Abdominal Aortic Calcification Tied to 80% Increase in Risk of CV Events, Death

Josh Lewis, PhD

With many recent studies outlining the potential prognostic value of abdominal aortic calcification (AAC) as seen in noninvasive imaging modalities, results of a meta-analysis and systematic review are providing clinicians with an overview of cardiovascular risk associated with AAC these observational studies.

Insights from the study, which included data from 52 studies completed by March 2018, indicate patients with any or advanced AAC saw their risk of cardiovascular disease events, cardiovascular mortality, and all-cause mortality increase by 80% or more compared to their counterparts without AAC.

"Heart disease is often a silent killer as many people don't know they are at risk or that they have the early warning signs, such as abdominal or coronary artery calcification," said lead investigator Josh Lewis, PhD, associate professor in cardiometabolic health at Edith Cowan University, in a statement. "The abdominal aorta is one of the first sites where the build-up of calcium in the arteries can occur - even before the heart. If we pick this up early, we can intervene and implement lifestyle and medication changes to help stop the condition progressing."

With a growing interest in the potential prognostic value of AAC, Lewis and a team of colleagues sought to compile and assess findings from prospective studies examining AAC and incident cardiovascular events and all-cause mortality. For their study, investigators performed searches of the MEDLINE and Embase databases from inception through 2018 with the aim of identifying cohort or case-control studies reporting associations between AAC and conditions including, coronary heart disease, cerebrovascular disease, heart failure, peripheral arterial disease, and/or all‐cause mortality.

Studies included in the meta-analysis and systematic review evaluated AAC using computed tomography, x-ray, or DXA. Summary risk ratios were estimated using random-effects models comparing the higher AAC groups to groups with the lowest reported AAC.

Overall, investigators identified 458 publications and 52 met inclusion criteria. Of the 52 studies chosen for inclusion, 50 were cohort studies and 2 were case-control studies. From these 52 studies, investigators obtained data related to 46 distinct cohorts and 36,092 individuals. Of note, only studies of patients with chronic kidney disease (57%) and the general older-elderly populations (26%) had sufficient data to include in the meta-analysis.

Upon analysis, results indicated people with any or more advanced AAC had a greater risk of cardiovascular events (RR, 1.83; 95% CI, 1.40-2.39), fatal cardiovascular events (RR, 1.85; 95% CI, 1.44-2.39), and all‐cause mortality (RR, 1.98; 95% CI, 1.55-2.53) compared to those in the lowest group of AAC. Additionally, this risk became greater when assessing risk among patients with chronic kidney disease and any or more advanced AAC, with increased risk noted for cardiovascular events (RR, 3.47; 95% CI, 2.21-5.45), fatal cardiovascular events (RR, 3.68; 95% CI, 2.32-5.84), and all‐cause mortality (RR, 2.40; 95% CI, 1.95-2.97).

"This can signal an early warning for doctors that they need to investigate and assess their patient's risk of heart attack or stroke,” added Lewis. "Ultimately, if we can identify this condition sooner, people can make lifestyle changes and start preventative treatments earlier, which could potentially save many lives in the future."

This study, “Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta‐Analysis of Observational Studies,” was published in the Journal of the American Heart Association.