title: Ascending and descending thoracic aorta calcification in type 2 diabetes mellitus.
abstract: BACKGROUND
  Calcification of the thoracic aorta is a risk factor for cardiovascular disease and peripheral arterial disease but has not been well studied in diabetics. In addition, many studies consider aortic calcium as a single anatomic entity, whereas calcification of the ascending and descending portions of the thoracic aorta may represent separate phenotypes. We sought to characterize the prevalence of ascending and descending aortic calcium among diabetics and to assess their associations with cardiovascular risk factors, coronary artery calcium, and peripheral arterial disease.
  
  
  METHODS
  Within the Penn Diabetes Heart Study, a cross-sectional study of subjects with type 2 diabetes mellitus but without coronary or renal disease, we quantified Agatston scores of the ascending and descending thoracic aorta in 1739 subjects (63% male, 61% Caucasian). Multivariate logistic and Tobit regressions were used to assess associations with cardiovascular risk factors, coronary calcium, and peripheral arterial disease.
  
  
  RESULTS
  Of all subjects, 54% had thoracic aortic calcium; of these, 37% had calcium solely in the ascending thoracic aorta and 20% solely in the descending thoracic aorta. In multivariate regression, age, Caucasian race, systolic blood pressure, low-density lipoprotein cholesterol, smoking, and diabetes duration were independently associated with calcium of both the ascending and descending thoracic aorta (P < .001 for all). Ascending and descending aortic calcium were each independently associated with coronary calcium in multivariate regression, but only calcification of the descending thoracic aortic was associated with low ankle-brachial index.
  
  
  CONCLUSIONS
  Ascending and descending thoracic aortic calcium have similar associations with traditional cardiovascular risk factors in diabetics and are independently associated with coronary artery calcium. Only calcium in the descending aorta is associated with peripheral arterial disease. Delineation of both phenotypes may provide information about the individualized vascular disease and risk profile of patients with type 2 diabetes mellitus.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Churchill
authors.affiliation: Department of Cardiovascular Medicine, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Suraj P
authors.initials: SP
authors.lastname: Rasania
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Hashmi
authors.initials: H
authors.lastname: Rafeek
authors.affiliation: Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Claire K
authors.initials: CK
authors.lastname: Mulvey
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Terembula
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Ferrari
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Jha
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lilly
authors.affiliation: Jefferson Vascular Center, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Luis H
authors.initials: LH
authors.lastname: Eraso
authors.affiliation: Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Muredach P
authors.initials: MP
authors.lastname: Reilly
authors.affiliation: Division of Cardiology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA. Electronic address: aqasim@medicine.ucsf.edu.
authors.forename: Atif N
authors.initials: AN
authors.lastname: Qasim
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000175:diagnosis / Q000453:epidemiology*; D001027:Aortography / Q000379:methods; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010414:Pennsylvania / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000175:diagnosis / Q000453:epidemiology*
keywords: Aorta; Arteriosclerosis; Calcium; Computed tomography; Diabetes mellitus type 2