Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

Abstract

Background— Atherosclerosis is a major contributor to global morbidity and mortality. Although atherosclerosis is a systemic disease, its burden varies considerably across vessel beds, which may translate into differences in mortality risk. Methods and Results— From 2003 to 2006, a sample of 2408 elderly participants (mean age, 69.6±6.7 years; 52.4% female) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. Mortality follow-up was complete until January 1, 2012. We investigated associations of calcification in each vessel bed with mortality using Cox regression, adjusting for age, sex, and cardiovascular risk factors. Next, all vessel beds were included into 1 model to investigate independency of associations. Finally, we investigated the predictive value of calcification beyond the predictors included in the Pooled Cohort equations. During 15 775 person-years of follow-up, 283 participants died. Larger calcification volumes in all vessels were related to higher risks of all-cause mortality, cardiovascular, and noncardiovascular mortality, independent of cardiovascular risk factors. Most prominent associations were found for aortic arch calcification and cardiovascular mortality (age- and sex-adjusted hazard ratio per 1-SD increase 2.72 [95% confidence interval, 1.85–4.02]), independent of calcification elsewhere (hazard ratio, 1.75 (95% confidence interval, 1.13–2.72]). Calcification in any vessel improved prediction for all 3 outcomes. Conclusions— Atherosclerotic load in major vessel beds is associated with an increased risk of death. In particular, aortic arch calcification volume yields unique information with regard to mortality in addition to atherosclerosis in other vessel beds.

Aortic Atheroma Increases the Risk of Long-Term Mortality in 20,000 Patients

“…(16) Nonetheless, we found an equally strong association between the ascending and descending aortic atheroma and risk of mortality.…”

“…(15) Atherosclerotic load in major vessel beds is associated with an increased risk of death. (16) When comparing atheromatous disease in the coronary arteries, aortic arch, extracranial carotid arteries, and intracranial carotid, Bos. et al found that aortic arch atherosclerosis was found to be associated with the greatest increase in mortality.…”

Density of calcium in the ascending thoracic aorta and risk of incident cardiovascular disease events

“…Prior studies have demonstrated the important role of calcification in the aortic arch and descending thoracic aorta. 3,23 Furthermore, many associations that were observed were of borderline or no statistical significance, possibly due to the small sample size of participants with ATAC and insufficient statistical power. Second, in the Agatston method, density scores are arbitrarily capped at a maximum value of 4, potentially underestimating the inverse association of ATAC density with CHD and CVD in plaques of attenuation in excess of 400 HU.…”

Nontraditional Risk Factors in Cardiovascular Disease Risk Assessment

“…Evidence for the harms of nontraditional risk factor assessment was limited to 8 studies evaluating CAC score; no eligible studies evaluated the potential harms of the ABI or hsCRP level. Four studies reported radiation exposure for CT imaging to obtain CAC score, 43,55,62,75 and 5 studies reported other potential adverse events from CAC score measurement such as psychological outcomes, adverse cardiovascular events, and health care utilization. 45,66,67,75,80 Overall, the radiation exposure or effective radiation dose per CT examination is low: 2 mSv or less.…”