Article Text

Download PDFPDF
Original article
Calcification of the abdominal aorta as an independent predictor of cardiovascular events: a meta-analysis
  1. Frederico Bastos Gonçalves1,2,3,
  2. Michiel T Voûte1,
  3. Sanne E Hoeks3,
  4. Michel B Chonchol4,
  5. Eric E Boersma5,
  6. Robert J Stolker3,
  7. Hence J M Verhagen1
  1. 1Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Angiology and Vascular Surgery, Hospital de Santa Marta, CHLC, Lisbon, Portugal
  3. 3Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  4. 4Division of Renal Diseases and Hypertension, University of Colorado, School of Medicine, Aurora, Denver, Colorado, USA
  5. 5Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  1. Correspondence to Professor H J M Verhagen, Department of Vascular Surgery, Erasmus University Medical Centre, 's-Gravendijkwal 230, Rotterdam 3015CE, The Netherlands; h.verhagen{at}


Context Abdominal aortic calcification (AAC) is a common finding in patients with atherosclerosis.

Objective The aim of this study was to demonstrate the incremental value of AAC in predicting long term cardiovascular (CV) outcome by conducting a meta-analysis of observational studies.

Data sources MEDLINE and Cochrane databases.

Study selection Longitudinal studies with at least 2 years of follow-up, reporting the influence of AAC on CV outcome of general population patients.

Data extraction Four separate end points—coronary events, cerebrovascular events, all CV events and CV related death—were tested for their relationship with AAC at baseline, using weighted random effects meta-analysis. Heterogeneity was calculated using Q and I2 statistic tests. Publication bias was assessed by funnel plot symmetry and trim and fill methods. The importance of calcium quantification was also explored (sensitivity analysis).

Results 10 studies were included. An increased relative risk (RR) was found for all end points: for coronary events (five studies, n=11250) 1.81 (95% CI 1.54 to 2.14); for cerebrovascular events (four studies, n=9736) 1.37 (1.22 to 3.54); for all CV events (four studies, n=4960) 1.64 (1.24 to 2.17); and for CV death (three studies, n=4986) 1.72 (1.03 to 2.86). Analysis of studies presenting results in categories (no/minimal, moderate and severe calcification) revealed a stepwise increase in the RR for all end points. Significant heterogeneity was found in the included studies. Sources of heterogeneity were identified in the publication date, duration of follow-up, and mean age and gender differences in the included patient cohorts.

Conclusion Existing data suggest that AAC is a strong predictor of CV related events or death in the general population. The predictive impact is greater in more calcified aortas. The generalisability of the meta-analysis is limited by heterogeneity in the coronary events, all CV events and CV death end points.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding FMVBG and SEH are supported by an unrestricted research grant from the Dutch Organisation of ‘Lijf & Leven’. MTV is supported by an unrestricted research grant from The Netherlands Heart Foundation (No 2009B020).

  • Competing interests None.

  • Provenance and peer review Not commissioned; not externally peer reviewed.