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Published on: May 31, 2016
Aortic and Iliac Calcifications as Predictors of Aortic Dissection, Aneurysm Rupture, and Peripheral Vascular
Cecilie Skov Petersen1, Zuzanna Karon1, Lasse M Obel2,3
1Departments of Cardiology (C.S.P., Z.K., S.H., M.S., A.C.P.D.), Odense University Hospital, Odense, Denmark.
Insights
Severe aortic and iliac calcification significantly increases the risk of aortic events and major adverse limb events (MALEs). Quantifying this calcification may improve risk assessment for patients with aortic aneurysm or peripheral artery disease.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Epidemiology
Background:
- Limited evidence exists on the link between aortic and iliac calcification and major adverse cardiovascular outcomes.
- Aortic events include aortic dissection or aneurysm rupture.
- Major adverse limb events (MALEs) encompass peripheral revascularization and lower limb amputation.
Purpose of the Study:
- To investigate the association between aortic and iliac calcifications and aortic events.
- To examine the association between aortic and iliac calcifications and MALEs.
Main Methods:
- Population-based prospective cohort study using data from the Danish Cardiovascular Screening (DANCAVAS) trials.
- Thoracoabdominal aortic computed tomography scans were used to measure calcification in a 5-segment model.
- Competing risk hazard regression models were employed, adjusting for demographics and cardiovascular risk factors.
Main Results:
- Over 13,000 participants were followed for a mean of 8 years.
- Severe calcification in the abdominal aorta and iliac arteries showed a significantly increased risk for aortic events (SHR 7.61 and 13.52, respectively).
- Calcification in all aortic segments and iliac arteries was strongly associated with increased risk of MALEs.
Conclusions:
- Severe aortic and iliac calcification is linked to a substantially higher risk of aortic events and MALEs.
- Quantifying aortic calcification can offer valuable prognostic insights.
- This quantification may enhance risk stratification for patients with aortic aneurysm or peripheral artery disease.
Background:
There is limited evidence of the relationship between aortic and iliac calcification and aortic events (aortic dissection or aneurysm rupture) and major adverse limb events (MALEs; peripheral revascularization and lower limb amputation). The aim of this population-based prospective cohort study was to investigate the association of aortic and iliac calcifications with aortic events and MALEs.
Methods:
All participants from the DANCAVAS (Danish Cardiovascular Screening) trials who received a full thoracoabdominal aortic computed tomography scan with recorded measurements of aortic and iliac calcification were included. The aorta and iliac artery calcifications were measured in a 5-segment model and categorized into quartiles, apart from the ascending aorta, which was categorized into 4 exposure groups, as the majority of participants had no calcification in the ascending aorta. The participants were followed from inclusion in the DANCAVAS trial until aortic events, MALE, death, or end of follow-up on May 1, 2025. We used a competing risk hazard regression model adjusted for demographics, cardiovascular risk factors, aortic diameter, and ankle-brachial index.
Results:
In total, 13 065 participants were included in this study (94% men; mean age, 67±4 years). Participants were followed for a mean of 8 years, during which 42 experienced an aortic event, and 311 experienced a MALE. The analyses of the aortic event outcome showed significantly increased subdistribution hazard ratios (SHRs) when having calcification scores in the fourth group or quartile for the ascending and abdominal aorta (SHR, 3.06 [95% CI, 1.15-8.16]; SHR, 7.61 [95% CI, 1.44-40.22], respectively). Calcification scores in the fourth group or quartile were strongly associated with MALEs in all segments: ascending aorta (SHR, 2.20 (95% CI, 1.56-3.10]), aortic arch (SHR, 6.49 [95% CI, 3.10-13.56]), descending aorta (SHR, 2.43; [95% CI, 1.45-4.08]), abdominal aorta (SHR, 7.89 [2.95-21.15]), and iliac arteries (SHR, 13.52 [95% CI, 4.32-42.24]).
Conclusions:
Severe aortic and iliac calcification was associated with significantly higher risk of aortic events and MALEs, suggesting that quantifying aortic calcification may provide valuable prognostic information and potentially improve the risk stratification in patients with aortic aneurysm or peripheral artery disease.
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