Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study

Joshua R. Lewis, John T. Schousboe, Wai H. Lim, Germaine Wong, Kevin E. Wilson, Kun Zhu, Peter L. Thompson, Douglas P. Kiel, Richard L. Prince

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Abstract

Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45%) had low AAC (AAC24 score 0 or 1), 387 (37%) moderate AAC (AAC24 score 2–5), and 197 (19%) had high AAC (AAC24 score ≥6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37%, 39%, and 49%, respectively, p = 0.008 for trend), ASVD deaths (15%, 21%, and 27%, respectively, p < 0.001 for trend), and all-cause mortality (30%, 38%, and 44%, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95% CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95% CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95% CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95% CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95% CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long-term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies.

Original languageEnglish
Pages (from-to)1001-1010
Number of pages10
JournalJournal of Bone and Mineral Research
Volume33
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

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Vascular Diseases
Bone Density
Spine
Prospective Studies
Hospitalization
Independent Living
Primary Prevention
Bone and Bones
Mortality
Health

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@article{93d6056b52ce4fa8aa7ad5d14342c3cf,
title = "Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study",
abstract = "Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45{\%}) had low AAC (AAC24 score 0 or 1), 387 (37{\%}) moderate AAC (AAC24 score 2–5), and 197 (19{\%}) had high AAC (AAC24 score ≥6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37{\%}, 39{\%}, and 49{\%}, respectively, p = 0.008 for trend), ASVD deaths (15{\%}, 21{\%}, and 27{\%}, respectively, p < 0.001 for trend), and all-cause mortality (30{\%}, 38{\%}, and 44{\%}, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95{\%} CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95{\%} CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95{\%} CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95{\%} CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95{\%} CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long-term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies.",
keywords = "AGING, CARDIOVASCULAR DISEASE, EPIDEMIOLOGY",
author = "Lewis, {Joshua R.} and Schousboe, {John T.} and Lim, {Wai H.} and Germaine Wong and Wilson, {Kevin E.} and Kun Zhu and Thompson, {Peter L.} and Kiel, {Douglas P.} and Prince, {Richard L.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1002/jbmr.3405",
language = "English",
volume = "33",
pages = "1001--1010",
journal = "Journal of Bone & Mineral Research",
issn = "0884-0431",
publisher = "John Wiley & Sons",
number = "6",

}

TY - JOUR

T1 - Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing

T2 - A Prospective Study

AU - Lewis, Joshua R.

AU - Schousboe, John T.

AU - Lim, Wai H.

AU - Wong, Germaine

AU - Wilson, Kevin E.

AU - Zhu, Kun

AU - Thompson, Peter L.

AU - Kiel, Douglas P.

AU - Prince, Richard L.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45%) had low AAC (AAC24 score 0 or 1), 387 (37%) moderate AAC (AAC24 score 2–5), and 197 (19%) had high AAC (AAC24 score ≥6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37%, 39%, and 49%, respectively, p = 0.008 for trend), ASVD deaths (15%, 21%, and 27%, respectively, p < 0.001 for trend), and all-cause mortality (30%, 38%, and 44%, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95% CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95% CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95% CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95% CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95% CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long-term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies.

AB - Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45%) had low AAC (AAC24 score 0 or 1), 387 (37%) moderate AAC (AAC24 score 2–5), and 197 (19%) had high AAC (AAC24 score ≥6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37%, 39%, and 49%, respectively, p = 0.008 for trend), ASVD deaths (15%, 21%, and 27%, respectively, p < 0.001 for trend), and all-cause mortality (30%, 38%, and 44%, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95% CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95% CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95% CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95% CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95% CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long-term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies.

KW - AGING

KW - CARDIOVASCULAR DISEASE

KW - EPIDEMIOLOGY

UR - http://www.scopus.com/inward/record.url?scp=85044314556&partnerID=8YFLogxK

U2 - 10.1002/jbmr.3405

DO - 10.1002/jbmr.3405

M3 - Article

VL - 33

SP - 1001

EP - 1010

JO - Journal of Bone & Mineral Research

JF - Journal of Bone & Mineral Research

SN - 0884-0431

IS - 6

ER -