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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.

Radavelli-Bagatini, S., Bondonno, C. P., Dalla Via, J., Sim, M., Gebre, A. K., Blekkenhorst, L. C., Connolly, E. L., Bondonno, N. P., Schousboe, J. T., Woodman, R. J., Zhu, K., Mullin, S., Szulc, P., Jackson, B., Dimmock, J., Schlaich, M. P., Cox, K. L., Kiel, D. P., Lim, W. H., . . . Lewis, J. R. (2024). Impact of provision of abdominal aortic calcification results on fruit and vegetable intake: 12-week randomized phase 2 controlled trial. Nature Communications, 15(1), 8126. https://doi.org/10.1038/s41467-024-52172-1

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Provision of non-invasive vascular imaging results to individuals has been shown to improve cardiovascular disease risk factor control: its impact on diet remains uncertain. In this two-arm, single-blind, parallel, 12-week randomized controlled trial, 240 participants, 57.5% females aged 60–80 y had abdominal aortic calcification and clinical assessments performed at a hospital clinic. Participants were randomized 1:1 to receive (intervention n = 121) or not (control n = 119) their calcification results. Both groups received educational resources on cardiovascular disease risk control and were unblinded to the intervention. Outcome measures were performed at baseline and 12 weeks. The primary outcomes of the study were changes in fruit and vegetable intake measures over 12 weeks assessed using plasma carotenoid concentrations (biomarkers of FV intake) and a food frequency questionnaire. Secondary outcomes included 12-week changes in other aspects of the diet, physical activity, body weight, blood pressure, heart rate, lipid profile, glucose concentrations, estimated cardiovascular disease risk score, and medication use. Between-group differences were tested using linear mixed-effects regression. There were no between-group differences in the primary outcomes at 12 weeks: plasma carotenoids (mean difference +0.03 µg/mL [95%CI −0.06, 0.13]) and fruit and vegetable intakes (+18 g/d [−37, 72]). However, the provision of calcification results led to between-group differences in serum total (−0.22 mmol/L [−0.41, −0.04]) and non-HDL (−0.19 mmol/L [−0.35, −0.03]) cholesterol, and estimated cardiovascular disease risk score (−0.24% [−0.47, −0.02]). No between-group differences were seen for other secondary outcomes. In this work, providing vascular imaging results did not improve diet but did improve some cardiovascular disease risk factors (Australian and New Zealand Clinical Trials Registry ACTRN12618001087246).

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Porter, T., Sim, M., Prince, R. L., Schousboe, J. T., Bondonno, C., Lim, W. H., Zhu, K., Kiel, D. P., Hodgson, J. M., Laws, S. M., & Lewis, J. R. (2022). Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study. The Lancet Regional Health – Western Pacific, 26. https://doi.org/10.1016/j.lanwpc.2022.100502

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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 < 0.001 for trend), and all‐cause mortality (30%, 38%, and 44%, respectively, p < 0.001 for trend). After adjusting for Framingham risk scores, women with high AAC had increased relative hazard for ASVD events, HR 1.37 (95% CI, 1.07 to 1.77; p = 0.013) compared to women with low AAC. Similarly, women with moderate AAC and high AAC had increased relative hazards for ASVD deaths HR 1.41 (95% CI, 1.03 to 1.94; p = 0.034) and HR 1.80 (95% CI, 1.26 to 2.57; p = 0.001), or any deaths HR 1.30 (95% CI, 1.03 to 1.64; p = 0.026) and HR 1.53 (95% CI, 1.17 to 2.00; p = 0.002), compared to women with low AAC. In conclusion, more advanced AAC on images captured for VFA is associated with long‐term ASVD hospitalizations and deaths before and after adjusting for Framingham risk scores. AAC assessment could be considered in addition to VFA to identify individuals who may benefit for more aggressive cardiovascular primary prevention strategies. © 2018 American Society for Bone and Mineral Research

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Objective: Examine if two inexpensive measures of atherosclerotic vascular diseases (ASVD), abdominal aortic calcification (AAC) and high-sensitivity cardiac troponin I (hs-cTnI) provide complementary information for 10-year ASVD mortality and all-cause mortality risk in older women.

Methods: 908 community-dwelling women without prevalent ASVD (≥75 years) were followed-up between 2003 and 2013. AAC and plasma hs-cTnI measures were obtained in 2003. AAC was assessed on lateral spine images using a semiquantitative method (AAC24). Linked health records were used for mortality outcomes.

Results: Mean±SD age was 79.9±2.6 years. 276 (30.4%) women died during follow-up, including 138 (15.2%) ASVD-related deaths. AAC24 and hs-cTnI were independently associated with ASVD and all-cause mortality (p<0.001). The cohort was dichotomised into four groups: (1) low AAC24 (AAC24: 0 or 1) and <median hs-cTnI (n=163, referent), (2) moderate-extensive AAC24 (AAC24:>1) and <median hs-cTnI (n=280), (3) low AAC24 and ≥median hs-cTnI (n=148) and (4) moderate-extensive AAC24 and ≥median hs-cTnI (n=317). Compared with the referent group, a stepwise increase in relative hazard (HR (95% CI)) for ASVD mortality was seen at 2.39 (1.05 to 5.46), 3.18 (1.35 to 7.79) and 5.38 (2.44 to 11.85), respectively. A similar associations were observed for all-cause mortality, at 1.58 (0.99-2.52), 2.38 (1.46-3.89) and 3.02 (1.93-4.72), respectively (all p<0.05).

Conclusion: Higher AAC and elevated hs-cTnI were associated with higher risk of ASVD mortality and all-cause mortality, independent of each other. Stratifying by moderate to extensive AAC and elevated hs-cTnI identified women at very high risk. Further studies investigating whether combining factors may improve risk prediction are needed.

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To the Editor: In their report on ARCH (the Active-Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk), Saag and colleagues (Oct. 12 issue)¹ report that postmenopausal women with osteoporosis who received 12 months of treatment with romosozumab, an antisclerostin antibody, followed by alendronate had a significantly lower risk of fracture than did those who received alendronate alone.¹ However, there was a higher rate of serious cardiovascular adverse events in the romosozumab group than in the alendronate group (2.5% vs. 1.9%), including a higher rate of cardiac ischemic and cerebrovascular events (0.8% vs. 0.3%). Those findings were not . . .

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The objective of the study was to determine the association between AAC and neuromuscular function over 5 years. Participants in this study were ambulant women over 70 years old residing in Perth, Western Australia who participated in the Calcium Intake Fracture Outcomes Study, a randomised controlled trial of calcium supplementation. 1046 women (mean age = 74.9 ± 2.6 years; BMI = 27.1 ± 4.4 kg/m²) were included. Lateral spine images captured during bone density testing were scored for AAC (AAC24; 0-24) at baseline. Severe AAC (AAC_sev) was defined using established cut points (AAC24 ≥ 6). At baseline and follow-up, isometric grip strength was assessed using a dynamometer. Mobility was assessed by the Timed-Up-and-Go (TUG) test. Using pre-defined criteria, muscle weakness was considered as grip strength < 22 kg and poor mobility defined as TUG > 10.2 s. A subset of women had appendicular lean mass (ALM) determined by dual-energy X-ray absorptiometry at baseline and follow-up (n = 261). AAC_sev was evident in 193 (18.5%) women. Average decline in grip strength after 5 years was greater in those with AAC_sev than those without (3.6 ± 3.7 vs. 2.9 ± 4.2 kg; p = 0.034). This remained significant after adjustment for age, treatment allocation, diabetes, smoking history, renal function, medical record-derived prevalent vascular disease, BMI and physical activity (β = – 0.184; 95% confidence interval: – 0.361, – 0.008; p = 0.040). AAC_sev was not associated with 5-year changes in TUG or ALM in univariable or multivariable analyses (all p > 0.05). In older women, severe aortic calcification was associated with greater 5-year decline in muscle strength, but not TUG or ALM. These findings support the concept that vascular disease may have an effect on the loss of muscular strength.

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