Department of Medicine, University of Auckland, Auckland, New Zealand.
J Bone Miner Res. 2010 Mar;25(3):505-12. doi: 10.1359/jbmr.091005.
Abdominal aortic calcification (AAC) measured on spine X-rays is an established risk factor for cardiovascular disease. We investigated whether AAC assessed using vertebral morphometry and a recently developed scoring system (AAC-8) is reliable and associated with cardiovascular risk factors or events. A total of 1471 healthy postmenopausal women and 323 healthy middle-aged and older men participated in 5 and 2 year trials of calcium supplements, respectively. AAC-8 was assessed on vertebral morphometry images at baseline and follow-up. In addition, 163 men also had coronary artery calcification measured using computed tomography. Cardiovascular events during the trials were independently adjudicated. We found strong inter- and intrameasurer agreement for AAC-8 (kappa > 0.87). The prevalence of AAC increased with age (p < .01) in women and in men. AAC was associated with many established cardiovascular risk factors, with serum calcium in women (p = .002) and with higher coronary calcium scores in men (p = .03). Estimated 5 year cardiovascular risk increased with increasing AAC-8 score (p < .001) in women and in men. The presence of AAC independently predicted myocardial infarction (MI) in women [hazards ratio (HR) = 2.30, p = .007] and men (HR = 5.32, p = .04), even after adjustment for estimated cardiovascular risk in women. In women, AAC independently predicted cardiovascular events (MI, stroke, or sudden death) (HR = 1.74, p = .007), and changes in AAC-8 score over time were associated with MI and cardiovascular events, even after adjustment for estimated cardiovascular risk. In summary, scoring AAC on vertebral morphometric scans is a reproducible method of assessing cardiovascular risk that independently predicts incident MI and cardiovascular events, even after taking into account traditional cardiovascular risk factors.
脊柱 X 光片上测量的腹主动脉钙化 (AAC) 是心血管疾病的既定危险因素。我们研究了使用椎体形态计量学和最近开发的评分系统 (AAC-8) 评估的 AAC 是否可靠，以及与心血管危险因素或事件是否相关。共有 1471 名健康绝经后妇女和 323 名健康中年及以上男性分别参加了为期 5 年和 2 年的钙补充剂试验。在基线和随访时，使用椎体形态计量图像评估 AAC-8。此外，163 名男性还接受了冠状动脉钙化的计算机断层扫描检查。试验期间的心血管事件由独立裁判裁决。我们发现 AAC-8 的观察者间和观察者内一致性很强（kappa > 0.87）。在女性和男性中，AAC 的患病率随着年龄的增长而增加（p <.01）。AAC 与许多已确立的心血管危险因素相关，在女性中与血清钙相关（p =.002），在男性中与较高的冠状动脉钙评分相关（p =.03）。在女性和男性中，随着 AAC-8 评分的增加，估计的 5 年心血管风险增加（p <.001）。AAC 的存在独立预测了女性的心肌梗死 (MI)（风险比 [HR] = 2.30，p =.007）和男性（HR = 5.32，p =.04），即使在调整女性估计心血管风险后也是如此。在女性中，AAC 独立预测了心血管事件（MI、中风或猝死）（HR = 1.74，p =.007），即使在调整估计心血管风险后，AAC-8 评分随时间的变化也与 MI 和心血管事件相关。总之，在椎体形态计量扫描上对 AAC 进行评分是一种评估心血管风险的可重复方法，可独立预测 MI 事件和心血管事件的发生，即使考虑到传统的心血管危险因素也是如此。
