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Updated: Nov 21, 2025

Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
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Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta-Analysis of Observational Studies

Kevin Leow1, Pawel Szulc2, John T Schousboe3,4

  • 1Centre for Kidney Research School of Public Health Faculty of Medicine and Health Children's Hospital at WestmeadThe University of Sydney New South Wales Australia.

Journal of the American Heart Association
|January 13, 2021
PubMed

Insights

Abdominal aortic calcification (AAC) significantly increases the risk of cardiovascular events and mortality in older adults and those with chronic kidney disease. Identifying AAC aids in better cardiovascular risk management.

Area of Science:

  • Cardiovascular epidemiology
  • Medical imaging
  • Nephrology

Background:

  • The prognostic significance of abdominal aortic calcification (AAC) detected via noninvasive imaging is not well-established.
  • Previous research has yielded uncertain conclusions regarding the predictive value of AAC for cardiovascular outcomes.

Purpose of the Study:

  • To systematically evaluate the prognostic importance of abdominal aortic calcification (AAC) for cardiovascular events and all-cause mortality.
  • To synthesize evidence from prospective studies to clarify the association between AAC and adverse health outcomes.

Main Methods:

  • A comprehensive meta-analysis was conducted by searching MEDLINE and Embase databases up to March 2018.
  • Data from 52 prospective studies (36,092 participants) were analyzed, focusing on populations with chronic kidney disease and elderly individuals.
  • Random-effects models were used to estimate summary risk ratios (RRs) comparing higher AAC groups to the lowest AAC group.

Main Results:

  • Individuals with any or more advanced AAC exhibited a significantly higher risk of cardiovascular events (RR, 1.83), fatal cardiovascular events (RR, 1.85), and all-cause mortality (RR, 1.98).
  • Patients with chronic kidney disease and AAC showed a markedly elevated risk of cardiovascular events (RR, 3.47), fatal cardiovascular events (RR, 3.68), and all-cause mortality (RR, 2.40).
  • The meta-analysis was primarily feasible for elderly populations and those with chronic kidney disease.

Conclusions:

  • Abdominal aortic calcification is a significant predictor of adverse cardiovascular outcomes and mortality, particularly in high-risk groups.
  • Elderly individuals and patients with chronic kidney disease presenting with AAC face substantially greater risks of future cardiovascular events and poorer prognosis.
  • Assessing AAC can enhance clinicians' understanding and management of cardiovascular risk in these patient populations.

Keywords:
abdominal aortic calcificationall‐cause mortalitycardiovascular events and deathschronic kidney diseasegeneral population

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