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Published on: May 31, 2016
Calcified atherosclerosis in different vascular beds and the risk of mortality
Matthew A Allison1, Stephanie Hsi, Christina L Wassel
1Department of Family and Preventive Medicine, University of California San Diego, USA. mallison@ucsd.edu
Insights
Calcified atherosclerosis in the thoracic aorta, carotids, and iliac arteries increases total mortality risk. Coronary artery calcium predicts cardiovascular disease mortality, highlighting location-specific risks.
Area of Science:
- Cardiovascular imaging and epidemiology.
- Atherosclerosis research.
- Mortality risk stratification.
Background:
- Calcified atherosclerosis is a marker of cardiovascular disease.
- The prognostic value of calcification varies by vascular bed.
- Understanding these differences can improve risk prediction.
Purpose of the Study:
- To investigate the association between calcified atherosclerosis in different vascular beds and total and cause-specific mortality.
- To determine if calcification location and severity provide unique mortality information.
- To compare the predictive value of coronary versus non-coronary calcifications.
Main Methods:
- Retrospective analysis of 4544 patients undergoing computed tomography (CT) scans.
- Assessment of calcified atherosclerosis in thoracic aorta, carotids, iliac, and coronary arteries.
- Mortality data obtained via death certificate adjudication over an average follow-up of 7.8 years.
Main Results:
- Thoracic aorta, carotid, and iliac artery calcification were associated with increased total mortality (HRs 2.1, 1.60, 1.67, respectively).
- Coronary artery calcium was associated with cardiovascular disease mortality (HR 3.4).
- Iliac artery calcification severity was the strongest predictor for all mortality types; non-coronary beds did not significantly improve risk models.
Conclusions:
- The relationship between calcified atherosclerosis and mortality is vascular bed-dependent.
- Location and severity of arterial calcification offer distinct prognostic information.
- Integrating calcification data from multiple vascular beds may enhance mortality risk assessment.
Objective:
The goal of this study was to determine differences in risks for total and cause-specific mortality related to calcified atherosclerosis in different vascular beds.
Methods And Results:
A total of 4544 patients underwent computed tomography scans that were interrogated for calcium in different vascular beds. Mortality assessment was conducted by death certificate adjudication. At baseline, the mean age was 56.8 years, and 43% were female. After an average of 7.8 years, there were 163 deaths. With full adjustment, the presence of calcium in the thoracic aorta (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.2-3.5), carotids (HR, 1.60; CI, 1.1-2.5), and iliac (HR, 1.67; CI, 1.0-2.9) arteries were associated with total mortality, whereas the presence of coronary calcium was associated with cardiovascular disease (CVD) mortality (HR, 3.4; CI, 0.8-10.9). For severity of calcium burden, a 1-SD increment in the iliac arteries was the strongest predictor for all types of mortality. C-statistics were not significantly larger when noncoronary vascular beds were added to models with CVD risk factors or CVD risk factors plus coronary artery calcium.
Conclusions:
The associations between calcified atherosclerosis and mortality differ by vascular bed, suggesting that the location and severity of calcification in different vascular beds provide unique information for mortality.
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