serum EDPs and abdominal aortic calcification (AAC) in PD patients remain limited. Method 126 eligible PD patients were included and first grouped by the presence of AAC by an abdominal computed tomography (CT) scan. Patients with AAC were then grouped into severer and non-severer group according to the annularity of calcification. Logistic regression analysis was conducted to analyze the association between EDPs and AAC or severer AAC. Nomograms were generated to evaluate individualized risk of AAC and severer AAC. Results Serum EDPs were significantly elevated in PD patients compared with healthy controls (interquartile ranges: 37.65-55.02 versus 24.23-39.20 ng/mL; p&amp;lt;0.001), and gradually increased as AAC worsens. Moreover, EDPs had the most excellent discriminatory power to differentiate AAC compared with other mineral metabolism markers. After adjustment for potential variables, higher EDPs were associated with greater risk of developing AAC (Odds ratio: 1.056, 95%CI: 1.010-1.103) and severer AAC (Odds ratio: 1.062, 95%CI: 1.004-1.123). Receiver operating curve analysis (ROC) revealed that a combination of EDPs substantially improved the accuracy of diagnostic performance for AAC and severer AAC. Nomogram demonstrated exceptional ability in recognizing PD patients with susceptibility to AAC or severer AAC. Conclusion Serum EDPs can predict the presence and severity of AAC in PD patients, indicating the possible roles to recognize PD patients at risk for developing AAC and severer AAC.

The relationship between vascular calcifications and urolithiasis in a large, multiethnic patient population.

Several studies have reported associations between vascular calcifications and urinary stone disease (USD). However, results have been inconsistent and the majority of studies did not report on race/ethnicity. We examined the association between vascular calcifications and USD in a large, racially/ethnically diverse patient population. We identified 672 USD cases and 672 controls (i.e., patients without a history of USD) from patients who underwent non-contrast CT imaging at Montefiore Medical Center in Bronx, NewYorkbetween 2004 and 2013. Controls were matched to cases on age, sex and race/ethnicity. The non-contrast CT imaging was used to measure abdominal aortic calcification (AAC) and calculate the AAC severity score. Logistic regression models were used to examine associations of AAC presence and severity score with risks of USD and stone types. Cases and controls had similar AAC prevalence (45.2% vs. 44.8%, p = 0.87), and AAC severity score (median 10 vs. 9.3, p = 0.47). The presence of AAC (OR= 0.98, 95% CI 0.78-1.23; p = 0.86) or AAC severity score were not associated with risk of USD: ORs of 0.96, 0.87, 1.07 and 1.03 for increasing AAC quartiles (p-trend = 0.54). There were also no associations in the stratified analyses by race/ethnicity or by sex. However, when USD patients were stratified by stone type, brushite/apatite stone formers had an inverse association with the lowest quartile of AAC severity score (OR= 0.35, 95% CI 0.11-0.84, p = 0.04) in comparison to patients without AAC. Overall, we found no association between vascular calcifications and risk of urinary stone disease in this large, hospital-based, case-control study.

P1273EFFECTS OF ABDOMINAL AORTIC CALCIFICATION PROGRESSION ON OUTCOMES IN MAINTENANCE HEMODIALYSIS PATIENTS

Abstract Background and Aims Vascular calcification is the risk factor for cardiovascular event, cardiovascular mortality and all-cause mortality in maintenance hemodialysis (MHD) patients. We investigated the effects of abdominal aortic calcification (AAC) progression on outcomes in MHD patients. Method 111 patients who were on MHD between Jun. 2014 and Oct. 2014 in the dialysis center and finished the AAC examination at baseline and two years later were included prospectively. We evaluated the progression of AAC by AAC score (AACs) at baseline and two years later. According to the change of AACs, the patients were divided into rapid AAC progression group (change of AACs&amp;gt;median) and non-rapid AAC progression group (change of AACs≤median). We investigated the effects of AAC progression on outcomes in MHD patients in the follow-up period. Kaplan-Meier analysis was used to compare their survival rate. Uni- and multivariable Cox proportional hazard regression models were used to determine the risk factors of all-cause mortality, cardiovascular mortality and cardiovascular events. Results The presence of AAC was 78.4% (87/111), rapid AAC progression was seen in 54 patients, and non-rapid AAC progression was seen in 57 patients. The mean follow-up duration was 27.9(27.1, 28.0) months. Kaplan-Meier analysis showed that patients in rapid AAC progression group had a higher risk of mortality as compared to patients in non-rapid AAC progression group (P=0.017). Multivariate Cox regression analysis demonstrated that high baseline AACs (HR=1.135, 95%CI∼1.001∼1.286, P=0.048), hypoproteinemia (HR=0.789, 95%CI 0.640∼0.972, P=0.026) were independent risk factors for all-cause mortality. High baseline AACs (HR=1.187, 95%CI 1.038∼1.356, P=0.012), low spKt/V (HR=0.103, 95%CI 0.013∼0.801, P=0.030) were independent risk factors for cardiovascular mortality. Low spKt/V (HR=0.018, 95%CI 0.003∼0.115, P=0.000), hypoproteinemia (HR=0.736, 95%CI 0.608∼0.890, P=0.002) were independent risk factors for cardiovascular events. Conclusion Abdominal aortic calcification progression may increase the risk of cardiovascular events and death in MHD patients. Severity of abdominal aortic calcification, adequacy of dialysis, and nutritional status are predictors of outcomes in MHD patients.

SUN-545 High Prevalence of Cardiometabolic Diseases and Abdominal Aortic Calcification in Psoriasis

Psoriasis has been shown to increase the risk of cardiovascular disease. Studies indicate that the presence of abdominal aortic calcification (AAC) is a strong predictor of future cardiovascular events and all-cause mortality. Multi-detector computed tomography provides a reliable and accurate method for the detection of abdominal aortic calcification. The aim of this study was to investigate the prevalence of AAC in patients with psoriasis. Adult psoriasis patients (n=69) and controls (n=80) were recruited from the Dermatology and Rheumatology clinics at 3 academic hospitals in Johannesburg, South Africa. Controls were matched for gender, ethnicity and body mass index (BMI). Non-contrast abdominal CT imaging was performed on patients and controls. The images were then assessed for presence and location (supra-coeliac, supramesenteric, supra-renal, proximal infra-renal, aortic bifurcation) of AAC. Patients had a mean age and disease duration of 53.3 ± 14.5 years and 18.9 ± 13.3 years, respectively. There was a significantly higher prevalence of smoking, hypertension and type 2 diabetes in patients compared to controls (56.5% vs 25.0%, P<0.005; 72.5% vs 55.0%, P<0.005; 24.6% vs 3.80%, P<0.0005, respectively). Furthermore, there was a significantly higher prevalence of AAC at any site in psoriasis patients (47.8% vs 22.5%, P<0.005). The aortic bifurcation was the commonest site for AAC in patients and controls, and the prevalence was significantly higher in the psoriasis group (42.0% vs 21.3%, p<0.005). However, multivariable logistic regression analysis demonstrated that age, smoking and the metabolic syndrome were significantly associated with AAC (P<0.0001, P=0.0002, P=0.027 respectively) and attenuated the relationship between psoriasis and AAC to non-significance (P=0.376). This suggests the increased risk of aortic calcification in psoriasis is mediated by the high prevalence of cardiometabolic disease in this population. These data highlight the increased cardiovascular disease risk within subjects with psoriasis and the need for lifestyle modification to decrease risk factor burden.

Bone status and aortic calcifications in chondrocalcinosis patients

Abstract Aim: We aimed to examine the association between several circulating bone turnover markers [ osteocalcin (OC), osteoprotegerin (OPG), beta-CrossLaps (β-CTx)], hip and spine bone mineral density (BMD) and abdominal aortic calcification (AAC) in patients with chondrocalcinosis (CC). Methods: Thirty-six patients with CC and thirty-seven controls were consecutively enrolled in this pilot case-control, cross-sectional study. The following parameters were assessed: serum levels of OC, OPG and β-CTx by enzyme-linked immunosorbent assay (ELISA); hip and spine BMD by dual-energy X-ray absorptiometry and AAC score by lateral radiography. Results: Patients with CC had higher levels of serum bone turnover markers and AAC score than the control group: OC [6.5 (3.5-9.9) vs 4.5 (2.6-7.2) ng/ml; p=0.05], OPG [(7.7 (6.2-9.4) vs 6.5 (5.5-8.12) pmol/ml; p=0.02], β-CTx [6078 (5870-6171) vs 5851 (5465-6109) pg/ml; p=0.02] and AAC score (3.6±6.2 vs 0.5±2; p=0.006). Conversely, even if statistical significance was not reached, hip and spine BMD was lower in patients with CC. Additionally, we found a positive correlation between OPG and AAC, but also between OPG and osteoporosis in patients with CC. Conclusion: Patients with CC are characterized by higher circulating OC, OPG and β-CTx. The presence of AAC was more common in patients with CC, being only associated with serum OPG.

SUN-101 PREVALENCE AND CORRELATES OF CARDIOVASCULAR CALCIFICATION AND ITS PROGNOSTIC EFFECTS AMONG PATIENTS WITH CHRONIC KIDNEY DISEASE: RESULTS FROM THE C-STRIDE STUDY

Cardiovascular calcification is highly prevalent in patients with chronic kidney disease (CKD) and is predictive of cardiovascular disease (CVD). To date, most studies have focused on Abdominal aortic calcification (AAC) and cardiac valve calcification (CVC) found in dialysis patients. However, information regarding AAC and CVC in non-dialysis CKD patients is limited. We hypothesized that there is a close association between vascular calcification and the prognosis of non-dialysis CKD patients. To test this hypothesis, we conducted a multicenter prospective study to identify the characteristics and risk factors associated with cardiovascular calcification, and its relationship to prognosis, in patients with CKD stages 1 to 4. The C-STRIDE is an ongoing multicenter prospective study lead by the Peking University First Hospital that includes 39 clinical centers located in 28 cities in 22 provinces of China. It strictly adhered to the Helsinki declaration, and all participants signed written informed consent. Cardiovascular calcification was evaluated at baseline by lateral abdominal radiography to detect aortic calcifications, and by echocardiogram to detect valvular calcifications, respectively. We prospectively followed up over more than five years with 3168 CKD patients in the C-STRIDE study. Demographic and laboratory data were collected and analyzed. Among 3168 patients from the C-STRIDE study, a subgroup of 2235 patientswas selected to undergolateral abdominal radiography and a second subgroup of 2756 patients was selected toundergoechocardiography. AAC was present in 206 patients (9.22%) and CVC was present in 163 patients (5.91%). Age, gender, history of CVD, smoking, hypertension, diabetes, levels of hemoglobin, low-density lipoprotein cholesterol and uric acid were associated with presence of AAC, while only age, history of CVD, levels of serum albumin and low-density lipoprotein cholesterol were associated with presence of CVC (all p-values<0.05) (Table 1 & 2). Survival analyses showed that cardiovascular events and all-cause mortality were significantly greater in patients with AAC or with CVC (all p-values for log-rank tests<0.05) (Table 3 & 4). However, there is no significant associations between presence of AAC or CVC and the outcomes in the multivariable Cox regression analysis after adjustment for age and sex. Demographic and traditional cardiovascular risk factors were associated with cardiovascular calcification, especially AAC. However, the presence of cardiovascular calcification cannot predict the future risk of cardiovascular events in the current study.

Study of serum sclerostin levels and its role in vascular calcification in patients with chronic kidney disease

ObjectiveThe aim of this work was to study serum sclerostin levels in patients with chronic kidney disease (CKD) not on dialysis and those on regular hemodialysis and its role in vascular calcification.BackgroundCKD, whether starting hemodialysis (HD) or not, is associated with an increase in the risk for vascular calcification, which can only be partially explained by known classical risk factors. Sclerostin is an osteocyte-derived inhibitor of the Wnt pathway and has been shown to play a key role in vascular calcification in patients with CKD.Patients and methodsThis cross-sectional study was carried out on 80 patients with CKD attending Menoufia University Hospital. Patients were classified into 40 patients with CKD who were not on HD (group I) and 40 patients with CKD on regular HD more than 6 months (group II), who were compared with 15 controls (group III). Abdominal aortic calcification (AAC) was assessed using lateral lumbar radiography. Echocardiography was used to assess aortic valve calcification (AVC) calcification. Patient’s basic clinical and biochemical data were recorded. Serum sclerostin level was measured using commercially available enzyme-linked immunosorbent assay kits.ResultsSclerostin levels among the patients with CKD on HD (116.8±0.103.69 Pmol/l) was significantly higher than that of CKD predialysis group (28.63±0.36.26 Pmol/l), which in turn was statistically higher than control group (6.6±0.2.9 Pmol) (P=0.000). AAC was observed in 16 (40%) patients in CKD predialysis group, whereas in CKD on HD group, 26 (65%) patients had AAC. AVC was observed in 14 (35%) patients in CKD predialysis group, whereas in CKD on HD group, 21 (52.5%) patients had AVC. Using binary regression analysis, sclerostin was identified as an independent predictor for the presence of AAC (OR: 1.017; P=0.000) and AVC (OR: 1.013; P=0.001) in patients with CKD.ConclusionPatients with CKD (predialysis and on HD) exhibit an increase in sclerostin levels. Sclerostin expansion correlated positively with vascular and valvular calcification. Sclerostin is an independent risk factor for heart valve calcification and AAC in patients with CKD.

OR13-6 Hyperparathyroidism and Abdominal Aortic Calcification in Older African American Women: PODA Trial

Background: Abdominal aortic calcification (AAC) detected on lateral vertebral fracture assessment (VFA) images have shown to be independently associated with increased cardiovascular risk and mortality. Vitamin D deficiency and toxicity have also been linked with vascular calcification. Objective: The objective of this study is to determine the natural progression of AAC in older African American (AA) women. We also wanted to evaluate the relationship between bone mineral markers and AAC. Methods: The study of relationship of Physical performance, Osteoporosis prevention with Vitamin D in older African Americans (PODA) is a randomized, double-blind, placebo-controlled 3-year trial examining the effect of vitamin D on bone loss and physical performance in 260 healthy AA women with mean age of 68.2 (65.4-72.5). Serum 25(OH)D levels were maintained above 75 nmol/l in the active group. We studied VFA images and assessed AAC using the Kauppila score(1). The scores were obtained separately for the anterior and posterior walls of L1-4 vertebrae, resulting in a range from 0 to 6 at each vertebral level and 0 to 24 for the total score. We used the antero-posterior severity score (AAC24) to report composite calcification scores and prospectively collected data annually for the PODA study participants over the course of 3 years. AAC24 cut off score of =>5 has shown to be associated with higher (2.4fold) cardiovascular mortality. Results: There were 14.7%(16/109) subjects with presence of AAC (calcification score>0) in the vitamin D group compared to 12.1%(14/116) in the placebo group. Prevalence of extended AAC (AAC24 score>=5) at baseline was 6.4%(7/109) in the vitamin D group and 3.5%(4/116) in the placebo group. At 36 months, the prevalence was 12.7%(9/71) in the vitamin D group and 6.9%(5/73) in the placebo group. The extended calcification scores (AAC24 score >=5) over time were not different in the vitamin D group compared to the placebo group (p-value for time and group interaction was 0.654). We found no association between AAC and serum creatinine, serum calcium, serum 25(OH)D, beta-crosslaps, and bone specific alkaline phosphatase. Interestingly, we found that as PTH increased over time, the odds of calcification (AAC >=5) also increased (p-value for time and PTH interaction was 0.009). Conclusion: Our study showed that a significant positive association exists between PTH and AAC independent of age and treatment group. In contrast to prior observational studies, we found no significant association between vitamin D status and rates of progression of AAC in older AA women.

Longitudinal changes in bone mineral density, bone mineral content and bone area at the lumbar spine and hip in postmenopausal women, and the influence of abdominal aortic calcification

Longitudinal studies often report that spine bone mineral density (BMD), measured by DXA, is stable in older adults, which has been attributed to osteophyte development and the presence of aortic calcification. A decline in projected spine area as a result of loss of intervertebral disc height might also contribute to higher BMD. We utilised data from 297 postmenopausal women (mean 73 years) who had DXA measurements of the lumbar spine, total hip and femoral neck 5 years apart, and abdominal aortic calcification scoring from vertebral morphometry. BMD declined by −4.4% at the total hip and −3.9% at the femoral neck (p < 0.001), but did not change at the spine (−0.5%, p = 0.12). In contrast, bone mineral content (BMC) declined by −4.0% at the total hip, −2.5% at the femoral neck and −1.7% at the spine (all p < 0.001). Bone area increased by 0.5% at the hip and 1.6% at the femoral neck but declined by −1.2% at the spine (all p < 0.001). 43% of the cohort had abdominal aortic calcification (AAC) present at baseline. The presence of AAC at baseline was not related to changes in BMD or BMC at the total hip or femoral neck, nor to BMD at the spine. However, women with AAC present had a smaller loss of BMC at the spine than those without (−0.8% versus −2.4%, p = 0.03). AAC score increased more over 5 years among those with AAC at baseline than those without (0.28 versus 0.16, p = 0.036). Thus, the stability of spine BMD is the result of both a loss of projected bone area (as a result of intervertebral disc changes and/or a decrease in projected area of the vertebral bodies) and the effects of aortic calcification. Future clinical trials should consider assessing changes in spine BMC as a more informative index of spine mineral status.

The association of serum adiponectin with abdominal aortic calcification in Japanese male hemodialysis patients: a cross-sectional observational study

The negative relation of serum adiponectin to atherosclerosis becomes a positive association in patients with chronic kidney disease (CKD). We conducted a small-scale cross-sectional observational study, in 101 Japanese male hemodialysis patients, to examine the relationship of serum adiponectin and leptin to abdominal aortic calcification (AAC). The presence of AAC was evaluated from simple X-ray radiographs of the left lateral abdomen. Serum adiponectin was significantly higher in AAC-positive patients [18.8 (13.0–28.1) μg/mL] than in AAC-negative patients [15.4 (8.9–22.8) μg/mL] (p = 0.03), whereas serum leptin did not differ significantly between the two groups. Multiple logistic regression analysis showed that log adiponectin, but not log leptin, was independently and significantly associated in a positive manner with AAC (odds ratio: 16.31, 95% confidence interval: 1.70–156.41, p = 0.02), after adjustment for age, body weight, percentage body fat, hemodialysis duration, prevalence of diabetes mellitus, and other risk factors. In conclusion, we found a positive and independent association of serum adiponectin with AAC in male hemodialysis patients, indicating that the reversed association between serum adiponectin and atherosclerosis in patients with CKD dose not result from increased serum adiponectin due to the impaired urinary secretion.

Vascular Disease and Kidney Stones: Abdominal Aortic Calcifications Are Associated with Low Urine pH and Hypocitraturia.

Vascular calcifications are associated with nephrolithiasis. Although studies have demonstrated correlations with vascular disease and calcium stones in kidney stone formers (KSF), an etiologic link has remained elusive. As a noncontrast CT (NCCT) scan is typically part of a stone evaluation, our objective was to evaluate the association of NCCT-based assessment of abdominal aortic calcifications (AACs) with 24-hour urine parameters and stone composition. Ninety-seven KSF were included with CT imaging and 24-hour urine studies. For each patient, semi-automated CT software was utilized to provide an AAC Agatston score from the celiac axis to the aortic bifurcation. Univariate analysis was performed to compare patients with or without AAC. Multivariate logistic regression was performed to assess for variables associated with 24-hour urine parameters and stone composition. The presence of AAC was associated with hypertension, diabetes, peripheral vascular disease, and coronary artery disease. Patients with any AAC showed lower 24-hour urine citrate (399 vs 593 mg/day, p < 0.001) and lower 24-hour urine pH (5.862 vs 6.328, p = 0.003). When controlling for age, system comorbidities, the presence of AAC was associated with low urine pH <6 (odds ratio [OR] 2.86, p = 0.032) and hypocitraturia <320 mg/day (OR 4.37, p = 0.005). The receiver operating characteristic curve showed that increasing AAC was associated with low urine pH (area under the curve [AUC] 0.683, p = 0.002) and uric acid stone formation (AUC 0.698, p = 0.045). NCCT-based diagnosis of AAC is associated with low urine pH, hypocitraturia, and uric acid stone formation. The presence of AAC could be considered an additional prognosticator for the utility of alkalinization therapy.

Vitamin D status and abdominal aortic calcification in postmenopausal women.

Vitamin D has an important role in bone metabolism and may be involved in the process of vascular calcification. The objective of this study was to evaluate the effect of vitamin D status on the presence of abdominal aortic calcification (AAC). We enrolled, in a cross-sectional study, 429 postmenopausal women [mean age, weight, and BMI of 59.5±8.3 (50-83) years, 75.8±13.3 (35-165) kg, and 29.9±5.2 (14.6-50.8) kg/m2, respectively]. Lateral vertebral fracture assessment (VFA) images and scans of the lumbar spine and proximal femur were obtained using a Lunar Prodigy densitometer. Vertebral fractures (VFs) were defined using the Genant semiquantitative (SQ) approach. We used the Kauppila score to assess AAC extension. Clinical risk factors of osteoporosis were collected, and 25-hydroxy vitamin D was measured using electrochemiluminescence (Roche). Prevalence of osteoporosis and hypovitaminosis D (<20ng/ml) was 21.0% and 78.1%, respectively. VFs grade 2/3 were identified in 76 patients (17.7%). Two thirds of the evaluable participants did not have any detectable AAC. The prevalence of significant atherosclerotic burden, defined as a radiographic 24-point AAC score of 5 or higher, was 7.9%. The group of women with extended AAC were older and had a statistically significant higher menopause duration and more prevalent grade 2/3 VFs. Compared to women with normal values of vitamin D, women with vitamin D insufficiency (<20ng/ml) and deficiency (<10ng/ml) had a lower BMD and more prevalent VFs. No difference was noted with regard to AAC among the three groups. Multiple stepwise conditional logistic regression analysis showed that the presence of AAC was associated significantly with age and the presence of VFs. Extended aortic calcifications are independently associated with prevalent VFA-identified VFs but not with serum vitamin D levels in postmenopausal women. VFA imaging using DXA may detect at the same time prevalent VFs and AAC, an important cardiovascular disease risk factor.

Mineral and Bone Disorder and Its Association with Cardiovascular Parameters in Chinese Patients with Chronic Kidney Disease.

Background:Mineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.Methods:Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients’ entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.Results:Altogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml·min−1.1.73 m−2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.Conclusions:In Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Impact of abdominal aortic calcification on long-term cardiovascular outcomes in patients with chronic kidney disease

BackgroundThe presence of abdominal aortic calcification (AAC) can predict cardiovascular (CV) outcomes in hemodialysis patients. However, little is known about the predictive value of AAC for CV outcomes in chronic kidney disease (CKD) patients without hemodialysis. The aim of this study was to investigate the prevalence and the predictive value of AAC in asymptomatic CKD patients. MethodsWe prospectively evaluated 347 asymptomatic CKD patients without hemodialysis [median estimated glomerular filtration rate (eGFR): 43.2 mL/min/1.73 m2]. A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) as a semi-quantitative measure of AAC. The patients were divided into three groups according to the tertiles of ACI. ResultsAmong the subjects, AAC was found (ACI > 0) in 296 patients (86.3%), and the median ACI was 11.4%. During the median follow-up of 41.5 months, a total of 33 CV events were observed. Patients with the highest tertile of ACI had the highest risk of CV outcomes compared with the other two groups (96.5%, 93.0%, and 74.3%, respectively; p < 0.001). The Cox proportional hazard models showed that ACI was an independent predictor of CV outcomes (hazard ratio 1.36, 95% confidence interval 1.17–1.60, p < 0.001). The C-index was also significantly increased by adding eGFR and ACI values to the model along with the other conventional risk factors (0.79 versus 0.66, p = 0.043). ConclusionEvaluation of the AAC provides useful information for predicting adverse clinical outcomes among asymptomatic CKD patients without hemodialysis.