Severity Of Abdominal Aortic Calcification Research Articles

Systematic evaluation of abdominal aortic calcification in patients with a recent clinical fracture visiting the Fracture Liaison Service.

Abdominal aortic calcification (AAC) is associated with an increased risk of cardiovascular disease (CVD), osteoporosis and fractures. We aimed to analyze the prevalence and severity of AAC and to assess whether index fracture location, bone mineral density (BMD) and prevalent VFs are associated with AAC in patients with a recent fracture. Cross-sectional cohort study of patients with a recent clinical fracture (aged 50-90years) attending the FLS. Patients received a BMD measurement and lateral spine imaging using Dual-energy X-ray absorptiometry. AAC prevalence was assessed using the AAC-24 score and categorized as none, moderate (AAC-24 1-4) and severe (AAC-24 ≥ 5). Multivariate logistic regression analyses were performed to study the association between risk factors and AAC presence/ severity. AAC was present in 478 (27.6%) of 1731 patients of whom 207 (43.3%) had moderate and 271 (56.7%) severe AAC. The presence of AAC was associated with age, BMI, smoking, history of CVD and prevalent grade 2 or 3 VFs, but index fracture location and BMD were not associated with AAC or severe AAC. In patients with AAC (n = 318) without a history of CVD, there was no association between index fracture location and BMD. In that subgroup, severe AAC was not associated with prevalent VFs. In FLS patients, the prevalence of AAC and severe AAC was 27.6% and 15.7%. Index fracture location and BMD were not associated with AAC or severe AAC. Prevalent VFs were associated with AAC, but not with severe AAC in the subgroup of patients without CVD.

Association between Ward's triangle bone mineral density levels and abdominal aortic calcification: Data from the national health and nutrition examination survey 2013–2014

BACKGROUND & AIMSDespite extensive research into the cardiovascular implications of abdominal aortic calcification (AAC), there is a scarcity of robust studies exploring its association with Ward's triangle bone mineral density (BMD). This study aimed to evaluate this relationship in a nationally representative sample and compare the predictive value with femoral neck BMD and total femur BMD. METHODSWe conducted a cross-sectional analysis of 2013-2014 National Health and Nutrition Examination Survey (NHANES) data, utilizing a complex, stratified, multistage, cluster sampling design. BMD measurements at Ward's triangle, femoral neck, and total femur were assessed using DXA scans. AAC severity was defined by a Kauppila score of ≥5. Predictors of AAC-24 scores were identified through correlation and linear regression models. Stratified regression and restricted cubic splines were applied to explore subgroup and dose-response relationships. RESULTSOf the 2,965 participants representing 116,562,500 individuals in the U.S., 11% had severe AAC. Ward's triangle BMD showed a significant negative association with AAC-24 scores (β = -1.90, 95% CI: -2.80 to -1.00, P < 0.002) and a reduced risk of severe AAC (OR = 0.85, 95% CI: 0.76 to 0.95, P = 0.010). Non-linear associations were observed between Ward's triangle BMD and AAC outcomes. Ward's triangle BMD outperformed femoral neck and total femur BMD in predicting AAC. CONCLUSIONSHigher Ward's triangle BMD is linked to lower odds of severe AAC, highlighting its potential for improved early detection of AAC over femoral neck and total femur BMD. Healthcare providers should consider the implications of reduced Ward's triangle BMD for systemic atherosclerosis and recommend early AAC screening for enhanced cardiovascular risk management.

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Vascular calcification in kidney stone formers: the impact of age and stone composition.

An increased prevalence of vascular calcification (VC) has been reported in kidney stone formers (KSFs), along with an elevated cardiovascular risk. The aim of the current study is to assess whether VC in these patients develops at a younger age and is influenced by stone composition. This single-center, matched case-control study included KSFs with uric acid or calcium oxalate stones (diagnosed based on stone analysis) and age- and sex-matched controls without a history of nephrolithiasis. The prevalence and severity of abdominal aortic calcification (AAC) and bone mineral density (BMD) were compared between KSFs and non-KSFs. In total, 335 patients were investigated: 134 with calcium oxalate stones, 67 with uric acid stones, and 134 controls. Overall, the prevalence of AAC was significantly higher among calcium stone formers than among the controls (67.9% vs. 47%, p = 0.002). In patients under 60 years of age, those with calcium oxalate stones exhibited both a significantly elevated AAC prevalence (61.9% vs. 31.3%, p = 0.016) and severity (94.8 ± 15.4 vs. 30.3 ± 15.95, p = 0.001) compared to the controls. Within the age group of 40-49, osteoporosis was identified only in the KSFs. Multivariate analysis identified age, smoking, and the presence of calcium stones as independent predictors of AAC. This study highlights that VC and osteoporosis occur in KSFs at a younger age than in non-stone-formers, suggesting potential premature VC. Its pathogenesis is intriguing and needs to be elucidated. Early evaluation and intervention may be crucial for mitigating the cardiovascular risk in this population.

Association between Abdominal Aortic Calcification and Coronary Heart Disease in Essential Hypertension: A Cross-Sectional Study from the 2013-2014 National Health and Nutrition Examination Survey.

This study aimed to investigate the association between abdominal aortic calcification (AAC) and coronary heart disease (CHD) in essential hypertension (EH). This study included patients diagnosed with EH during the 2013-2014 NHANES survey cycle. The study cohort was categorized into the following four groups based on their AAC-24 score: no AAC (0); mild AAC (1-4); moderate AAC (5-15); and severe AAC (16-24). Logistic regression models were used to assess the association between AAC and CHD. Restricted cubic spline curves (RCS) were used to explore possible nonlinear relationships between AAC and CHD. The prevalence of CHD was found to be higher in the moderate AAC and severe AAC groups than in the group without AAC (40.1% versus 30.9%, 47.7% versus 30.9%). On a continuous scale, the fully adjusted model showed a 7% increase in the risk of CHD prevalence per score increase in AAC [OR (95% CI) = 1.07 (1.03-1.11)]. On a categorical scale, the fully adjusted model showed the risk of CHD prevalence in EH patients with moderate AAC and severe AAC was 2.06 (95%CI, 1.23-3.45) and 2.18 (1.09-5.25) times higher than that in patients without AAC, respectively. The RCS curve suggested a dose-response linear relationship between AAC and CHD. These findings highlight that in patients with EH, a higher severity of AAC is associated with a higher risk of CHD prevalence.

Modic Changes in the Lumbar Spine: Exploring Their Association with Abdominal Aortic Calcification as a Potential Indicator of Systemic Atherosclerosis

Study DesignCross-sectional study on the correlation between abdominal aortic calcification (AAC) and Modic changes (MC). ObjectiveTo investigate whether AAC, a marker for a poor vascular status, is associated with MC in patients suffering from degenerative disc disease. Summary of Background DataLittle is known regarding the etiology of MC in the lumbar spine. Currently, insufficient vascularization of the endplate has been proposed to contribute to the appearance of MC. MethodsRadiological images of patients (n=130) suffering from degenerative lumbar disc disease were reviewed. Type and severity of MC were assessed using MR images, and severity of AAC was evaluated using CT images or fluoroscopy. Both items were dichotomized into minimal and relevant grades. The correlation between them was studied using Spearman’s correlation test, with age as a covariate. ResultsOf the patients, 113 (87%) demonstrated MC (31% type I, 63% type II, and 6% type III) (55% relevant grade), and 68% had AAC (44% relevant grade). Spearman statistical analysis revealed that AAC was correlated with age (p<0.001), whereas MC were not (p=0.142). AAC severity was significantly correlated with MC, remaining so after age adjustment (p<0.05). While MC type I lacked correlation with AAC, MC type II were significantly correlated with AAC (0.288, P=0.015); however, this association lost significance after adjusting for age (P=0.057). ConclusionAAC and MC (mainly MC type II) are associated, indicating that reduced blood supply or even a poor systemic vascularization status due to atherosclerotic disease may play a role in the formation of MC. Future studies focusing on the etiology of MC should pay more attention to patients’ vascular status and determinants of abdominal aorta calcification.

Automatic Segmentation and Quantification of Abdominal Aortic Calcification in Lateral Lumbar Radiographs Based on Deep-Learning-Based Algorithms.

To investigate the performance of deep-learning-based algorithms for the automatic segmentation and quantification of abdominal aortic calcification (AAC) in lateral lumbar radiographs, we retrospectively collected 1359 consecutive lateral lumbar radiographs. The data were randomly divided into model development and hold-out test datasets. The model development dataset was used to develop U-shaped fully convolutional network (U-Net) models to segment the landmarks of vertebrae T12-L5, the aorta, and anterior and posterior aortic calcifications. The AAC lengths were calculated, resulting in an automatic Kauppila score output. The vertebral levels, AAC scores, and AAC severity were obtained from clinical reports and analyzed by an experienced expert (reference standard) and the model. Compared with the reference standard, the U-Net model demonstrated a good performance in predicting the total AAC score in the hold-out test dataset, with a correlation coefficient of 0.97 (p <0.001). The overall accuracy for the AAC severity was 0.77 for the model and 0.74 for the clinical report. Additionally, the Kendall coefficient of concordance of the total AAC score prediction was 0.89 between the model-predicted score and the reference standard, and 0.88 between the structured clinical report and the reference standard. In conclusion, the U-Net-based deep learning approach demonstrated a relatively high model performance in automatically segmenting and quantifying ACC.

Accelerated Bone Loss in Older Men With Severe Abdominal Aortic Calcification-the Prospective MINOS Study.

Data on the association between the severity of abdominal aortic calcification (AAC) and bone loss are discordant. Our aim was to assess the association between baseline AAC and prospectively assessed bone loss in older men. This prospective cohort study started in 1995 (MINOS). Men aged 50 to 85 years (n = 778) had AAC assessed on the lateral radiograph of the spine using Kauppila's semiquantitative score and was followed prospectively for 7.5 years. Bone mineral density (BMD) and bone mineral content (BMC) were measured by dual-energy x-ray absorptiometry every 18 months. Statistical analysis was performed using linear mixed models. In comparison to men without AAC (AAC = 0), severe AAC (>6) was associated with more rapid bone loss at the total hip (-0.62 ± 0.06 vs -0.32 ± 0.04%/year; P < .001), trochanter, and distal forearm (-0.72 ± 0.06 vs -0.45 ± 0.03%/year; P < .001). The highest decile (AAC >10) was associated with more rapid bone loss at the femoral neck, whole body, and ultradistal radius (-0.86 ± 0.12 vs -0.34 ± 0.05%/year; P < .001). The results were similar for BMD and for BMC. The patterns were similar in sensitivity analyses (eg, after excluding men with abdominal obesity, after excluding current smokers, after excluding men with ischemic heart disease or with diabetes mellitus, after excluding men with abnormal concentrations of lipids, bioavailable 17β-estradiol or 25-hydroxycholecalciferol, after excluding men with glomerular filtration rate <60 mL/min). Severe AAC is associated with faster bone loss in older men and may contribute to the higher fracture risk observed in this population.

Coffee consumption and abdominal aortic calcification among adults with and without hypertension, diabetes, and cardiovascular diseases

Background and aimsThis study was performed to investigate the effect of coffee consumption on abdominal aortic calcification (AAC) among adults with and without hypertension, diabetes, and cardiovascular diseases (CVD). Methods and resultsA total of 2548 participants from the National Health and Nutrition Examination Survey (NHANES) 2013–2014 were included. Coffee consumption was obtained from 24-h dietary recalls. Dual-energy X-ray absorptiometry (DXA) was used to measure the severity of AAC. In the fully adjusted model, compared with non-drinkers, high coffee consumption (≥390 g/d) was associated with higher AAC scores among participants with hypertension (β = 0.72, 95% CI: 0.21–1.22), diabetes (β = 1.20, 95% CI: 0.35–2.05), and CVD (β = 2.03, 95% CI: 0.71–3.36). We did not observe such an association among participants without hypertension, diabetes, and CVD. Furthermore, decaffeinated coffee was not associated with AAC. ConclusionIn conclusion, patients with hypertension, diabetes, and CVD should focus on coffee consumption, especially caffeinated coffee, to reduce the burden of AAC.

Clinical study on the correlation between monocyte-related ratios and calcification of the abdominal aorta in peritoneal dialysis patients.

We aimed to investigate the relationship between monocyte/lymphocyte ratio (MLR) and monocyte/high-density lipoprotein ratio (MHR) with abdominal aortic calcification (AAC) in patients on peritoneal dialysis (PD). The time-averaged (TA) of relevant indexes and AAC scores (AACs) of 160 eligible patients were measured. Patients divided into the new AAC (n=57) and the other without (n=82). High TA-MLR (OR=110.537, p=0.018) and long duration of dialysis (OR=1.045, p < 0.001) were independent risk factors of the new AAC. Patients divided into the no AAC (n=82), the moderate-to-severe AAC (n=26), and the mild AAC (n=52). High TA-MLR (OR=42.649, p=0.032), high age at starting PD (OR=1.055, p < 0.001), and long duration of PD (OR=1.036, p < 0.001) were independent risk factors of AAC severity. MLR is an independent risk factor for the occurrence and severity of AAC and its value for the assessment of AAC is better than MHR.

Abdominal aortic calcification score can predict all-cause and cardiovascular mortality in maintenance hemodialysis patients

Purpose Abdominal aortic calcification (AAC) assessed by using standard lateral lumbar radiographs can be graded, and composite summary scores (range, 0–24) have been shown to be highly predictive of subsequent cardiovascular morbidity and mortality in hemodialysis (HD) patients. However, few studies have sought to determine the optimal AAC score cutoff values for the prediction of mortality among HD patients. Methods This retrospective cohort study included 408 hemodialysis patients. AAC severity was quantified by the AAC score, which was measured by lateral lumbar radiography with complete follow-up data from January 2015 to December 2021. We used receiver operating characteristic (ROC) analysis to find the cutoff AAC value for the prediction of mortality. The Kaplan–Meier method was used to analyze all-cause and cardiovascular mortality. Results The cutoff calcification score for the prediction of mortality was 4.5 (sensitivity, 67.3%; specificity, 70.4%). The patients with AAC scores above 4.5 had significantly higher all-cause (log-rank p < 0.001) and cardiovascular (log-rank p < 0.001) mortality rates than those with AAC scores below 4.5. In the multivariate regression analyses, an AAC score above 4.5 was a significant factor associated with all-cause mortality (HR: 2.079, p = 0.002) and cardiovascular mortality (HR: 2.610, p < 0.001). Conclusions AAC is a reliable aortic calcification marker. HD patients with an AAC score > 4.5 have significantly elevated all-cause and cardiovascular mortality compared with those with an AAC score ≤ 4.5. AAC was a better predictor than cardiac valve calcification for mortality in HD patients.

Abdominal aortic calcification as prognostic marker in continuous ambulatory peritoneal dialysis.

Patients with chronic kidney disease (CKD) on dialysis are at high risk of cardiovascular complications and mortality. We investigated the prognostic role of presence and severity of abdominal aortic calcification (AAC) detected by a simple lateral lumbar X-ray as a risk marker in CAPD. A prospective study was undertaken in 45 patients on CAPD (continuous ambulatory peritoneal dialysis). Lateral lumbar films of consented patients were checked for the presence of AAC at the level of L1-L4 lumbar vertebrae. The severity of aortic calcification was graded as per Antero-Posterior Severity Score (APSS). These APSS grades were correlated with the patient's demographic, biochemical, and echocardiographic findings. The patients were followed up prospectively for one year. 45 patients formed the study group. Mean standard deviation (SD) age and body mass index (BMI) were 57.2 (11.9) years and 25.8 (4.7) kg/m2, respectively. Males constituted 62% of the cohort. Average duration of dialysis was 34.3 months. Diabetic kidney disease was seen in 75%. The prevalence of AAC was 47%. AAC was positively correlated with age of patient (r=0.378; p=0.01). No correlation with BMI, diabetes, hypertension, dialysis vintage, serum calcium, phosphorus, and PTH was seen; whereas a trend towards negative correlation with alkaline phosphatase was seen. Mitral valve calcification had a significant association with APSS severity. Patients with severe APSS (≥4) had poor survival, with an average survival of 37 months (Log-rank test p=0.026). ROC analysis showed that APSS 3 predicted 1-year mortality with a specificity of 89% and sensitivity of 62% (AUC=0.73) (p=0.007). Abdominal aortic calcification was present in 47% of our CAPD patients. A simple lateral pelvic skiagram can be utilized as a cost-effective tool in prediction of All-cause mortality and cardiac valvular calcification.

High rate of abdominal aortic calcification in COPD patients and its relationship with musculoskeletal fragility.

Osteoporosis, sarcopenia, and cardiovascular disease are frequent comorbidities in COPD. Considering routine x-ray as a simple tool to access vertebral fractures and vascular calcification, the rate and severity of abdominal aortic calcification (AAC) and its association with musculoskeletal outcomes were investigated in COPD patients. Ninety-six COPD patients (44 men and 52 women, 65.8 (51-83) and 64.3 (44-85) years-old, respectively) underwent spirometry, laboratory workout, bone mineral density (BMD) measurements with body composition analysis, and thoracolumbar spine radiography. Vertebral fractures (VFs) and AAC were defined using Genant semiquantitative approach and Kauppila score, respectively. Densitometric osteoporosis and VFs grades 2-3 were detected in almost 40% and 23% of the participants, respectively. Two-thirds of the participants had AAC ≥ 1 while significant atherosclerotic burden (extended AAC, Kauppila score ≥ 5) was seen in 40.6% of the sample. Women with significant atherosclerotic burden were older (P = 0.044) and had lower femoral neck BMD (P = 0.012) when compared to those with an AAC score < 5. Multivariate logistic regression analyses showed that body fat tended to be associated with increased odds of extended AAC in men (OR = 1.06, 95% CI 0.99-1.13, P = 0.099) while femoral neck BMD (0.01g/cm2) was found to be significantly associated with extended AAC in women (OR = 0.95, 95% CI 0.92-0.99; P = 0.018). COPD patients present a very high rate of AAC and its extended phenotype. Easily measured by conventional spine radiography, AAC severity in women with COPD is associated with low bone mass at the femoral neck, a surrogate marker for musculoskeletal fragility.

Abdominal aortic calcification and cognitive function among older adults: Cross-sectional analysis of National Health and Nutrition Examination Survey, 2013-2014.

Subclinical atherosclerotic disease is an emerging risk factor for cognitive function among older adults, though less is known about the association between abdominal aortic calcification (AAC) and cognitive function. This study aimed to examine the cross-sectional association of AAC with cognitive function in a nationally representative sample of population in the U.S. A total of 1,209 older adults (60 years or older) in the 2013-2014 National Health and Nutrition Examination Survey were included. AAC was obtained with dual-energy X-ray absorptiometry. Cognitive function was examined using the CERAD Word Learning subtest (memory), Digit Symbol Substitution Test (executive function/processing speed), and Animal Fluency Test (language). Test-specific and global cognition z-scores were created based on means and standard deviations of cognitive tests. Multivariable linear regression models were used to examine the associations of presence of AAC and severity of AAC with cognition z-scores. Adjusted for covariates, presence of AAC was associated with poorer global cognition (beta (β)=-0.17, 95% confidence interval (CI): -0.28, -0.06), memory (β=-0.20, 95% CI: -0.31, -0.09), and language ability (β=-0.15, 95% CI: -0.29, -0.01). More severe AAC was associated with poorer cognitive function. The associations were significant among participants <75years. The presence of AAC and greater severity of AAC, were associated with poorer cognitive function, particularly among older adults <75years. Future research is expected to assess whether lowering global vascular risk can slow cognitive decline.

Levels of serum ecto-nucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) predicts severity of abdominal aortic calcification in end-stage renal disease patients receiving regular dialysis.

To investigate the correlation between serum ectonucleotide pyrophosphatase/phosphodiesterase-1 (ENPP1) level and severity of abdominal vascular calcification in end-stage renal disease (ESRD) patients receiving dialysis. A total of 124 patients were consecutively enrolled into the study in our local institution. Based on the Kidney Disease Improving Global Outcomes (KDIGO) guidelines and recommendations, abdomen lateral X-ray was used to determine abdominal aortic calcification score (AACS) for each patient at enrollment. Patients were divided into three groups based on AACS: no or mild calcification group, moderate calcification group, and severe calcification group. The relationships between ENPP1 levels and AACS were assessed by Spearman analysis and the value of ENPP1 in predicting severity of abdominal aortic calcification was evaluated by receiver operating characteristic (ROC). The level of ENPP1 in dialysis patients was (7.68 ± 1.67) ng/ml. There was no significant difference in serum ENPP1 level between peritoneal dialysis patients and hemodialysis patients (p > 0.05). The AACS of dialysis patients was negatively correlated with ENPP1 value (r=-0.70). Compared to no/mild calcification patients, the levels of serum ENPP1 in patients with moderate/severe calcification were decreased significantly (p < 0.01). The severity of vascular calcification was correlated with serum ENPP1 value, the severer the vascular calcification, the lower the serum ENPP1 level, and the difference was statistically significant (all p < 0.05). The area under ROC curve of ENPP1 was 0.90, the corresponding sensitivity was 0.86, and the specificity was 0.87. Levels of serum ENPP1 in non-diabetic ESRD patients are negatively related to the severity of abdominal aortic vascular calcification.

Measurement of Aortic Atherosclerotic Disease Severity: A Novel Tool for Simplified, Objective Disease Scoring Using CT Angiography.

IntroductionVascular calcification is a recognized indicator of cardiovascular morbidity and mortality. Calcium scoring is a widely used tool to measure coronary artery calcification, however has limitations for use elsewhere in the body. There is currently no gold standard for quantifying abdominal aortic calcification (AAC).We propose a simple and reproducible method to assess the severity of AAC using multiplanar reconstruction (MPR) in CT angiograms (CTA).MethodsA retrospective analysis of CTAs from 75 patients over two years was performed. Using a novel six-point scoring system, three radiologists independently scored the severity of AAC in the distal abdominal aorta. Interclass correlation (ICC) was used to assess the degree of agreement between the three raters.Calcium scoring of the same region was also calculated for each patient. We used Spearman's rank correlation coefficient to compare the CT calcium score with the corresponding average rater's atheroma score.ResultsThere was significant agreement between raters’ scores, with an ICC value = 0.972, 95% (CI 0.959-0.981, p < 0.0001). There was also a strong correlation between an average rater's atheroma score with the corresponding CT calcium score, rho = 0.85 (p < 0.0001).ConclusionThe results show excellent reproducibility of scores between radiologists, as well as a strong correlation between this novel scoring tool and calcium scores, indicating that it is a reliable method for the grading of AAC. We propose that this simple semi-quantitative method could form a widely used system for AAC disease stratification.

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.

Unraveling the link between metabolic syndrome and abdominal aortic calcification

Background & aimsOver the last few decades, the prevalence of metabolic syndrome (MetS) has gradually increased. As we know, many prior studies have connected MetS with diabetes, coronary heart disease, and cardiovascular disease. Abdominal aortic calcification (AAC) is a good marker of morbidity and mortality of vascular disease, as its degree may be associated with the severity of coronary artery calcification and disease. The aim of this article is to investigate the connection between MetS and AAC. Methods and resultsThis retrospective observational study included 2731 participants aged 58 years from the National Health and Nutrition Examination Survey (NHANES) (2013–2014). We used Dual-Energy X-ray Absorptiometry to define the degree of AAC. We defined MetS according to the National Cholesterol Education Program Adult Treatment Panel III definition.A total of 2731 participants with complete data were included for data analysis. In the fully adjusted model, an increase in the severity of AAC with the number of MetS components was still significant with βvalues of AAC Total 24 Score 0.498 (95% confidence interval (CI): 0.018,0.978), 1.016 (95% CI: 0.514,1.519) and 1.426 (95% CI: 0.916,1.937) respectively in 2, 3 and ≧ 4 components. Additionally, associations were observed between MetS components, including blood pressure, HDL and glucose with βvalues of AAC Total 24 Score 0.332(95% CI: 0.069, 0.595), 0.652(95% CI: 0.380, 0.925) and 0.534 (95% CI: 0.285, 0.783) after fully adjusted, respectively. ConclusionThe results indicated that, in the US adult population, a greater number of components of MetS were significantly associated with AAC. Among the components of metabolic syndrome, the blood pressure, HDL and blood sugar were observed apparent association with AAC.

Clinical Relevance of Serum Selenium Levels and Abdominal Aortic Calcification

Selenium (Se) is an essential micronutrient with antioxidative properties, but previous studies have shown that extremely high circulating Se concentrations are associated with a higher prevalence of cardiovascular diseases (CVDs). To date, it remains unknown whether this association has connections with arterial calcification. A total of 982 participants with both serum Se concentration and abdominal aortic calcification (AAC) score data were enrolled from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), a cross-sectional study of a noninstitutionalized population in the USA. Serum Se levels were determined by inductively coupled plasma-dynamic reaction cell-mass spectrometry. AAC was obtained from dual-energy X-ray absorptiometry and quantified by the Kauppila score system. Severe AAC was defined as Kauppila score ≥ 5. Among all participants, the mean serum Se level was 132.89μg/L. The average AAC score was 1.51, and 11.7% had severe AAC. Compared with those in the lowest quartile of Se (< 121.1μg/L), the highest quartile subgroup (> 143.1μg/L) was associated with a higher mean AAC score (β-coefficient 0.88; 95% CI 0.28, 1.47; p = 0.004) and greater odds of having severe AAC (odds ratio 2.19; 95% CI 1.10, 4.36; p = 0.026) after adjusting for demographic, biochemical, and clinical characteristics. The concentrations of other circulating trace elements showed no statistically significant association with the AAC score. High serum Se levels were independently associated with an increased mean AAC score and aggravated AAC severity among noninstitutionalized US adults. Serum Se might adversely affect the cardiovascular system when the serum Se concentration exceeds 143μg/L.