Calcification of the abdominal aorta is an under-appreciated cardiovascular disease risk factor in the general population

Association between cardiometabolic index and abdominal aortic calcification in US adults from the NHANES

Abdominal aortic calcification (AAC) and atherosclerosis are prevalent conditions among older adults, and recent research suggests that their association may extend beyond the effects of aging alone. An essential instrument for determining the possibility of cardiovascular disease (CVD) is the cardiometabolic index (CMI), a new lipid-based index sensitive to visceral obesity. However, little has been established about the relationship between CMI and AAC. We examined CMI and AAC data from the National Health and Nutrition Examination Survey (NHANES) conducted in 2013-2014 for this study. The relationship between AAC, severe abdominal aortic calcification (SAAC), and CMI was assessed using multiple linear and logistic regression models. The overall trend was visualized using smoothed curve modeling. Subgroup analyses were conducted to find possible moderating factors. Among the 2704 participants included, those with higher CMI levels exhibited much greater AAC scores and a higher prevalence of SAAC. In model 3, elevated CMI positively correlated with AAC (0.25 (0.09, 0.41)) and with the odds of SAAC (OR = 1.35 (1.09, 1.67)). Participants in the highest CMI quartile had an AAC score that was 0.65 units higher (β = 0.65 (0.26, 1.04)) and an 114% higher risk of SAAC (OR = 2.14 (1.29, 3.54)). Subgroup analyses indicated sex and smoking status significantly modified the relationship between CMI, AAC, and SAAC, while previously diagnosed with congestive heart failure (CHF) and heart attack significantly moderated the association between CMI and AAC. These results imply that greater AAC scores and a higher risk of SAAC are linked to heightened CMI, which represents visceral fat storage and disturbed lipid metabolism. Our findings indicate that CMI is correlated with AAC in certain demographic and cardiovascular subgroups, suggesting its potential as an exploratory indicator of elevated AAC risk in these populations.

Role of abdominal aortic calcification score in predicting cardiovascular risk in the general population

BACKGROUND

Abdominal aortic calcification (AAC) is closely related to cardiovascular disease. Although its clinical significances have primarily been investigated in patients with chronic kidney disease, its association with cardio-cerebrovascular mortality in the general middle-aged and elderly population has not been sufficiently investigated.

AIMS

To study the association of AAC and cardio-cerebrovascular mortality in both the entire general middle-aged and elderly populations and age subgroups.

METHODS

Data of participants of the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were analyzed. This study included middle-aged and elderly (≥ 40 years old) individuals who underwent dual-energy X-ray absorptiometry. The severity of AAC was assessed by an AAC scoring system (AAC score) with a maximum possible value of 24. Participants were tracked for survival status and major cause of death till 31st December 2019. This study utilized AAC score = 6 as the optimal cut-off according to Harrell's c statistic. Based on AAC scores, participants were trichotomized (0, 0-6, and ≥ 6). Groupwise survival curves and cumulative incidence functions were plotted to reveal the association of AAC and cardio-cerebrovascular mortality. Given results under trichotomization, combination of participants with AAC scores 0 and 0-6 was conducted to reaffirm the association of AAC and adverse prognosis.

RESULTS

Correlation between increased AAC score and poorer survival, higher cumulative incidence of events was revealed. Cox models identified AAC score ≥ 6 as an independent risk factor of cardio-cerebrovascular mortality (AAC score ≥ 6 vs. AAC score = 0: Hazard ratio: 2.38, P = 0.008) after adjusting for cardiovascular risk factors. Results remained significant after regrouping (AAC score ≥ 6 vs. AAC score < 6: Hazard ratio: 2.06, P = 0.016). Subgroup analysis provided no evidence of unparallel change in hazard for the same amount of increase in AAC score among middle-aged (40-65 years old) and elderly (≥ 65 years old) individuals.

CONCLUSIONS

AAC score ≥ 6 independently indicate increased risk of cardio-cerebrovascular death and would be effective in risk stratification among the general middle-aged and elderly population in clinical practice.

Genomic Characterisation of the Relationship and Causal Links Between Vascular Calcification, Alzheimer's Disease, and Cognitive Traits

Background/Objectives: Observational studies suggest a link between vascular calcification and dementia or cognitive decline, but the evidence is conflicting, and the underlying mechanisms are unclear. Here, we investigate the shared genetic and causal relationships of vascular calcification-coronary artery calcification (CAC) and abdominal aortic calcification (AAC)-with Alzheimer's disease (AD), and five cognitive traits. Methods: We analyse large-scale genome-wide association studies (GWAS) summary statistics, using well-regarded methods, including linkage disequilibrium score regression (LDSC), Mendelian randomisation (MR), pairwise GWAS (GWAS-PW), and gene-based association analysis. Results: Our findings reveal a nominally significant positive genome-wide genetic correlation between CAC and AD, which becomes non-significant after excluding the APOE region. CAC and AAC demonstrate significant negative correlations with cognitive performance and educational attainment. MR found no causal association between CAC or AAC and AD or cognitive traits, except for a bidirectional borderline-significant association between AAC and fluid intelligence scores. Pairwise-GWAS analysis identifies no shared causal SNPs (posterior probability of association [PPA]3 < 0.5). However, we find pleiotropic loci (PPA4 > 0.9), particularly on chromosome 19, with gene association analyses revealing significant genes in shared regions, including APOE, TOMM40, NECTIN2, and APOC1. Moreover, we identify suggestively significant loci (PPA4 > 0.5) on chromosomes 1, 6, 7, 9 and 19, implicating pleiotropic genes, including NAV1, IPO9, PHACTR1, UFL1, FHL5, and FOCAD. Conclusions: Current findings reveal limited genetic correlation and no significant causal associations of CAC and AAC with AD or cognitive traits. However, significant pleiotropic loci, particularly at the APOE region, highlight the complex interplay between vascular calcification and neurodegenerative processes. Given APOE's roles in lipid metabolism, neuroinflammation, and vascular integrity, its involvement may link vascular and neurodegenerative disorders, pointing to potential targets for further investigation.

J, Draganova L, Anderson G, Jonnalagadda US, Hayward R, Shroff R, Wen WTL, Verhulst A, Foo RSY, Shanahan CM. Mineral Stress Drives Loss of Heterochromatin: An Early Harbinger of Vascular Inflammaging and Calcification

BACKGROUND

Vascular calcification is a detrimental aging pathology markedly accelerated in patients with chronic kidney disease. PLA (prelamin A) is a biomarker of vascular smooth muscle cell aging that accelerates calcification however the mechanisms remain undefined.

METHODS

Vascular smooth muscle cells were transduced with PLA using an adenoviral vector and epigenetic modifications were monitored using immunofluorescence and targeted polymerase chain reaction array. Epigenetic findings were verified in vivo using immunohistochemistry in human vessels, in a mouse model of inducible prelamin A expression, and in a rat model of chronic kidney disease-induced calcification. Transcriptomic and chromatin immunoprecipitation followed by sequencing analyses were used to identify gene targets impacted by changes in the epigenetic landscape. Molecular tools and antibody arrays were used to monitor the effects of mineral dysregulation on heterochromatin, inflammation, aging, and calcification.

RESULTS

Here, we report that depletion of the repressive heterochromatin marks, H3K9me3 (histone H3, lysine 9, trimethylation) and H3K27me3 (histone H3, lysine 27,trimethylation), is an early hallmark of vascular aging induced by both nuclear lamina dysfunction and dysregulated mineral metabolism, which act to modulate the expression of key epigenetic writers and erasers. Global analysis of H3K9me3 and H3K27me3 marks and pathway analysis revealed deregulation of insulin signaling and autophagy pathways as well as cross-talking DNA damage and NF-κB (nuclear factor κB) inflammatory pathways consistent with early activation of the senescence-associated secretory phenotype. Expression of PLA in vivo induced loss of heterochromatin and promoted inflammation and osteogenic differentiation which preceded aging indices, such as DNA damage and senescence. Vessels from children on dialysis and rats with chronic kidney disease showed prelamin A accumulation and accelerated loss of heterochromatin before the onset of calcification.

CONCLUSIONS

Dysregulated mineral metabolism drives changes in the epigenetic landscape and nuclear lamina dysfunction that together promote early induction of inflammaging pathways priming the vasculature for downstream pathological change.

Correlation analysis of estimated pulse wave velocity and severe abdominal aortic calcification: based on the National Health and Nutrition Examination Survey database

Objective.To investigate how severe abdominal aortic calcification (SAAC) and estimated pulse wave velocity (ePWV) relate to each other and to all-cause and cardiovascular disease (CVD) mortalities.Approach.National Health and Nutrition Examination Survey 2013-2014 data were analyzed. ePWV, computed using age and mean blood pressure, served as an independent variable. Dependent variable SAAC (AAC score >6) was quantified using dual-energy x-ray absorptiometry and Kauppila grading. A weighted logistic regression model, interaction terms, and restricted cubic spline analysis examined relationship between ePWV and SAAC. Kaplan-Meier curves were drawn among SAAC people. A weighted Cox regression model was built to examine associations of ePWV with all-cause and CVD mortalities.Main results.2849 individuals were included. A strong positive connection (odds ratio (OR) > 1,P< 0.05) was seen between ePWV and SAAC risk. Interaction termP-value indicated that only ethnicity (P< 0.05) had an impact on this link but smoking, alcohol use, age, sex, body mass index, or hypertension did not. SAAC patients showed greater ePWV, all-cause and CVD mortalities (P< 0.05) than non-SAAC subjects. Greater ePWV (>12.00 m s-1) was associated with higher risks of all-cause and CVD mortalities in SAAC participants (hazard ratio (HR) > 1,P< 0.05). Significance.This study, for the first time based on the NHANES database, reveals a positive correlation between ePWV and SAAC, and identifies ePWV as an independent predictor of all-cause and cardiovascular mortality risk in patients with SAAC, providing a new biomarker for the prevention and early intervention of cardiovascular diseases.

The relationship between dietary vitamin B1 intake and severe abdominal aortic calcification among the general population in the United States

Background

Vitamin B1 deficiency is closely associated with vascular system damage, but the relationship between dietary vitamin B1 intake and abdominal aortic calcification (AAC) remains unclear and warrants further investigation.

Methods

2,640 participants from the National Health and Nutrition Examination Survey (NHANES) 2013-2014 were included in the study. Severe AAC was defined as Kauppila score >5. Multivariable logistic regression analysis and restricted cubic splines (RCS) were used to examine the relationship between dietary vitamin B1 and severe AAC.

Results

The increase in dietary intake of vitamin B1 is significantly correlated with a decrease in the risk of severe AAC (OR: 0.601, 95% CI: 0.406, 0.892). Compared to the first quartile of dietary vitamin B1 intake, the fourth quartile had a significantly reduced risk of severe AAC (OR: 0.358, 95% CI: 0.172, 0.744). RCS indicated a decreasing trend in the risk of severe AAC with increasing dietary vitamin B1 intake.

Conclusion

Our research findings indicate that the increase in dietary intake of vitamin B1 is significantly associated with a decrease in the risk of severe AAC. Thus, increasing dietary vitamin B1 intake appropriately may reduce the risk of severe AAC.

Systematic identification of therapeutic targets for coronary artery calcification: an integrated transcriptomic and proteomic Mendelian randomization

BACKGROUND

Coronary artery calcification (CAC) is associated with an increased risk of mortality and cardiovascular events. However, none therapeutic drugs have been proven effective for CAC treatment. The objective of this study was to identify potential therapeutic targets for CAC through the utilization of Mendelian randomization (MR) and colocalization analysis.

METHODS

The expression quantitative trait loci (eQTLs) of 16,943 genes from the eQTLGen consortium and protein quantitative trait loci (pQTLs) of 4,412 proteins from a plasma proteome were utilized as genetic instruments. Genetic associations with CAC were derived from a GWAS meta-analysis of 26,909 individuals. The MR and colocalization analysis were utilized to identify potential target genes.

RESULTS

A total of 671 genes were found to be significantly associated with the risk of CAC based on transcriptomic MR analysis at a false discovery rate <0.05, while proteomic MR analysis identified 15 genes with significant associations with CAC at the same threshold. With robust evidence from colocalization analysis, we observed positive associations between CWF19L2, JARID2, and MANBA and the risk of CAC, while KLB exhibited an inverse association. In summary, our study identified 23 potential therapeutic targets for CAC. Further downstream analysis revealed IGFBP3, ABCC6, ULK3, DOT1L, KLB and AMH as promising candidates for repurposing in the treatment of CAC.

CONCLUSION

The integrated MR analysis of transcriptomic and proteomic data identified multiple potential drug targets for the treatment of CAC. ULK3, DOT1L, and AMH were recognized as novel targets for drug repurposing for CAC and deserve further investigation.

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy

INTRODUCTION

To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy.

METHODS

Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs.

RESULTS

Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery.

CONCLUSIONS

There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Causal association between blood metabolites and abdominal aortic calcification: A bidirectional Mendelian randomization study

Previous studies have reported correlations between metabolic factors and abdominal aortic calcification (AAC). However, the causal relationship between blood metabolites and AAC remains to be fully explored. We employed bidirectional two-sample Mendelian randomization (MR) to investigate the potential causal relationships between 486 blood metabolites and AAC. The inverse variance weighted method was primarily utilized for MR analysis, and the MR-Egger, weighted median, and Robust Adjusted Profile Score methods were used for supplementary analysis. Sensitivity analyses were conducted using Radial MR, MR-PRESSO, Cochran Q test, MR-Egger intercept, and leave-one-out analysis to evaluate the heterogeneity and pleiotropy. Furthermore, the Steiger test and linkage disequilibrium score regression were used to assess genetic correlation and directionality. Multivariable MR analysis was performed to evaluate the direct effect of metabolites on AAC. Through rigorous screening, we identified 6 metabolites with presumed causal effects on AAC: 4-methyl-2-oxopentanoate (effect size [ES] 0.46, 95% confidence interval [CI]: 0.10-0.82), erythrose (ES -0.35, 95% CI: -0.59 to -0.11), 10-undecenoate (11:1n1) (ES 0.14, 95% CI: 0.03-0.25), 1-myristoylglycerophosphocholine (ES 0.31, 95% CI: 0.11-0.50), glycerol 2-phosphate (ES 0.20, 95% CI: 0.04-0.37), and the unidentified metabolite X-11469 (ES 0.19, 95% CI: 0.08-0.30). Multivariable MR analysis revealed that genetically predicted erythrose, 10-undecenoate, 1-myristoylglycerophosphocholine, and X-11469 could directly affect AAC independent of other metabolites. Reverse MR analysis revealed an alteration in 12 blood metabolites due to AAC, including caffeine, 1,7-dimethylurate, arachidonic acid, and 1-arachidonoylglycerophosphocholine. This study provides evidence supporting a causal relationship between metabolites and AAC. These findings help elucidate the underlying biological mechanisms of AAC and may offer insights into screening, prevention, and treatment approaches.

Abdominal Aorta Calcification Identified on DXA Scans and the Risk of Mortality in Adults

BACKGROUND

Abdominal aortic calcification (AAC) on lateral lumbar radiographs increases the risk of cardiovascular events and mortality. However, data on the association between AAC detected in dual energy X-ray absorptiometry (DXA) and the risk of mortality in the general population are scarce.

METHODS

The present study was based on data from participants aged ≥40 years in the National Health and Nutrition Examination Survey (NHANES) cycle of 2013 to 2014. Vertebral assessment of lateral spine DXA scans was used to provide AAC measurements at vertebrae L1-L4. The extent of AAC was defined according to the Kauppila AAC-24 scores (0-1, 2-5, ≥6), and the NHANES 2019 public-use linked mortality files were used to assess mortality status.

RESULTS

Of the 2,962 participants who were included in this study, with a mean age of 57.4 years and a median follow-up of 69.9 months, 252 (8.5%) died. Of the deaths, 84 (33.3%) occurred due to cardiovascular disease. The Cox proportional hazards models revealed that participants with AAC-24 scores ≥6 were 1.7 times more likely to die than those with AAC-24 scores 0-1 (Hazard ratio, 1.75; 95% confidence interval, 1.13-2.71). Moreover, older adults and women with AAC-24 scores ≥6 were 2.8 and 2.4 times more likely to die than their counterparts with AAC-24 scores 0-1, respectively. Conversely, a non-significant risk of cardiovascular mortality was found among participants with AAC-24 scores ≥6.

CONCLUSIONS

The extent of AAC detected on vertebral fracture assessment DXA was associated with an increased risk of all-cause mortality in adults, particularly older adults and women.

DXA beyond bone mineral density and the REMS technique: new insights for current radiologists practice

Osteoporosis is the most prevalent skeletal disorder, a condition that is associated with significant social and healthcare burden. In the elderly, osteoporosis is commonly associated with sarcopenia, further increasing the risk of fracture. Several imaging techniques are available for a non-invasive evaluation of osteoporosis and sarcopenia. This review focuses on dual-energy X-ray absorptiometry (DXA), as this technique offers the possibility to evaluate bone mineral density and body composition parameters with good precision and accuracy. DXA is also able to evaluate the amount of aortic calcification for cardiovascular risk estimation. Additionally, new DXA-based parameters have been developed in recent years to further refine fracture risk estimation, such as the Trabecular Bone Score and the Bone Strain Index. Finally, we describe the recent advances of a newly developed ultrasound-based technology known as Radiofrequency Echographic Multi-Spectrometry, which represent the latest non-ionizing approach for osteoporosis evaluation at central sites.

Associations between Life's Essential 8 and abdominal aortic calcification among US Adults: a cross-sectional study

BACKGROUND

Cardiovascular health (CVH) and abdominal aortic calcification (AAC) are closely linked to cardiovascular disease (CVD) and related mortality. However, the relationship between CVH metrics via Life's Essential 8 (LE8) and AAC remains unexplored.

METHODS

The study analyzed data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cohort, which included adults aged 40 or above. The research used the LE8 algorithm to evaluate CVH. Semi-quantitative AAC-24 scoring techniques were employed to assess AAC, categorized into no calcification, mild to moderate calcification, and severe calcification.

RESULTS

The primary analysis involved 2,478 participants. Following adjustments for multiple factors, the LE8 score exhibited a significant association with ACC risk (Mild-moderate ACC: 0.87, 95% CI: 0.81,0.93; Severe ACC: 0.77, 95% CI: 0.69,0.87, all P < 0.001), indicating an almost linear dose-response relationship. Compared to the low CVH group, the moderate CVH group showed lower odds ratios (OR) for mild-moderate and severe calcification (OR = 0.78, 95% CI: 0.61-0.99, P = 0.041; OR = 0.68, 95% CI: 0.46-0.99, P = 0.047, respectively). Moreover, the high CVH group demonstrated even lower ORs for mild-moderate and severe calcification (OR = 0.46, 95% CI: 0.31, 0.69, P < 0.001; OR = 0.29, 95% CI: 0.14, 0.59, P = 0.001, respectively). Interactions were found between chronic kidney disease (CKD) condition, history of CVD, marital status and CVH metrics to ACC. Participants without CKD exhibited a more pronounced negative association between the CVH metric and both mild-moderate and severe ACC. Those lacking a history of CVD, and never married/widowed/divorced/separated showed a stronger negative association between the CVH metric and severe ACC.

CONCLUSIONS

The novel CVH metrics demonstrated an inverse correlation with the risk of AAC. These findings suggest that embracing improved CVH levels may assist in alleviating the burden of ACC.

Association of abdominal aortic calcification and lower back pain in patients with degenerative spondylolisthesis

ABSTRACT

Abdominal aortic calcification (AAC) is hypothesized to lead to ischemic pain of the lower back. This retrospective study aims to identify the relationship between AAC and lower back pain (LBP) in patients with degenerative lumbar spondylolisthesis. Lower back pain was assessed preoperatively and 2 years after surgery using the numeric analogue scale. Abdominal aortic calcification was assessed according to the Kauppila classification and was grouped into no, moderate, and severe. A multivariable regression, adjusted for age, sex, body mass index, hypertension, and smoking status, was used to assess the association between AAC and preoperative/postoperative LBP as well as change in LBP after surgery. A total of 262 patients were included in the final analysis. The multivariable logistic regression demonstrated an increased odds ratio (OR) for preoperative LBP ≥ 4 numeric analogue scale (OR = 9.49, 95% confidence interval [CI]: 2.71-40.59, P < 0.001) and postoperative LBP ≥ 4 (OR = 1.72, 95% CI: 0.92-3.21, P = 0.008) in patients with severe AAC compared with patients with no AAC. Both moderate and severe AAC were associated with reduced improvement in LBP after surgery (moderate AAC: OR = 0.44, 95% CI: 0.22-0.85, P = 0.016; severe AAC: OR = 0.41, 95% CI: 0.2-0.82, P = 0.012). This study demonstrates an independent association between AAC and LBP and reduced improvement after surgery. Evaluation of AAC could play a role in patient education and might be considered part of the differential diagnosis for LBP, although further prospective studies are needed.

Computational Study of Abdominal Aortic Aneurysm Walls Accounting for Patient-Specific Non-Uniform Intraluminal Thrombus Thickness and Distinct Material Models: A Pre- and Post-Rupture Case

An intraluminal thrombus (ILT) is present in the majority of abdominal aortic aneurysms, playing a crucial role in their growth and rupture. Although most computational studies do not include the ILT, in the present study, this is taken into account, laying out the whole simulation procedure, namely, from computed tomography scans to medical image segmentation, geometry reconstruction, mesh generation, biomaterial modeling, finite element analysis, and post-processing, all carried out in open software. By processing the tomography scans of a patient's aneurysm before and after rupture, digital twins are reconstructed assuming a uniform aortic wall thickness. The ILT and the aortic wall are assigned different biomaterial models; namely, the first is modeled as an isotropic linear elastic material, and the second is modeled as the Mooney-Rivlin hyperelastic material as well as the transversely isotropic hyperelastic Holzapfel-Gasser-Ogden nonlinear material. The implementation of the latter requires the designation of local Cartesian coordinate systems in the aortic wall, suitably oriented in space, for the proper orientation of the collagen fibers. The composite aneurysm geometries (ILT and aortic wall structures) are loaded with normal and hypertensive static intraluminal pressure. Based on the calculated stress and strain distributions, ILT seems to be protecting the aneurysm from a structural point of view, as the highest stresses appear in the thrombus-free areas of the aneurysmal wall.

Association of dietary live microbe intake with abdominal aortic calcification in US adults: a cross-sectional study of NHANES 2013-2014

OBJECT

To explore the potential association between dietary live microbe intake and abdominal aortic calcification (AAC).

METHODS

We conducted a cross-section study based on the National Health and Nutrition Examination Survey (NHANES). We categorized the participants into three groups (low, medium, and high dietary intake of live microbes) according to Sanders's dietary live microbe classification system and participants' 24-h dietary recall data. AAC was quantified by using dual-energy X-ray absorptiometry (DXA) and diagnosed by using the Kauppila AAC-24 score system. The analyses utilized weighted logistic regression and weighted linear regression.

RESULTS

A total of 2,586 participants were included. After the full adjustment for covariates, compared to participants with a low dietary live microbe intake, participants with a high dietary live microbe intake had a significantly lower risk of severe AAC (OR: 0.39, 95% CI: 0.22, 0.68, p = 0.003), and the AAC score was also significantly decreased (β:-0.53, 95% CI: -0.83, -0.23, p = 0.002).

CONCLUSION

In this study, more dietary live microbial intake was associated with lower AAC scores and a lower risk of severe AAC. However, more research is needed to verify this.

Clinical significance of neutrophil-to-lymphocyte ratio on the risk of abdominal aortic calcification and decreased bone mineral density in patients with end-stage kidney disease

Inflammation plays a major role in the pathogenesis of chronic kidney disease (CKD), but the relationship between systemic inflammation and CKD-mineral bone disease is unclear. We aimed to investigate whether the neutrophil-to-lymphocyte ratio (NLR) is related to abdominal aortic calcification (AAC) and bone mineral density (BMD) in dialysis patients. In this cross-sectional analysis using baseline data of a multicenter cohort, a total of 759 patients were divided into three groups according to NLR level, and the associations between NLR and Kauppila AAC score (AACS) and BMD were assessed. The highest tertile NLR group had more males, alcohol consumers, higher diabetes prevalence, and higher comorbidity index than the lowest tertile NLR group. Fasting glucose and C-reactive protein levels were higher, while serum albumin, serum iron, and lipid profiles except triglycerides were lower in the highest tertile group. AACS was significantly higher in the highest tertile group than in the lowest and middle tertile groups (p = 0.017), but the mean areal BMD and T-score of the lumbar spine and femur were not different between groups. NLR level was positively correlated with AACS in all aortic wall segments except L1 and L3 anterior. In multivariable logistic regression analysis, the highest tertile NLR group was independently associated with AAC (odds ratio 2.876, 95% confidence interval 1.250-6.619, p = 0.013) but was not associated with osteoporosis in the lumbar spine and femur after adjusting for confounding factors. The NLR can be used as a potential indicator of AAC in dialysis patients.

Massive Calcified Abdominal Aortic Aneurysm Presenting as Low Back Pain

Calcified abdominal aortic aneurysm (CAAA) is a radiological finding that manifests the calcification in the bulged aortic walls. CAAA has high mortality. The presence of calcification as a key player in abdominal aortic aneurysm (AAA) rupture risk was reported in the literature. Factors contributing to a CAAA compared to AAA are age, dyslipidemia, hypertension, diabetes mellitus, genetics, disturbances in calcium-phosphate homeostasis, and smoking. There are a few genetic mutations associated with CAAA as well. Causes of AAA include lipid build-up in the aortic wall, inflammatory diseases, traumas, blood vessel diseases that supply the aortic wall, and connective tissue disorders.

Deep learning based phenotyping of medical images improves power for gene discovery of complex disease

Electronic health records are often incomplete, reducing the power of genetic association studies. For some diseases, such as knee osteoarthritis where the routine course of diagnosis involves an X-ray, image-based phenotyping offers an alternate and unbiased way to ascertain disease cases. We investigated this by training a deep-learning model to ascertain knee osteoarthritis cases from knee DXA scans that achieved clinician-level performance. Using our model, we identified 1931 (178%) more cases than currently diagnosed in the health record. Individuals diagnosed as cases by our model had higher rates of self-reported knee pain, for longer durations and with increased severity compared to control individuals. We trained another deep-learning model to measure the knee joint space width, a quantitative phenotype linked to knee osteoarthritis severity. In performing genetic association analysis, we found that use of a quantitative measure improved the number of genome-wide significant loci we discovered by an order of magnitude compared with our binary model of cases and controls despite the two phenotypes being highly genetically correlated. In addition we discovered associations between our quantitative measure of knee osteoarthritis and increased risk of adult fractures- a leading cause of injury-related death in older individuals-, illustrating the capability of image-based phenotyping to reveal epidemiological associations not captured in the electronic health record. For diseases with radiographic diagnosis, our results demonstrate the potential for using deep learning to phenotype at biobank scale, improving power for both genetic and epidemiological association analysis.