title: Abdominal aortic calcification on vertebral morphometry images predicts incident myocardial infarction.
abstract: Abdominal aortic calcification (AAC) measured on spine X-rays is an established risk factor for cardiovascular disease. We investigated whether AAC assessed using vertebral morphometry and a recently developed scoring system (AAC-8) is reliable and associated with cardiovascular risk factors or events. A total of 1471 healthy postmenopausal women and 323 healthy middle-aged and older men participated in 5 and 2 year trials of calcium supplements, respectively. AAC-8 was assessed on vertebral morphometry images at baseline and follow-up. In addition, 163 men also had coronary artery calcification measured using computed tomography. Cardiovascular events during the trials were independently adjudicated. We found strong inter- and intrameasurer agreement for AAC-8 (kappa > 0.87). The prevalence of AAC increased with age (p < .01) in women and in men. AAC was associated with many established cardiovascular risk factors, with serum calcium in women (p = .002) and with higher coronary calcium scores in men (p = .03). Estimated 5 year cardiovascular risk increased with increasing AAC-8 score (p < .001) in women and in men. The presence of AAC independently predicted myocardial infarction (MI) in women [hazards ratio (HR) = 2.30, p = .007] and men (HR = 5.32, p = .04), even after adjustment for estimated cardiovascular risk in women. In women, AAC independently predicted cardiovascular events (MI, stroke, or sudden death) (HR = 1.74, p = .007), and changes in AAC-8 score over time were associated with MI and cardiovascular events, even after adjustment for estimated cardiovascular risk. In summary, scoring AAC on vertebral morphometric scans is a reproducible method of assessing cardiovascular risk that independently predicts incident MI and cardiovascular events, even after taking into account traditional cardiovascular risk factors.
authors.affiliation: Department of Medicine, University of Auckland, Auckland, New Zealand. m.bolland@auckland.ac.nz
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Bolland
authors.forename: Tom K M
authors.initials: TK
authors.lastname: Wang
authors.forename: Niels C
authors.initials: NC
authors.lastname: van Pelt
authors.forename: Anne M
authors.initials: AM
authors.lastname: Horne
authors.forename: Barbara H
authors.initials: BH
authors.lastname: Mason
authors.forename: Ruth W
authors.initials: RW
authors.lastname: Ames
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Grey
authors.forename: Peter N
authors.initials: PN
authors.lastname: Ruygrok
authors.forename: Greg D
authors.initials: GD
authors.lastname: Gamble
authors.forename: Ian R
authors.initials: IR
authors.lastname: Reid
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D001012:Aorta, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology*; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D002114:Calcinosis / Q000150:complications* / Q000473:pathology*; D002118:Calcium / Q000008:administration & dosage; D016022:Case-Control Studies; D019587:Dietary Supplements; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging; D011379:Prognosis; D012307:Risk Factors; D013131:Spine / Q000000981:diagnostic imaging* / Q000473:pathology
chemical_list: D002118:Calcium