S-EPMC6415911 - Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study. - OmicsDI

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Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study.

ABSTRACT: Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 1999. Cardiovascular risk factors were assessed in 1998, whereas 14.5-year atherosclerotic vascular disease (ASVD)-related hospitalizations and deaths (events) were available through linked health records. Using established cut points for AAC 471 women (45%) had low AAC (AAC24 score 0 or 1), 387 (37%) moderate AAC (AAC24 score 2-5), and 197 (19%) had high AAC (AAC24 score ?6). Over 14.5 years, 420 women experienced an ASVD event. Increasing severity of AAC was associated with increased absolute risk of ASVD events (37%, 39%, and 49%, respectively, p?=?0.008 for trend), ASVD deaths (15%, 21%, and 27%, respectively, p?

SUBMITTER: Lewis JR

PROVIDER: S-EPMC6415911 | biostudies-literature | 2018 Jun

REPOSITORIES: biostudies-literature

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Long-Term Atherosclerotic Vascular Disease Risk and Prognosis in Elderly Women With Abdominal Aortic Calcification on Lateral Spine Images Captured During Bone Density Testing: A Prospective Study.

Lewis Joshua R JR Schousboe John T JT Lim Wai H WH Wong Germaine G Wilson Kevin E KE Zhu Kun K Thompson Peter L PL Kiel Douglas P DP Prince Richard L RL

Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research 20180325 6

Lateral spine images are captured using bone densitometers for vertebral fracture assessment (VFA) in older women. Abdominal aortic calcification (AAC) is commonly seen on these images; however, the long-term prognosis in women with AAC remains uncertain. In a prospective study of 1052 community-dwelling ambulant white women over 70 years old abdominal aortic calcification 24 scale (AAC24) scores were calculated from digital lateral spine images captured during bone density testing in 1998 or 19 ...[more]

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Project description:BackgroundLateral spine images for vertebral fracture assessment can be easily obtained on modern bone density machines. Abdominal aortic calcification (AAC) can be scored on these images by trained imaging specialists to assess cardiovascular disease risk. However, this process is laborious and requires careful training.MethodsTraining and testing of model performance of the convolutional neural network (CNN) algorithm for automated AAC-24 scoring utilised 5012 lateral spine images (2 manufacturers, 4 models of bone density machines), with trained imaging specialist AAC scores. Validation occurred in a registry-based cohort study of 8565 older men and women with images captured as part of routine clinical practice for fracture risk assessment. Cox proportional hazards models were used to estimate the association between machine-learning AAC (ML-AAC-24) scores with future incident Major Adverse Cardiovascular Events (MACE) that including death, hospitalised acute myocardial infarction or ischemic cerebrovascular disease ascertained from linked healthcare data.FindingsThe average intraclass correlation coefficient between imaging specialist and ML-AAC-24 scores for 5012 images was 0.84 (95% CI 0.83, 0.84) with classification accuracy of 80% for established AAC groups. During a mean follow-up 4 years in the registry-based cohort, MACE outcomes were reported in 1177 people (13.7%). With increasing ML-AAC-24 scores there was an increasing proportion of people with MACE (low 7.9%, moderate 14.5%, high 21.2%), as well as individual MACE components (all p-trend <0.001). After multivariable adjustment, moderate and high ML-AAC-24 groups remained significantly associated with MACE (HR 1.54, 95% CI 1.31-1.80 & HR 2.06, 95% CI 1.75-2.42, respectively), compared to those with low ML-AAC-24.InterpretationThe ML-AAC-24 scores had substantial levels of agreement with trained imaging specialists, and was associated with a substantial gradient of risk for cardiovascular events in a real-world setting. This approach could be readily implemented into these clinical settings to improve identification of people at high CVD risk.FundingThe study was supported by a National Health and Medical Research Council of Australia Ideas grant and the Rady Innovation Fund, Rady Faculty of Health Sciences, University of Manitoba.

Project description:BackgroundDementia after the age of 80 years (late-life) is increasingly common due to vascular and non-vascular risk factors. Identifying individuals at higher risk of late-life dementia remains a global priority.MethodsIn prospective study of 958 ambulant community-dwelling older women (≥70 years), lateral spine images (LSI) captured in 1998 (baseline) from a bone density machine were used to assess abdominal aortic calcification (AAC). AAC was classified into established categories (low, moderate and extensive). Cardiovascular risk factors and apolipoprotein E (APOE) genotyping were evaluated. Incident 14.5-year late-life dementia was identified from linked hospital and mortality records.FindingsAt baseline women were 75.0 ± 2.6 years, 44.7% had low AAC, 36.4% had moderate AAC and 18.9% had extensive AAC. Over 14.5- years, 150 (15.7%) women had a late-life dementia hospitalisation (n = 132) and/or death (n = 58). Compared to those with low AAC, women with moderate and extensive AAC were more likely to suffer late-life dementia hospitalisations (9.3%, 15.5%, 18.3%, respectively) and deaths (2.8%, 8.3%, 9.4%, respectively). After adjustment for cardiovascular risk factors and APOE, women with moderate and extensive AAC had twice the relative hazards of late-life dementia (moderate, aHR 2.03 95%CI 1.38-2.97; extensive, aHR 2.10 95%CI 1.33-3.32), compared to women with low AAC.InterpretationIn community-dwelling older women, those with more advanced AAC had higher risk of late-life dementia, independent of cardiovascular risk factors and APOE genotype. Given the widespread use of bone density testing, simultaneously capturing AAC information may be a novel, non-invasive, scalable approach to identify older women at risk of late-life dementia.FundingKidney Health Australia, Healthway Health Promotion Foundation of Western Australia, Sir Charles Gairdner Hospital Research Advisory Committee Grant, National Health and Medical Research Council of Australia.

Project description:IntroductionAbdominal aortic calcification (AAC) is associated with low bone mass and increased fracture risk. Two previous meta-analyses have investigated the association between AAC and fracture. However, these meta-analyses only identified articles until December 2016, undertook limited searches and did not explore potential sources of between-study heterogeneity. We aim to undertake a sensitive and comprehensive assessment of the relationship between AAC, bone mineral density (BMD) as well as prevalent and incident fractures.MethodsWe will search MEDLINE, EMBASE, Web of Science core collection and Google Scholar (top 200 articles sorted by relevance) from their inception to 1 June 2018. Reference lists of included studies and previous systematic reviews will be hand searched for additional eligible studies. Retrospective and prospective cohort studies (cross-sectional, case-control and longitudinal) reporting the association between AAC, BMD and fracture at any site will be included. At least two investigators will independently: (A) evaluate study eligibility and extract data, with a third investigator to adjudicate when discrepancies occur, (B) assess study quality by the Newcastle-Ottawa Scale for each cohort/study. The meta-analysis will be reported in adherence to the Meta-analysis of Observational Studies in Epidemiology criteria. AAC will be grouped as either: (1) AAC present or absent, (2) AAC categorised as 'low' (referent-lowest reported group) versus 'high' (all other groups) or (3) dose-response when AAC was assessed in ?3 groups. Where primary event data were reported in individual studies, pooled risk differences and risk ratios with 95%?CI will be calculated, from which, a summary estimate will be determined using DerSimonian-Laird random effects models. For the AAC and BMD pooled analyses, estimates will be expressed as standardised mean difference with 95%?CI. We will examine the likelihood of publication bias and where possible, investigate potential reasons for between-study heterogeneity using subgroup analyses and meta-regression.Ethics and disseminationThe study will be submitted to a peer- reviewed journal and disseminated via research presentations.Prospero registration numberCRD42018088019.