Severity Of Abdominal Aortic Calcification Research Articles

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.

Null association between abdominal muscle and calcified atherosclerosis in community-living persons without clinical cardiovascular disease: The multi-ethnic study of atherosclerosis

ObjectiveLean muscle loss has been hypothesized to explain J-shaped relationships of body mass index (BMI) with cardiovascular disease (CVD), yet associations of muscle mass with CVD are largely unknown. We hypothesized that low abdominal lean muscle area would be associated with greater calcified atherosclerosis, independent of other CVD risk factors. Materials/MethodsWe investigated 1020 participants from the Multi-Ethnic Study of Atherosclerosis who were free of clinical CVD. Computed tomography (CT) scans at the 4th and 5th lumbar disk space were used to estimate abdominal lean muscle area. Chest and abdominal CT scans were used to assess coronary artery calcification(CAC), thoracic aortic calcification (TAC), and abdominal aortic calcification (AAC). ResultsThe mean age was 64±10years, 48% were female, and mean BMI was 28±5kg/m2. In models adjusted for demographics, physical activity, caloric intake, and traditional CVD risk factors, there was no inverse association of abdominal muscle mass with CAC (prevalence ratio [PR] 1.02 [95% CI 0.95,1.10]), TAC (PR 1.13 [95%CI 0.92, 1.39]) or AAC (PR 0.99 [95%CI 0.94, 1.04]) prevalence. Similarly, there was no significant inverse relationship between abdominal lean muscle area and CAC, TAC, and AAC severity. ConclusionIn community-living individuals without clinical CVD, greater abdominal lean muscle area is not associated with less calcified atherosclerosis.

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 Prevalence of Aortic Calcification on Vertebral Fracture Assessment Imaging Among Patients With Rheumatoid Arthritis

Patients with rheumatoid arthritis (RA) are at increased risk of osteoporosis (OP) and cardiovascular disease (CVD). Dual-energy X-ray absorptiometry scans have been validated for identifying patients with RA at risk for fracture. Reliable CVD risk stratification remains an unmet need in this population. Vertebral fracture assessment (VFA)–detected abdominal aortic calcification (AAC) has been validated as a marker of CVD in other populations, but the prevalence among patients with RA is unknown. In this study, we determined the prevalence and severity of AAC on VFA scans in a cohort of patients with RA. AAC was detected in 211 of the 603 (35%) eligible subjects; 24% were graded as severe. In multivariable analyses, the presence of AAC was significantly associated with longer disease duration and higher disease activity (p<0.05). Further studies are needed on the relationship between AAC and CVD in patients with RA.

Association of Abdominal Aortic Calcification with Lifestyle and Risk Factors of Cardiovascular Disease

BackgroundAbdominal aortic calcification (AAC) is a marker of subclinical atherosclerotic disease and an independent predictor of subsequent vascular morbidity and mortality. This study was conducted to investigate the association of AAC with lifestyle and risk factors of cardiovascular disease.MethodsThe results of the abdominal computed tomography of 380 patients who visited Chungnam National University Hospital for a health checkup from January 1, 2008 to December 31, 2009 were reviewed. A six-point scale was used in grading the overall severity of the calcification in three areas of the abdominal aorta, including the area superior to the renal artery, the upper-half area inferior to the renal artery, and the lower-half area inferior to the renal artery, in addition to the common iliac artery. The association of the AAC severity with the age, lifestyle factors, and risk factors of cardiovascular disease was analyzed via multiple linear regression analysis.ResultsIn the male subjects, the age, presence of dyslipidemia and smoking were positively related to AAC, but exercising was negatively related to AAC (total R2 = 0.563). In the female subjects, the age and presence of diabetes mellitus, hypertension, and dyslipidemia were positively related to AAC, but exercising was negatively related to AAC (total R2 = 0.547).ConclusionAAC was related to both the male and female subjects' age, presence of dyslipidemia, and exercising, to smoking in the male subjects and to the presence of diabetes mellitus and hypertension in the female subjects.

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.

Serum Level of the Phosphaturic Factor FGF23 Is Associated with Abdominal Aortic Calcification in Men: The STRAMBO Study

Calcification inhibitor deficiencies, mineral imbalance, and phenotypic transformation of vascular cells to osteogenic cells initiate and sustain vascular calcification. Fibroblast growth factor-23 (FGF23) is a key molecule regulating mineral homeostasis. Our objective was to assess the association of serum FGF23 levels with mineral metabolism parameters and abdominal aortic calcification (AAC) in men. This was a cross-sectional analysis in the STRAMBO cohort. Men holding a private health insurance cover with Mutuelle de Travailleurs de la Région Lyonnaise were included in the study. Participants included male volunteers aged 20-87 (n = 1130). Nonfasting blood collection was done. AAC was semiquantitatively assessed from vertebral fracture assessment scans obtained using dual-energy x-ray absorptiometry. We evaluated the association between FGF23 concentration and AAC severity in men. In 350 men aged 60 yr or younger, FGF23 levels decreased with age (r = -0.21; P < 0.001) but were not associated with any other parameter. In 780 men aged over 60 yr, serum FGF23 correlated with age (r = 0.37; P < 0.001) and, after adjustment for confounders, with glomerular filtration rate (r = -0.31; P < 0.001) and PTH levels (r = 0.25; P < 0.001). After adjustment for confounders, self-reported ischemic heart disease, diabetes mellitus as well as higher concentrations of C-reactive protein and osteoprotegerin were all associated with higher FGF23 levels. After adjustment for confounders, subjects in the highest FGF23 quartile had higher prevalence of severe AAC compared with the three lower quartiles combined (odds ratio = 1.88; 95% confidence interval = 1.22-2.85; P < 0.005). In healthy older men, circulating FGF23 is associated with parameters of mineral metabolism, including bone metabolism-regulating cytokines, and with severe AAC independent of traditional risk factors.

Association of Osteocalcin and Abdominal Aortic Calcification in Older Women: The Study of Osteoporotic Fractures

Osteocalcin (OC) is produced by osteoblasts and vascular smooth muscle cells. In animal models, serum OC levels are strongly correlated with vascular calcium content, however, the association of OC with vascular calcification in humans is uncertain. The Study of Osteoporotic Fractures (SOF) enrolled community-living women, age ≥65 years. The present study included a subsample of 363 randomly selected SOF participants. Serum total OC was measured by ELISA, and abdominal aortic calcification (AAC) was evaluated on lateral lumbar radiographs. We examined the cross-sectional association between serum OC and AAC. The mean serum OC level was 24 ± 11 ng/ml and AAC was present in 188 subjects (52%). We observed no association of OC and AAC in either unadjusted or adjusted analyses. For example, each standard deviation higher OC level was associated with an odds ratio (OR) for AAC prevalence (AAC score >0) near unity (OR = 1.06; 95% CI, 0.82–1.36) in models adjusted for CVD risk factors. Further adjustment for intact parathyroid hormone, bone-specific alkaline phosphatase, 25-hydroxyvitamin D, and hip and spine bone mineral density did not materially change the results (OR = 1.22; 95% CI, 0.86–1.75). Similarly, higher OC levels were not associated with severity of AAC (P = 0.87). In conclusion, among community-living older women, serum OC is not associated with AAC. These findings suggest that serum OC levels may more closely reflect bone formation than vascular calcification in humans.

A Radiographic Study on the Associations of Age and Prevalence of Vertebral Fractures with Abdominal Aortic Calcification in Japanese Postmenopausal Women and Men

The purpose of the present study was to determine the associations of age and history of non- and low-traumatic fractures with the severity of abdominal aortic calcification in Japanese postmenopausal women and men. Four hundred and one Japanese persons (24 men and 377 postmenopausal women, mean age: 73.8 years) for whom thoracic and lumbar spine radiographs had been obtained to evaluate their posture prior to patient participation in a fall-prevention exercise program were enrolled. The associations of sex, age, history of hip fracture, prevalence of vertebral fracture, and spondylosis grade (the Nathan degree) with the severity of abdominal aortic calcification (length of calcification, as evaluated according to the number of vertebral bodies) were analyzed. Nine subjects (2.2%) had a history of hip fracture, and 221 (55.1%) had at least one prevalent vertebral fracture. Two hundred and sixty-seven subjects (66.6%) had first-degree spondylosis. Age and the number of prevalent vertebral fractures, but not sex, history of hip fracture, or spondylosis grade, were significantly associated with the severity of abdominal aortic calcification. The present study confirmed that age and the number of vertebral fractures were associated with the severity of abdominal aortic calcification in Japanese postmenopausal women and men.

Inverse association between 25-hydroxyvitamin D concentrations and the severity of abdominal aortic calcification

Inverse association between 25-hydroxyvitamin D concentrations and the severity of abdominal aortic calcification

Abdominal aortic calcification in dialysis patients: results of the CORD study

Background. Patients with chronic kidney disease stage 5 have a high prevalence of vascular calcification, but the specific anatomical distribution and severity of abdominal aortic calcification (AAC), in contrast to coronary calcification, is less well documented. AAC may be recorded using plain radiographs. The present report is an analysis of baseline data on AAC in patients enrolled in the CORD (Calcification Outcome in Renal Disease) study.Methods. A total of 47 centres in six European countries participated in this cross-sectional study. Inclusion criteria were age ≥18 years and duration of dialysis ≥3 months. Lateral lumbar radiography of the abdominal aorta was used to determine the overall AAC score, which is related to the severity of calcific deposits at lumbar vertebral segments L1–L4. The reliability of the method was tested by double reading of 64 radiographs (coefficient of correlation 0.9).Results. A lateral lumbar radiograph was obtained in 933 patients. Calcification (AAC score ≥ 1) was present in 81% of the patients; its severity increased significantly from L1 to L4 (P < 0.0001) and affected all of these segments in 51% of patients. Independent predictors for the presence and severity of calcification were age (odds ratio [OR] 1.103/year; P < 0.0001), duration of dialysis (OR 1.110/year; P = 0.002) and history of cardiovascular disease (OR 3.247; P < 0.0001).Conclusions. AAC detected by lateral lumbar radiograph is associated with several risk factors of uraemic calcification. This semi-quantitative method is more widely available and less expensive than the current procedures for studying calcification and could form part of a pre-transplant workup and cardiovascular risk stratification.

Sex hormones, sex hormone binding globulin, and abdominal aortic calcification in women and men in the multi-ethnic study of atherosclerosis (MESA)

Background Conflicting findings exist regarding the associations of sex hormones with subclinical atherosclerosis. Methods This is a substudy from MESA of 881 postmenopausal women and 978 men who had both abdominal aortic calcification (AAC) quantified by computed tomography and sex hormone levels assessed [Testosterone (T), estradiol (E2), dehydroepiandrosterone (DHEA), and sex hormone binding globulin (SHBG)]. We examined the association of sex hormones with presence and extent of AAC. Results For women, SHBG was inversely associated with both AAC presence [OR = 0.62, 95% CI 0.42–0.91 for 1 unit greater log(SHBG) level] and extent [0.29 lower log(AAC) for 1 unit greater log(SHBG) level, β = −0.29 (95% CI −0.57 to −0.006)] adjusting for age, race, hypertension, smoking, diabetes, BMI, physical activity, and other sex hormones. After further adjustment for total and HDL-cholesterol, SHBG was not associated with ACC presence or extent. In men, there was no association between SHBG and AAC. In both men and women, neither T, E2, nor DHEA was associated with AAC presence or extent. Conclusion After adjustment for non-lipid cardiovascular risk factors, SHBG levels are inversely associated with both the presence and severity of AAC in women but not in men, which may be accounted for by HDL.

Vascular Calcification in Middle Age and Long-Term Risk of Hip Fracture: The Framingham Study

Osteoporosis and atherosclerosis frequently occur in the same individuals and may share similar pathogenic mechanisms. This study examined the relation between severity of aortic calcification in middle-age years and subsequent risk of hip fracture in women and men in the population-based Framingham Study. We assessed vascular calcification in women and men in middle age and risk of hip fracture at advanced age. Participants included 2499 Framingham cohort members (mean age, 61 yr; range, 47-80 yr). Semiquantitative methods were used to determine severity of abdominal aortic calcification on baseline radiographs. Information on potential confounding factors was obtained from study examinations conducted at, or before, baseline radiography. Hip fractures were ascertained by active surveillance and confirmed by medical records. Thirty-five-year cumulative incidence of hip fracture was 16% in women and 5% in men with prevalent aortic calcification at baseline (score 1+) and 14% in women and 4% in men without aortic calcification (score 0). Hazard ratios (HRs) and 95% CIs for hip fracture did not increase from the lowest to the highest category of aortic calcification. HRs were 1.0, 1.2 (95% CI, 0.9-1.8), 1.2 (95% CI, 0.7-1.9), 1.1 (95% CI, 0.7-1.7), and 1.4 (95% CI, 0.8-2.3) in women (p for trend = 0.44) and 1.0, 1.8 (95% CI, 0.8-3.8), 1.8 (95% CI, 0.7-4.6), 1.5 (95% CI, 0.6-3.9), and 1.2 (95% CI, 0.2-5.7) in men (p for trend = 0.29) for aortic calcification scores 0 (reference), 1-4, 4-5, 6-10, and 11+, respectively. However, aortic calcification score was strongly associated with increased risk of death (p for trend < 0.0001 in women and men). HRs (95% CIs) for mortality from the lowest to highest aortic calcification score were 1.0, 1.6 (1.4-1.9), 1.7 (1.4-2.1), 1.8 (1.5-2.2), and 2.1 (1.7-2.6) for women, and for men were 1.0, 1.4 (1.1-1.6), 1.4 (1.2-1.8), 1.6 (1.3-2.0), and 1.9 (1.5-2.5). Vascular calcification in middle-aged adults does not increase long-term hip fracture risk.

Relationship between CT anthropometric measurements, adipokines and abdominal aortic calcification

Background Visceral obesity and aortic calcification are both associated with cardiovascular events. The purpose of this study was to examine if visceral obesity was associated with the severity of abdominal aortic calcification. Methods One hundred and forty eight patients with peripheral artery disease were assessed by CT angiography. The severity of infrarenal abdominal aortic calcification was measured using a validated technique. The size of the visceral and subcutaneous compartments was estimated from anthropometric measurements made from the same CT. Calcification and anthropometric measurements were compared with Spearman's correlation and multiple logistic regression (adjusting for age, gender, hypertension, diabetes, smoking and cholesterol). Results The relative size of the visceral compartment estimated from CT diameter ratios was correlated with abdominal aortic calcification severity, r = 0.27, p = 0.001 and independently associated with calcification allowing for other cardiovascular risk factors (OR 6.63, 95% CI 1.90–23.14). The relative size of the visceral compartment was associated with serum osteoprotegerin levels, suggesting a possible mechanism underlying the detrimental influence of visceral adiposity. Conclusion The association of visceral adiposity and arterial calcification suggests one mechanism, which may contribute to the detrimental effects of central obesity.

Factors associated with calcification of the abdominal aorta in hemodialysis patients

Cardiovascular and cerebrovascular injury caused by arteriosclerosis has been the major cause of the death in hemodialysis (HD) patients. We quantitatively analyzed and evaluated the severity of abdominal aortic calcification in HD patients in comparison to risk factors for arteriosclerosis. One hundred thirty-seven HD patients were examined. Using image analysis software, areas of the calcified abdominal aorta were quantitatively analyzed on plain computerized tomography images. Other factors such as blood pressure (BP), lipid levels, and calcium (Ca) x phosphorus (Pi) value were also analyzed. Patients with a higher one-year average of systolic BP showed a higher severity of abdominal aortic calcification. That is, the severity of abdominal aortic calcification in patients with a one-year systolic BP average above 160 mm Hg was 31.5 +/- 13.6%, and this severity was significantly higher than that in patients with a one-year systolic BP average of less than 120 mm Hg (8.0 +/- 7.7%, P < 0.01). The severity of abdominal aortic calcification in patients demonstrating risk values of ectopic calcification, that is serum Ca x Pi > or = 60 (mg/dl), on more than 4 of 24 measurements within one year (25.8 +/- 13.6%) was significantly higher than the severity of aortic calcification in patients demonstrating this value less than four times in one year (P < 0.05). There was no correlation between levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, lipoprotein(a), and severity of abdominal aortic calcification. Systolic BP levels and the product of serum Ca and Pi were related to the severity of abdominal aortic calcification in HD patients. These observations suggested that BP control, as well as control of serum Ca and Pi levels, was important in preventing the progression of abdominal aortic arteriosclerosis.

Preliminary study on relationship between vertebral fracture and aortic calcification in postmenopausal women

The prevalence of aortic calcification and osteoporosis increases with age. Several studies have postulated a direct relationship between the two disorders, suggesting that aortic calcification results from a redistribution of skeletal calcium in osteoporosis. We have undertaken a case-controlled study to reevaluate the possible relationship between the two age-related processes. Lateral spine radiographs of 122 postmenopausal Turkish women were analyzed to determine the presence or absence of vertebral fracture (n 1=44 andn 2=78, respectively). Abdominal aortic calcification was quantified in both groups using a subjective grading system (from no calcification to dense calcification adjacent to three vertebrae) and a semiquantitative method. Using the subjective method, the prevalence of aortic calcification increased from 41% in subjects aged 50–65 years to 78% in those over 75 years of age (И2=10.8;P<.005). The prevalence of aortic calcification was similar in women with and without vertebral fracture (60.0%vs 57.7%;P=.63). Using the semiquantitative method, there was no significant difference in the severity of abdominal aortic calcification between subjects with and without vertebral fractures (P=.74). Using logistic regression, the direction of the odds ratio suggested a greater risk of vertebral fracture in the presence of moderate or severe aortic calcification (1.3; 95% CI 0.5–3.9) and multiple loss of intervertebral disk spaces (2.0; 95% CI 0.6–7.4), but the number of subjects was small and the confidence intervals wide. These results do not support the hypothesis of a direct relationship between calcification and vertebral osteoporosis as a result of calcium redistribution in postmenopausal women. It is likely that factors other than vertebral deformity are of importance in the development of aortic calcification in the elderly.

Is Atherosclerosis Accelerated by Capd?

Cardiovascular complications in renal replacement therapy remain prevalent today. The question, "Is atherosclerosis accelerated in peritoneal dialysis (PD) patients," has not been resolved. Many cross-sectional studies have revealed that there are more atherogenic lipid profiles in continuous ambulatory peritoneal dialysis (CAPD) than in other dialytic modalities. However, it is not certain that CAPD per se may contribute to lipid abnormalities in continuing PD for a long time. Therefore, we tried to assess whether CAPD itself may change lipid profiles in the long-term period on CAPD. We measured conventional lipid profiles in 16 stable CAPD patients in whom total cholesterol (T.chol.) levels remained under 240 mg/dL at the time of starting observation. Diabetic end-stage renal disease (DMESRD) patients were excluded from this study. Blood sampling was performed under strict conditions indicating overnight fasting with 10 hours dwell of 2 L of 1.5% Dianeal. Plasma levels of T.chol., triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and atherogenic lipoprotein (apo B/A-I) did not show significant changes by serial measurements from the sixth month to the thirtieth month following the commencement of CAPD as their initial dialysis treatment. Recently it is reported that high plasma levels of Lp(a) lipoprotein are an independent risk factor in cardiovascular events in renal replacement therapy because Lp(a) has a close relation to intravascular thrombosis and acceleration of atherosclerosis. We found that the incident of vascular accidents was five episodes among 33 patients with higher (> 31 mg/dL) Lp(a) levels, while there was only one episode in 45 patients with lower (< 30 mg/dL) Lp(a) levels (p < 0.05, odds ratio: 7.9). However, severity of aortic calcification and incidence of positive treadmill test showed no difference in these two groups. No significant correlation was observed between duration on CAPD and plasma Lp(a) levels. From the fact mentioned above, we speculate that CAPD does not essentially affect lipid profiles if determined under the strict condition of blood sampling. In order to evaluate the atherosclerosis noninvasively, we have measured aortic pulse wave velocity (AoPWV) in 33 stable CAPD patients excluding those with DMESRD by two years' interval. Fifteen cases (46%) increased in AoPWV, however, lipid profiles did not differ from those of nonadvanced patients. Calcification of arteries is further evidence of acceleration in atherosclerotic change. Therefore, we have graded severity of abdominal aortic calcification into three categories: grade I denoted nil calcification, grade II denoted patchy calcification, and grade III denoted calcification along the entire abdominal wall, having a lead-pipe shape by lateral view of plain abdominal x-ray film. There were significant differences in the duration of CAPD (grade I: 41 months, grade II: 60 months, grade III: 68 months). AoPWV showed least in the grade I group, faster in grade II, and fastest in grade III, while lipid profiles did not show significant differences in three categories. From the analysis of serial changes of lipid profiles, AoPWV and aortic calcification, CAPD may present some risk of accelerating atherosclerosis, at least in some patients on long-term treatment. Risk factors contributing to acceleration of atherosclerosis is result not from lipid abnormalities, but from other factors which remained to be seen, for example, abnormalities in calcium metabolism.