Schousboe John T, Richter Sara A, Beran Mary Sue
HealthPartners Institute, HealthPartners, Bloomington, MN, USA; Park Nicollet Osteoporosis Center, Park Nicollet Clinic, HealthPartners, Minneapolis, MN, USA; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
Professional Data Analysts, Inc, Minneapolis, MN, USA.
J Clin Densitom. 2016 Oct;19(4):436-443. doi: 10.1016/j.jocd.2016.06.002. Epub 2016 Jul 8.
Abdominal aortic calcification (AAC) predicts incident atherosclerotic cardiovascular disease (ASCVD) events and can be accurately identified on densitometric lateral spine images obtained at the time of bone densitometry. Our objective was to estimate the proportion of patients referred for bone densitometry who have a high level of AAC and are not already known to have ASCVD or to be at high risk for ASCVD. AAC was scored on densitometric lateral spine images of 2168 individuals blinded to clinical diagnoses or risk factors using the 24-point Framingham scale. We ascertained preexisting ASCVD diagnoses and risk factors using electronic health record data. We used the risk calculator of the American Heart Association (AHA) and the American College of Cardiology (ACC) to estimate the 10-yr risk of hard ASCVD outcomes (myocardial infarction, death caused by coronary heart disease, or nonfatal or fatal stroke). A high level of AAC (AAC score ≥5) was present in 41 (6.1%, 95% confidence interval [CI]: 4.4%-8.2%) of those aged less than 65 yr, in 253 (23.1%, 95% CI: 20.7%-25.7%) of those aged 65-74 yr, and in 153 (37.8%, 95% CI: 33.0%-42.7%) of those aged 75-80 yr. Among those aged 65-74 yr, 16.9% (95% CI: 14.7%-19.3%) had a high level of AAC and no prior clinical diagnosis of ASCVD, but only 2.4% had a high level of AAC and a predicted 10-yr risk of hard ASCVD outcomes <7.5%. AAC is common among those aged 65 yr and older who were referred for bone densitometry and had no known ASCVD, although these individuals can also be recognized as being at intermediate to high risk using the AHA-ACC ASCVD risk calculator. Further studies regarding the impact of identification of AAC on provider and patient cardiovascular disease risk management choices are warranted.
腹主动脉钙化（AAC）可预测动脉粥样硬化性心血管疾病（ASCVD）事件的发生，并且可以在骨密度测量时获取的脊柱侧位密度图像上准确识别。我们的目的是估计因骨密度测量而转诊的患者中，AAC水平较高且尚未被诊断为ASCVD或处于ASCVD高风险的患者比例。使用24分的弗雷明汉量表，对2168名对临床诊断或危险因素不知情的个体的脊柱侧位密度图像进行AAC评分。我们利用电子健康记录数据确定已有的ASCVD诊断和危险因素。我们使用美国心脏协会（AHA）和美国心脏病学会（ACC）的风险计算器来估计10年发生严重ASCVD结局（心肌梗死、冠心病死亡、非致命或致命性卒中）的风险。在年龄小于65岁的人群中，41人（6.1%，95%置信区间[CI]：4.4%-8.2%）存在高水平的AAC；在65-74岁的人群中，253人（23.1%，95%CI：20.7%-25.7%）存在高水平的AAC；在75-80岁的人群中，153人（37.8%，95%CI：33.0%-42.7%）存在高水平的AAC。在65-74岁的人群中，16.9%（95%CI：14.7%-19.3%）存在高水平的AAC且既往无ASCVD临床诊断，但只有2.4%存在高水平的AAC且预测10年发生严重ASCVD结局的风险<7.5%。在因骨密度测量而转诊且无已知ASCVD的65岁及以上人群中，AAC很常见，尽管使用AHA-ACC ASCVD风险计算器也可将这些个体识别为中高风险。有必要进一步研究识别AAC对医疗服务提供者和患者心血管疾病风险管理选择的影响。
