Abdominal aortic calcification detected on lateral spine images from a bone densitometer predicts incident myocardial infarction or stroke in older women.
Among a cohort of elderly women, abdominal aortic calcification scored on baseline lateral spine densitometric images intended for vertebral fracture assessment was associated with subsequent myocardial infarction or stroke over a median 4-yr period, independent of clinical cardiovascular disease risk factors.


BACKGROUND
Cardiovascular disease (CVD) risk among older women is not adequately captured by traditional CVD risk factors. Lateral spine images obtained on bone densitometers for vertebral fracture assessment (VFA) can detect abdominal aortic calcification (AAC), an important marker of subclinical CVD. Our objective was to estimate the association between AAC scored on VFA images and subsequent myocardial infarction (MI) or stroke in elderly women.


METHODS
Among participants in a randomized controlled trial (women; age > 75 yr) of clodronate versus placebo, those who sustained an MI or stroke during the median 4-yr follow-up study period were selected as cases (n = 408), and 408 controls were randomly selected from the remainder of the parent study population. Baseline VFA images were scored for AAC with a previously validated 24-point scale and a newer, simpler 8-point scale.


RESULTS
The OR of incident MI or stroke for those in the middle and top tertiles, respectively, compared with the bottom tertile of AAC score were 1.14 (95% CI, 0.79-1.66) and 1.74 (95% CI, 1.19-2.56) for the 24-point scale and 1.42 (95% CI, 0.98-2.05) and 1.77 (95% CI, 1.22-2.55) for the 8-point scale, adjusted for age, high-density lipoprotein and low-density lipoprotein cholesterol, triglycerides, blood pressure, smoking, renal function, health status, and baseline diagnoses of diabetes mellitus, hypertension, angina, and prior stroke.


CONCLUSIONS
AAC scored on VFA images is independently associated with incident MI or stroke. Because bone densitometry is indicated for all women > or = 65 yr of age, VFA imaging offers an opportunity to capture this CVD risk factor in postmenopausal women undergoing bone densitometry at very little additional cost.
Schousboe
John T
JT
Park Nicollet Health Services, Minneapolis, Minnesota 55416, USA. john.schousboe@parknicollet.com
Taylor
Brent C
BC
Kiel
Douglas P
DP
Ensrud
Kristine E
KE
Wilson
Kevin E
KE
McCloskey
Eugene V
EV
D015502:Absorptiometry, Photon; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging*; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D002114:Calcinosis / Q000601:surgery*; D016022:Case-Control Studies; D004002:Clodronic Acid / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000097:blood / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging*; D012307:Risk Factors; D013131:Spine / Q000000981:diagnostic imaging*; D020521:Stroke / Q000000981:diagnostic imaging
D050071:Bone Density Conservation Agents; D004002:Clodronic Acid