Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance

Schousboe, John T.; Lewis, Joshua R.; Kiel, Douglas P.

doi:10.1016/j.bone.2017.01.025

Cited by 58 publications

(47 citation statements)

References 76 publications

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“…Use of DXA to assess AAC is attractive for many reasons including its minimal radiation exposure, lower cost, lower time burden, and ability to provide additional important health metrics including lean tissue mass (with implications for sarcopenia and frailty), visceral adiposity (with implications for central obesity and cardiometabolic disease), and bone density (with implications for osteopenia, osteoporosis, and fracture risk) 5 . DXA‐derived AAC measures have good levels of agreement with measures obtained from radiography and CT and show high inter‐rater and intra‐rater reliability 5 . According to our results from NHANES, AAC as assessed via DXA is associated with PP, an established measure of CVD risk.…”

Section: Discussionmentioning

confidence: 99%

“…Dual‐energy X‐ray absorptiometry (DXA) is conventionally used to measure bone density and body composition but also allows for measurement of abdominal aortic calcification (AAC) 4 . Measuring AAC with DXA is advantageous due to availability, lower radiation exposure, and lower cost 5 . Vascular calcification is a systemic process and AAC has been shown to associate with calcification and subclinical atherosclerosis in other vascular beds and is also a predictor of CVD events 6‐8 …”

Section: Introductionmentioning

confidence: 99%

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Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013‐2014

Heffernan

Barreira

2020

J of Clinical Hypertension

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Dual-energy X-ray absorptiometry (DXA) is a low-cost, minimal radiation technique commonly used to assess bone density and body composition that can also provide a measure of abdominal aortic calcification (AAC). We examined the association between pulse pressure (PP) and DXA-derived AAC in a nationally representative sample of US adults. Analyses were performed in 2,478 adults from the 2013-2014 NHANES cycle. AAC scores were calculated using a validated 24-point scale from thoraco-lumbar spine images (scored 1-6 across four vertebral heights from L1-L4 for both anterior and posterior aortic walls). We examined PP as a predictor of both the presence (dichotomous) and magnitude (continuous) of AAC in age-stratified analyses (<60 years of age and ≥60 years of age) adjusting for traditional cardiovascular disease risk factors, sex, mean arterial pressure and additionally for age and antihypertensive medication. The prevalence of AAC was 25.5%. PP was a predictor of the presence of AAC in fully adjusted models in adults <60 years of age (OR 1.31, P < .05) and ≥60 years of age (OR 1.33, P < .05). PP was also associated with the magnitude of AAC in the overall sample but did not retain significance after separating by agegroups and additionally adjusting for antihypertensive medication. In conclusion, PP is associated with the presence of AAC as measured by DXA in a nationally representative sample of US adults.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013‐2014

Heffernan

Barreira

2020

J of Clinical Hypertension

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“…In this article, we explore the hypothesis that the presence and severity of AAC is related to bone structure, prevalent fractures, and incident fractures using the same population in which we previously identified an association between AAC and CVD . To do this, we used lateral spine imaging undertaken at the time of bone density testing …”

Section: Introductionmentioning

confidence: 99%

Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women

Lewis

Eggermont

Schousboe

et al. 2019

Journal of Bone and Mineral Research

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Although a relationship between vascular disease and osteoporosis has been recognized, its clinical importance for fracture risk evaluation remains uncertain. Abdominal aortic calcification (AAC), a recognized measure of vascular disease detected on single‐energy images performed for vertebral fracture assessment, may also identify increased osteoporosis risk. In a prospective 10‐year study of 1024 older predominantly white women (mean age 75.0 ± 2.6 years) from the Perth Longitudinal Study of Aging cohort, we evaluated the association between AAC, skeletal structure, and fractures. AAC and spine fracture were assessed at the time of hip densitometry and heel quantitative ultrasound. AAC was scored 0 to 24 (AAC24) and categorized into low AAC (score 0 and 1, n = 459), moderate AAC (score 2 to 5, n = 373), and severe AAC (score >6, n = 192). Prevalent vertebral fractures were calculated using the Genant semiquantitative method. AAC24 scores were inversely related to hip BMD ( r s = –0.077, p = 0.013), heel broadband ultrasound attenuation ( r s = –0.074, p = 0.020), and the Stiffness Index ( r s = –0.073, p = 0.022). In cross‐sectional analyses, women with moderate to severe AAC were more likely to have prevalent fracture and lumbar spine imaging‐detected lumbar spine fractures, but not thoracic spine fractures (Mantel‐Haenszel test of trend p < 0.05). For 10‐year incident clinical fractures and fracture‐related hospitalizations, women with moderate to severe AAC (AAC24 score >1) had increased fracture risk (HR 1.48; 95% CI, 1.15 to 1.91; p = 0.002; HR 1.46; 95% CI, 1.07 to 1.99; p = 0.019, respectively) compared with women with low AAC. This relationship remained significant after adjusting for age and hip BMD for clinical fractures (HR 1.40; 95% CI, 1.08 to 1.81; p = 0.010), but was attenuated for fracture‐related hospitalizations (HR 1.33; 95% CI, 0.98 to 1.83; p = 0.073). In conclusion, older women with more marked AAC are at higher risk of fracture, not completely captured by bone structural predictors. These findings further support the concept that vascular calcification and bone pathology may share similar mechanisms of causation that remain to be fully elucidated © 2019 American Society for Bone and Mineral Research

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“…Abdominal CT represents the best imaging modality for quantification of abdominal aortic calcification (AAC). However, dual‐energy X‐ray absorptiometry (DXA) could also provide semiquantitative measurement of AAC 4 …”

mentioning

confidence: 99%

“…There are several semiquantitative methods for AAC assessment: (a) 24‐point or simplified 8‐point semiquantitative scoring method developed in the Framingham study; (b) Rotterdam scale; and (c) Mayo scale 4 . However, only the first scale has been validated.…”

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confidence: 99%

Pulse pressure and aortic calcification: Did we learn something?

Tadić

Cuspidi

2020

J of Clinical Hypertension

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Atherosclerosis is systemic vascular disease which affects the whole vascular bed, with some variations and predilection places.Calcification is a key component of atherosclerotic process.Coronary calcification could be easily quantified using computed tomography (CT) and estimated by coronary calcium score that represents an important predictor of cardiovascular morbidity and mortality. 1 Calcification of abdominal aorta has not been established as independent cardiovascular risk factor yet. However, studies showed that abdominal aortic calcification was related to cardiovascular events including myocardial infarction, stroke, heart failure, and cardiovascular mortality. 2-3 Abdominal CT represents the best imaging modality for quantification of abdominal aortic calcification (AAC). However, dual-energy X-ray absorptiometry (DXA) could also provide semiquantitative measurement of AAC. 4 Pulse pressure (PP) represents an important predictor of cardiovascular mortality, stroke, and cognitive decline. 5 The clinical significance of PP is still controversial because recent study showed that the young patients with highest PP had the lowest risk of incident hypertension. 6 In the current issue of the Journal, Heffernan et al 7 presented data from the National Health and Nutrition Examination Survey 2013-2014 and reported that PP was a predictor of the presence of AAC in fully adjusted models in adult US population. In the partial statistical model which did not include age and BP medications showed that systolic BP, diastolic BP, and PP were associated with AAC in patients in both age groups (>60 and <60 years old).However, after adjustment for age and antihypertensive therapy only PP remained associated with AAC in the whole population.Results regarding AAC score were different. The investigators revealed that only PP, but not SBP and DBP, was associated with AAC score in partial statistical model, but even is significance vanished after adjustment for age and antihypertensive medications. 7 There are several important points of this investigation that deserve further discussion.Abdominal aortic calcification is an active pathophysiological process, which is associated with advancing age, smoking, chronic inflammatory disorders, metabolic disorders, and chronic renal disease. 8 There are two types of AAC: (a) atherosclerotic or intimal calcifications and (b) non-atherosclerotic medial calcific sclerosis. Arterial intimal calcification is associated with lipid accumulations and increased macrophages activity within advanced atheromatous lesions. Medial calcifications are the result of degeneration of the vascular smooth muscle cells and calcification of the elastin fibrils. 8 The later is frequently seen in patients with advanced age, type II diabetes, and chronic renal disease. However, it is unclear if the presence of both forms of calcification within the abdominal aorta is consequence of common risk factors or other local and systemic factors. Even though DXA represents widely available imaging methods, there ...

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Abdominal aortic calcification on dual-energy X-ray absorptiometry: Methods of assessment and clinical significance

Cited by 58 publications

References 76 publications

Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013‐2014

Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013‐2014

Association Between Abdominal Aortic Calcification, Bone Mineral Density, and Fracture in Older Women

Pulse pressure and aortic calcification: Did we learn something?

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