Abdominal Aortic Calcification Detected on Lateral Spine Images From a Bone Densitometer Predicts Incident Myocardial Infarction or Stroke in Older Women

Authors

  • John T Schousboe MD, MS,

    Corresponding author
    1. Park Nicollet Health Services, Minneapolis, Minnesota, USA
    2. Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
    • Park Nicollet Health Services, 3800 Park Nicollet Boulevard, Minneapolis, MN 55416, USA
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    • Dr Schousboe receives research support from Hologic and is a consultant to Eli Lilly, Merck, and Amgen.

  • Brent C Taylor,

    1. Center for Chronic Disease Outcomes Research, Minneapolis VAMC, Minneapolis, Minnesota, USA
    2. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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    • Dr Taylor states that he has no conflicts of interest.

  • Douglas P Kiel,

    1. Hebrew SeniorLife, Boston, Massachusetts, USA
    2. Harvard Medical School, Boston, Massachusetts, USA
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    • Drs Kiel and McCloskey receive research support from Hologic.

  • Kristine E Ensrud,

    1. Center for Chronic Disease Outcomes Research, Minneapolis VAMC, Minneapolis, Minnesota, USA
    2. Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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    • Dr Ensrud receives research support from Bionovo, Eli Lilly, and Pfizer

  • Kevin E Wilson,

    1. Hologic, Bedford, Massachusetts, USA
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    • Dr Wilson is an employee of Hologic.

  • Eugene V McCloskey

    1. Academic Unit of Bone Metabolism, University of Sheffield, Sheffield, United Kingdom
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Abstract

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.

Introduction: 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.

Materials and 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 ≥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.

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