High rate of abdominal aortic calcification in COPD patients and its relationship with musculoskeletal fragility

A prospective cohort study on the joint associations of abdominal aortic calcification and systemic inflammation response index with mortality risk

Abdominal aortic calcification (AAC) and the systemic inflammation response index (SIRI) have been linked to both all-cause and cardiovascular disease (CVD)-related mortality. Whether combining AAC and SIRI improves the predictive ability for adverse outcomes remains poorly unexplored. The present study aims to investigate the joint associations of AAC and SIRI with the risk of all-cause and CVD-related mortality in the general population. This prospective cohort study included participants with AAC and SIRI data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Primary outcomes were death from any cause (all-cause mortality) and heart or cerebrovascular diseases (CVD-related mortality). AAC was categorized into three groups based on the AAC score: non-AAC (score = 0), low- moderate AAC (score > 0 and < 5), and severe AAC (score ≥ 5). SIRI ( x 109/L) was stratified by tertiles. Multivariable Cox regression analyses and competing risk models were employed to examine the individual associations of AAC and SIRI with the risk of all-cause and CVD-related mortality. Participants were further divided into four groups according to AAC (presence or absence) and SIRI (≤ or > median) to explore their joint association. A total of 2159 participants with a median age of 55 years were included in this study. 1031 (47.8%) were males and 1128 (52.2%) were females. For race, 317 (14.7%) were mexican american, 226 (10.5%) were other hispanic, 878 (40.7%) were white, 431 (20.0%) were black, and 307 (14.2%) were other race. During a median of 73 months follow-up, 119 deaths were recorded, 41 of which were CVD-related cases. AAC was presented in 553 participants (355 with low-moderate AAC and 198 with severe AAC), and the median SIRI was 1.05 × 109/L. After adjusting for potential confounding factors, AAC and SIRI were significantly associated with the risks of all-cause (AAC: HRsevere AAC vs. non-AAC = 2.903, 95% CI: 1.855 ~ 4.543, p for trend < 0.001; SIRI: HRtertile 3 vs. tertile 1 = 2.077, 95% CI: 1.264 ~ 3.411, p for trend = 0.001) and CVD-related death (AAC: HRsevere AAC vs. non-AAC = 4.579, 95% CI: 2.019 ~ 10.381, p for trend < 0.001; SIRI: HRtertile 3 vs. tertile 1 = 3.215, 95% CI: 1.253 ~ 8.246, p for trend = 0.006). These associations remained statistically significant even after mutual adjustment. Participants with both AAC presence and elevated SIRI had higher risk of adverse outcomes. Severe AAC and elevated SIRI were independently associated with an increased risk of all-cause and CVD-related mortality in the general population. Notably, individuals with both AAC presence and increased SIRI exhibited the greatest mortality risk. The combined assessment of AAC and SIRI may provide novel predictive value, offering a more comprehensive approach to identifying high-risk individuals and refining risk stratification strategies.

FRAX predicts cardiovascular risk in women undergoing osteoporosis screening: the Manitoba bone mineral density registry

Osteoporosis and cardiovascular disease (CVD) are highly prevalent in older women, with increasing evidence for shared risk factors and pathogenesis. Although FRAX was developed for the assessment of fracture risk, we hypothesized that it might also provide information on CVD risk. To test the ability of the FRAX tool and FRAX-defined risk factors to predict incident CVD in women undergoing osteoporosis screening with DXA, we performed a retrospective prognostic cohort study which included women aged 50 yr or older with a baseline DXA scan in the Manitoba Bone Mineral Density Registry between March 31, 1999 and March 31, 2018. FRAX scores for major osteoporotic fracture (MOF) were calculated on all participants. Incident MOF and major adverse CV events (MACE; hospitalized acute myocardial infarction [AMI], hospitalized non-hemorrhagic cerebrovascular disease [CVA], or all-cause death) were ascertained from linkage to population-based healthcare data. The study population comprised 59 696 women (mean age 65.7 ± 9.4 yr). Over mean 8.7 yr of observation, 6021 (10.1%) had MOF, 12 277 women (20.6%) had MACE, 2274 (3.8%) had AMI, 2061 (3.5%) had CVA, and 10 253 (17.2%) died. MACE rates per 1000 person-years by FRAX risk categories low (10-yr predicted MOF <10%), moderate (10%-19.9%) and high (≥20%) were 13.5, 34.0, and 64.6, respectively. Although weaker than the association with incident MOF, increasing FRAX quintile was associated with increasing risk for MACE (all P-trend <.001), even after excluding prior CVD and adjusting for age. HR for MACE per SD increase in FRAX was 1.99 (95%CI, 1.96-2.02). All FRAX-defined risk factors (except parental hip fracture and lower BMI) were independently associated with higher non-death CV events. Although FRAX is intended for fracture risk prediction, it has predictive value for cardiovascular risk.

Bone fragility, sarcopenia and cardiac calcifications in an elderly population: a preliminary study

BACKGROUND

Cardiovascular disease, osteoporosis and sarcopenia are very common age-related conditions. This study aimed at investigating the relationships of cardiac calcifications, as assessed by using GCCS with BMD, fragility fractures and sarcopenia in elderly subjects.

METHODS

In a cohort of 106 subjects (age 70.4 ± 5.8 yrs) we measured lumbar (BMD-LS), femoral BMD (femoral neck: BMD-FN, total femur: BMD-TH) and body composition (BMD-WB) with Dual-energy X-ray Absorptiometry (DXA) method. We also evaluated the presence of sarcopenia on the basis of the EWGSOP Consensus. All subjects, simultaneously, underwent to a transthoracic color doppler echocardiography exam to assess the presence of cardiac calcifications. The degree of non coronaric cardiac calcifications was evaluated using the Global Cardiac Calcium Score (GCCS).

RESULTS

The degree of cardiac calcification assessed by GCCS was significantly higher in osteoporotic patients (p < 0.001). Furthermore, an inverse correlation emerged between BMD and GCCS, statistical significance was found at lumbar spine and femoral sub-regions in female population (p < 0.01). Moreover by dividing population according to the presence of fragility fractures, we observed that GCCS values were significantly higher in subjects with fractures in respect of non-fractured ones (p < 0.05). Multiple regression models showed that BMD-LS and BMD-FT were independently associated with cardiac calcification. GCCS values were significantly associated with BMI and ASMM in women (p < 0.01 and p < 0.05, respectively) and with handgrip strength in men (p < 0.05).

CONCLUSIONS

Our data confirm the presence of a relationship between cardiac calcifications and decreased BMD values. It's also the first study that relates sarcopenia and valvular calcifications.