Abdominal Aortic Calcification Identified on Lateral Spine Images From Bone Densitometers Are a Marker of Generalized Atherosclerosis in Elderly Women.
OBJECTIVE
Dual-energy x-ray absorptiometry is a low-cost, minimal radiation technique used to improve fracture prediction. Dual-energy x-ray absorptiometry machines can also capture single-energy lateral spine images, and abdominal aortic calcification (AAC) is commonly seen on these images.


APPROACH AND RESULTS
We investigated whether dual-energy x-ray absorptiometry-derived measures of AAC were related to an established test of generalized atherosclerosis in 892 elderly white women aged >70 years with images captured during bone density testing in 1998/1999 and B-mode carotid ultrasound in 2001. AAC scores were calculated using a validated 24-point scale into low (AAC24 score, 0 or 1), moderate (AAC24 scores, 2-5), and severe AAC (AAC24 scores, >5) seen in 45%, 36%, and 19%, respectively. AAC24 scores were correlated with mean and maximum common carotid artery intimal medial thickness (rs=0.12, P<0.001 and rs=0.14, P<0.001). Compared with individuals with low AAC, those with moderate or severe calcification were more likely to have carotid atherosclerotic plaque (adjusted prevalence ratio (PR), 1.35; 95% confidence interval, 1.14-1.61; P<0.001 and prevalence ratio, 1.94; 95% confidence interval, 1.65-2.32; P<0.001, respectively) and moderate carotid stenosis (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.39-3.54; P=0.001 and adjusted prevalence ratio, 4.82; 95% confidence interval, 3.09-7.050; P<0.001, respectively). The addition of AAC24 scores to traditional risk factors improved identification of women with carotid atherosclerosis as quantified by C-statistic (+0.075, P<0.001), net reclassification (0.249, P<0.001), and integrated discrimination (0.065, P<0.001).


CONCLUSIONS
AAC identified on images from a dual-energy x-ray absorptiometry machine were strongly related to carotid ultrasound measures of atherosclerosis. This low-cost, minimal radiation technique used widely for osteoporosis screening is a promising marker of generalized extracoronary atherosclerosis.
['Lewis|Joshua R|JR|', 'Schousboe|John T|JT|', 'Lim|Wai H|WH|', 'Wong|Germaine|G|', 'Zhu|Kun|K|', 'Lim|Ee M|EM|', 'Wilson|Kevin E|KE|', 'Thompson|Peter L|PL|', 'Kiel|Douglas P|DP|', 'Prince|Richard L|RL|']
D015502:Absorptiometry, Photon D000368:Aged D001012:Aorta, Abdominal D001018:Aortic Diseases D001027:Aortography D050197:Atherosclerosis D002340:Carotid Artery Diseases D017536:Carotid Artery, Common D059168:Carotid Intima-Media Thickness D005260:Female D006801:Humans D033162:Incidental Findings D010024:Osteoporosis D058226:Plaque, Atherosclerotic D011237:Predictive Value of Tests D015995:Prevalence D011379:Prognosis D016032:Randomized Controlled Trials as Topic D015203:Reproducibility of Results D012307:Risk Factors D012720:Severity of Illness Index D013131:Spine D061205:Vascular Calcification D014904:Western Australia
atherosclerosis bone density common carotid artery osteoporosis cardiovascular disease