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

Schousboe, John T.; Taylor, Brent C.; Kiel, Douglas P.; Ensrud, Kristine E.; Wilson, Kevin E.; McCloskey, Eugène

doi:10.1359/jbmr.071024

Cited by 116 publications

(93 citation statements)

References 49 publications

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“…(32) Furthermore, aortic calcification is associated with increased risk of myocardial infarction. (33,34) Taken together, these findings suggest that osteoporotic fractures may have a higher impact on subsequent AMI among women than among men. In contrast, a study by Varosy and colleagues reported that the risk of coronary events was lower in those who had postmenopausal fractures.…”

Section: Discussionmentioning

confidence: 84%

Hip fracture and risk of acute myocardial infarction: A nationwide study

Chiang

Liu

Chen

et al. 2012

Journal of Bone and Mineral Research

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Osteoporotic fractures are associated with increased mortality risk. However, little data are available on the risk of acute myocardial infarction (AMI) after hip fracture. Therefore, we investigated whether hip fracture increased the risk of AMI in a large, nationwide cohort study. We obtained data from 8758 patients diagnosed with hip fracture from 2000 to 2009 and from 4 matched controls for each patient from the Longitudinal Health Insurance Database (LHID 2000), Taiwan. Controls were matched for age, sex, comorbid disorders, and enrollment date. All subjects were followed up from the date of enrollment until AMI, death, or the end of data collection (2009). Cox's regression model adjusted for age, sex, comorbid disorders, and medication was used to assess independent factors determining the risk of development of AMI. As expected, despite the matching, the hip fracture patients had more risk factors for AMI at baseline. A total of 8758 subjects with hip fractures and 35,032 controls were identified. Among these patients, 1183 (257 hip fracture patients and 926 controls) developed AMI during the median 3.2-year (interquartile range 1.4 to 5.8 years) follow-up period. Patients with hip fractures had a higher incidence of AMI occurrence when compared with controls (8.7/1000 person-years versus 6.82/1000 person-years). Multivariate analysis adjusted for baseline covariates indicated that hip fracture was associated with a greater risk for AMI development (hazard ratio [HR] ¼ 1.29; 95% confidence interval [CI] 1.12-1.48; p < 0.001). We conclude that hip fracture is independently associated with a higher risk of subsequent AMI. ß

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Section: Discussionmentioning

confidence: 84%

Hip fracture and risk of acute myocardial infarction: A nationwide study

Chiang

Liu

Chen

et al. 2012

Journal of Bone and Mineral Research

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“…Recently, abdominal aortic VC scores on baseline lateral DXA images, intended for vertebral fracture assessment in elderly women, were associated with subsequent myocardial infarction or stroke over a 4-yr period, independent of clinical CV disease risk factors (35). Therefore, imaging studies to detect subclinical CV disease, such as using lateral DXA to detect aortic VC, may be useful to improve identification of CKD 5D patients who may benefit from more aggressive treatment of risk factors such as stricter control of abnormal mineral metabolism, avoidance of calcium-based phosphate binders, or earlier renal transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have assessed the measurement of aortic calcification from bone densitometry images in the general population (33)(34)(35), and no study to date has reported this finding in CKD. The aim of this study was to determine and validate measurement of aortic calcification using DXA in a cohort of 40 prevalent hemodialysis (HD) subjects.…”

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confidence: 99%

Determination and Validation of Aortic Calcification Measurement from Lateral Bone Densitometry in Dialysis Patients

Toussaint

Lau

Strauss

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Vascular calcification (VC) contributes to increased cardiovascular (CV) disease in dialysis patientsand is inversely correlated with bone mineral density (BMD). Screening for VC may determine patients at greater CV risk and bone densitometry may have dual role in assessing VC as well as BMD. The aim of this study was to determine measurement of VC using dual-energy x-ray absorptiometry (DXA) with correlation to gold standard computed tomography (CT).Design, setting, participants, & measurements: Forty hemodialysis patients had abdominal aortic CT and lateral DXA of lumbar spine to determine aortic VC and BMD. Semiquantitative measurement of aortic VC from lateral DXA was determined using previously validated 24-and 8-point scales and correlated with aortic VC with CT. Anteroposterior (AP) and lateral DXA-reported BMD was compared with BMD from L2 through L4 with CT.Results: Patients, 70% men, 38% diabetic, had median age 58.5 yr. Aortic VC was present in 94% with CT and 68% on lateral DXA. For 24-and 8-point scores, intraclass correlation coefficients for intrarater agreement were 0.93 and 0.88, respectively. DXA-measured VC correlated with CT. Sensitivity and specificity for CT aortic VC > 500 HU was 50 and 86%, respectively, for DXA VC > 6 on a 24-point scale. Lateral DXA-reported BMD significantly correlated with BMD from CT, but AP DXA did not.Conclusions: Lateral DXA may be useful because images may provide concurrent assessment of aortic calcification as well as more accurate lumbar spine BMD, avoiding some of the limitations of AP DXA.

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“…(16)(17)(18)(19)(20)(21) Recently, we and others have reported that AAC can be measured on vertebral morphometric images obtained by dual-energy X-ray absorptiometry (DXA) and that the presence of AAC independently predicted incident MI, stroke, and cardiovascular events, even after adjusting for traditional cardiovascular risk factors. (22)(23)(24)(25) AAC also has been inversely associated with BMD in many studies. However, in some studies, this relationship did not persist after adjusting for age or other covariates, (26,27) whereas in others, such adjustments did not explain the association.…”

Section: Introductionmentioning

confidence: 99%

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

Wang

Bolland

Pelt

et al. 2010

Journal of Bone and Mineral Research

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Factors involved with calcium metabolism, such as serum calcium and phosphate and calcium intake, have been associated with vascular disease in different populations. We investigated whether this association is mediated via increased vascular calcification by assessing relationships between these factors and abdominal aortic calcification (AAC) and coronary artery calcification (CAC). A total of 1471 healthy postmenopausal women participated in a 5-year randomized, placebo-controlled trial of calcium 1 g/day, and 323 healthy middle-aged and older men participated in a 2-year randomized, placebo-controlled trial of calcium 600 or 1200 mg/day. AAC was assessed on vertebral morphometric images at baseline and follow-up. Based on computed tomography, 163 men had CAC assessed, on average, 1.5 years after study completion. In elderly women, AAC was positively related to serum calcium (p < .001), phosphate (p ¼ .04), and the calcium-phosphate product (p ¼ .003), but changes in AAC over time and incidence of cardiovascular events were not related to these variables. In middle-aged men, AAC and CAC were not consistently related to these variables. Neither dietary calcium intake nor calcium supplementation was associated with changes in the prevalence of AAC over time, and calcium supplementation also was not related to CAC scores in men. After adjusting for age, AAC was not associated with low bone mineral density (BMD) at baseline, changes in BMD over time, or fracture incidence. CAC also was not related to baseline BMD. In summary, serum calcium and phosphate are associated with AAC in older women, but dietary calcium intake and calcium supplementation were not associated with changes in AAC over 2 to 5 years. ß

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

Cited by 116 publications

References 49 publications

Hip fracture and risk of acute myocardial infarction: A nationwide study

Hip fracture and risk of acute myocardial infarction: A nationwide study

Determination and Validation of Aortic Calcification Measurement from Lateral Bone Densitometry in Dialysis Patients

Relationships between vascular calcification, calcium metabolism, bone density, and fractures

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