Abdominal aortic calcification on vertebral morphometry images predicts incident myocardial infarction

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

Section: Discussionmentioning

confidence: 85%

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

Chiang

Liu

Chen

et al. 2012

“…(25) The mean baseline serum total calcium and phosphate concentrations and calcium-phosphate product were significantly higher in women with baseline AAC than in those without baseline AAC (p < .001, p ¼ .04, and p ¼ .003, respectively; Table 2). Figure 1 shows that, across quartiles of total serum calcium at baseline, the proportion of women with AAC increased linearly at baseline (p < .001) and at 5 years (p < .001).…”

Section: Womenmentioning

confidence: 95%

“…Full details of the method have been published previously, including details of the inter-and intrameasurer agreements. (25) Coronary calcium scores (CAC)…”

Section: Abdominal Aortic Calcification Scoringmentioning

confidence: 99%

“…(10) Briefly, participants were seen 6-monthly during the trials, and adverse events were inquired after and recorded, but questions about specific symptoms were not asked. Standard definitions of MI and stroke were used, (10,25) and all self-reported events were verified independently from review of medical records.…”

Section: Cardiovascular Event Assessmentmentioning

confidence: 99%

“…(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%

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

Wang

Bolland

Pelt

et al. 2010

Self Cite

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

Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study

Lewis

Schousboe

Lim

et al. 2018

Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45%) had low AAC (AAC24 score 0 or 1), 387 (37%) moderate AAC (AAC24 score 2-5), and 197 (19%) had high AAC (AAC24 score ≥6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37%, 39%, and 49%, respectively, p = 0.008 for trend), ASVD deaths (15%, 21%, and 27%, respectively, p < 0.001 for trend), and all-cause mortality (30%, 38%, and 44%, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95% CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95% CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95% CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95% CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95% CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long-term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies. © 2018 American Society for Bone and Mineral Research.