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

Abstract

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.

Pulse pressure and aortic calcification: Did we learn something?

“…For this analysis, the anterior and posterior aortic walls were separated into four segments, corresponding to the areas of the lumbar vertebrae (L1‐L4). Within each of these eight segments, aortic calcification was visually estimated with a score ranging from 0 to 24 7 . This illustrates the potential limitation in assessment of AAC and unrecognizing small calcifications that could be prevalent in general population that has been described in the present study.…”

“…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.…”

“…There was no difference in prevalence of hypertension, diabetes, high cholesterol, and family history of myocardial infarction in patients <60 years old. Smoking status and PP were the only two parameters that differed between patients with AAC and those without AAC in the population below 60 years 7 . More parameters were responsible for AAC in the participants older than 60 years.…”

“…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).…”

“…Heffernan et al 7 used 24‐point semiquantitative score on DXA. For this analysis, the anterior and posterior aortic walls were separated into four segments, corresponding to the areas of the lumbar vertebrae (L1‐L4).…”