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Role of abdominal aortic calcification score in predicting cardiovascular risk in the general population
Yinze Ji1, Naqiang Lv1, Yingzhen Gu1
1Premium Care Center, Department of Cardiology, Fuwai Hospital, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, National Center for Cardiovascular Diseases, No.167 North Lishi Road, Xicheng District, Beijing, China.
Insights
Abdominal aortic calcification (AAC) is linked to cardiovascular disease. An AAC score of 6 or higher independently predicts increased risk of cardio-cerebrovascular mortality in middle-aged and elderly individuals.
Area of Science:
- Cardiology
- Gerontology
- Public Health
Background:
- Abdominal aortic calcification (AAC) is associated with cardiovascular disease.
- Its role in cardio-cerebrovascular mortality among the general middle-aged and elderly population requires further investigation.
- Previous research has primarily focused on patients with chronic kidney disease.
Purpose of the Study:
- To investigate the association between abdominal aortic calcification (AAC) and cardio-cerebrovascular mortality.
- To analyze this association in the general middle-aged and elderly population, including age-specific subgroups.
Main Methods:
- Analysis of National Health and Nutrition Examination Survey (NHANES) 2013-2014 data.
- Inclusion of middle-aged and elderly individuals (≥40 years) assessed via dual-energy X-ray absorptiometry.
- Assessment of AAC severity using an AAC scoring system (0-24), with a cut-off of AAC score ≥6 identified as significant.
Main Results:
- A correlation was observed between higher AAC scores and poorer survival rates.
- AAC score ≥6 was identified as an independent predictor of cardio-cerebrovascular mortality (HR: 2.38, P=0.008) after adjusting for risk factors.
- Results remained significant upon regrouping participants (HR: 2.06, P=0.016), with no significant differences between middle-aged and elderly subgroups.
Conclusions:
- An AAC score of 6 or greater independently indicates an elevated risk of cardio-cerebrovascular death.
- AAC scoring is effective for risk stratification in the general middle-aged and elderly population.
- These findings support the clinical utility of AAC assessment in cardiovascular risk evaluation.
Background:
Abdominal aortic calcification (AAC) is closely related to cardiovascular disease. Although its clinical significances have primarily been investigated in patients with chronic kidney disease, its association with cardio-cerebrovascular mortality in the general middle-aged and elderly population has not been sufficiently investigated.
Aims:
To study the association of AAC and cardio-cerebrovascular mortality in both the entire general middle-aged and elderly populations and age subgroups.
Methods:
Data of participants of the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were analyzed. This study included middle-aged and elderly (≥ 40 years old) individuals who underwent dual-energy X-ray absorptiometry. The severity of AAC was assessed by an AAC scoring system (AAC score) with a maximum possible value of 24. Participants were tracked for survival status and major cause of death till 31st December 2019. This study utilized AAC score = 6 as the optimal cut-off according to Harrell's c statistic. Based on AAC scores, participants were trichotomized (0, 0-6, and ≥ 6). Groupwise survival curves and cumulative incidence functions were plotted to reveal the association of AAC and cardio-cerebrovascular mortality. Given results under trichotomization, combination of participants with AAC scores 0 and 0-6 was conducted to reaffirm the association of AAC and adverse prognosis.
Results:
Correlation between increased AAC score and poorer survival, higher cumulative incidence of events was revealed. Cox models identified AAC score ≥ 6 as an independent risk factor of cardio-cerebrovascular mortality (AAC score ≥ 6 vs. AAC score = 0: Hazard ratio: 2.38, P = 0.008) after adjusting for cardiovascular risk factors. Results remained significant after regrouping (AAC score ≥ 6 vs. AAC score < 6: Hazard ratio: 2.06, P = 0.016). Subgroup analysis provided no evidence of unparallel change in hazard for the same amount of increase in AAC score among middle-aged (40-65 years old) and elderly (≥ 65 years old) individuals.
Conclusions:
AAC score ≥ 6 independently indicate increased risk of cardio-cerebrovascular death and would be effective in risk stratification among the general middle-aged and elderly population in clinical practice.
