Prognostic Value of Abdominal Aortic Calcification: A Systematic Review and Meta-Analysis of Observational Studies.

Kevin Leow, Pawel Szulc, John T Schousboe, Douglas P Kiel, Armando Teixeira-Pinto, Hassan Shaikh, Michael Sawang, Marc Sim, Nicola Bondonno, Jonathan M Hodgson, Ankit Sharma, Peter L Thompson, Richard L Prince, Jonathan C Craig, Wai H Lim, Germaine Wong, Joshua R Lewis

Journal: Journal of the American Heart Association 2021;10(2):e017205

PMID: 33439672

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Abstract

Background The prognostic importance of abdominal aortic calcification (AAC) viewed on noninvasive imaging modalities remains uncertain. Methods and Results We searched electronic databases (MEDLINE and Embase) until March 2018. Multiple reviewers identified prospective studies reporting AAC and incident cardiovascular events or all-cause mortality. Two independent reviewers assessed eligibility and risk of bias and extracted data. Summary risk ratios (RRs) were estimated using random-effects models comparing the higher AAC groups combined (any or more advanced AAC) to the lowest reported AAC group. We identified 52 studies (46 cohorts, 36 092 participants); only studies of patients with chronic kidney disease (57%) and the general older-elderly (median, 68 years; range, 60-80 years) populations (26%) had sufficient data to meta-analyze. People with any or more advanced AAC had higher risk of cardiovascular events (RR, 1.83; 95% CI, 1.40-2.39), fatal cardiovascular events (RR, 1.85; 95% CI, 1.44-2.39), and all-cause mortality (RR, 1.98; 95% CI, 1.55-2.53). Patients with chronic kidney disease with any or more advanced AAC had a higher risk of cardiovascular events (RR, 3.47; 95% CI, 2.21-5.45), fatal cardiovascular events (RR, 3.68; 95% CI, 2.32-5.84), and all-cause mortality (RR, 2.40; 95% CI, 1.95-2.97). Conclusions Higher-risk populations, such as the elderly and those with chronic kidney disease with AAC have substantially greater risk of future cardiovascular events and poorer prognosis. Providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better.

Address: Centre for Kidney Research School of Public Health Faculty of Medicine and Health Children's Hospital at WestmeadThe University of Sydney New South Wales Australia.; INSERM UMR 1033 University of LyonHospices Civils de Lyon Lyon France.; Park Nicollet Osteoporosis Center and HealthPartners Institute Minneapolis MN.; Division of Health Policy and Management University of Minnesota Minneapolis MN.; Department of Medicine Hinda and Arthur Marcus Institute for Aging ResearchHebrew Senior LifeBeth Israel Deaconess Medical CenterHarvard Medical School Boston MA.; Institute of Nutrition Research prior to school of medical and health sciences Edith Cowan University Joondalup Australia.; Medical School University of Western Australia Perth Australia.; Department of Cardiology Sir Charles Gairdner Hospital Perth Australia.; Harry Perkins Institute of Medical Research Perth Australia.; Medical School University of Western Australia Perth Australia.; Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia.; Centre for Kidney Research School of Public Health Faculty of Medicine and Health Children's Hospital at WestmeadThe University of Sydney New South Wales Australia.; College of Medicine and Public Health Flinders University Adelaide Australia.; Institute of Nutrition Research prior to school of medical and health sciences Edith Cowan University Joondalup Australia.; Department of Renal Medicine Sir Charles Gairdner Hospital Perth Australia.; Centre for Kidney Research School of Public Health Faculty of Medicine and Health Children's Hospital at WestmeadThe University of Sydney New South Wales Australia.; Institute of Nutrition Research prior to school of medical and health sciences Edith Cowan University Joondalup Australia.; Medical School University of Western Australia Perth Australia.

DOI: 10.1161/JAHA.120.017205

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MeSH Terms: Aorta, Abdominal, Aortic Diseases, Cardiovascular Diseases, Humans, Mortality, Prognosis, Risk Assessment, Vascular Calcification