title: Vertebral fracture assessment-detected abdominal aortic calcification and cardiovascular disease in rheumatoid arthritis.
abstract: OBJECTIVE
  Individuals with rheumatoid arthritis (RA) are at increased risk for cardiovascular disease (CVD). Traditional prediction tools underestimate this risk. Vertebral fracture assessment (VFA)-detected aortic calcification enhances CVD risk stratification in the general population but its relationship in RA is unclear. We assessed the presence of abdominal aortic calcification (AAC) on VFA images, and its association with CVD in RA patients.
  
  
  METHODS
  We determined the prevalence of cardiovascular events in a cohort of RA patients aged 40 years and older fulfilling the 1987 American College of Rheumatology classification criteria. Two blinded radiologists independently reviewed all VFA scans to determine the presence/severity of AAC using an established 24-point scale. Logistic regression analyses were performed to determine whether AAC could discriminate between RA patients with and without CVD, and to compare the ability of VFA-detected AAC to predict CVD to conventional CVD risk factors and the Framingham Risk Score.
  
  
  RESULTS
  603 subjects fulfilled study inclusion criteria. 230 (38%) subjects had 1 or more documented CVD event and 211 (35%) had AAC detected on VFA scans. Significantly more subjects with cardiovascular events had AAC on their VFA scans than controls (76% versus 10%; P < 0.05). VFA-detected AAC was a better predictor of CVD than traditional risk factors, and significantly out-performed the Framingham Risk Score for discriminating between the presence and absence of CVD (AUC 0.85 versus 0.58; P < 0.001).
  
  
  CONCLUSIONS
  There was a significant association between VFA-detected AAC and CVD in our study population. This finding may enhance cardiovascular disease risk prediction in RA patients.
authors.affiliation: Department of Rheumatology, Galway University Hospitals, Galway, Ireland. Electronic address: ausafmohammad@gmail.com.
authors.forename: Ausaf
authors.initials: A
authors.lastname: Mohammad
authors.affiliation: Department of Radiology, Galway University Hospitals, Galway, Ireland.
authors.forename: Derek
authors.initials: D
authors.lastname: Lohan
authors.affiliation: Department of Radiology, Galway University Hospitals, Galway, Ireland.
authors.forename: Diane
authors.initials: D
authors.lastname: Bergin
authors.affiliation: Department of Radiology, Galway University Hospitals, Galway, Ireland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Mooney
authors.affiliation: Department of Mathematics, NUI, Galway, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Newell
authors.affiliation: Clinical Research Facility, NUI, Galway, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: O' Donnell
authors.affiliation: Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905.
authors.forename: Shreyasee
authors.initials: S
authors.lastname: Amin
authors.affiliation: Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Coughlan
authors.affiliation: Department of Rheumatology, Galway University Hospitals, Galway, Ireland.
authors.forename: John J
authors.initials: JJ
authors.lastname: Carey
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging; D015519:Bone Density; D002114:Calcinosis / Q000150:complications* / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography
keywords: Abdominal aortic calcification; Cardiovascular disease; Framingham risk score; Rheumatoid arthritis; Vertebral fracture assessment