Article Text

Download PDFPDF
Original research
Abdominal aortic calcification, cardiac troponin I and atherosclerotic vascular disease mortality in older women
  1. Ryan Teh1,2,
  2. Richard L Prince1,3,
  3. Marc Sim1,4,
  4. John T Schousboe5,
  5. Warren D Raymond1,4,
  6. Pawel Szulc6,
  7. Wai Lim1,7,
  8. Jonathan M Hodgson1,4,
  9. Kun Zhu1,3,
  10. Douglas P Kiel8,
  11. Carl Schultz1,9,
  12. Peter L Thompson1,10,11,
  13. Joshua R Lewis1,4,12
  1. 1Medical School, The University of Western Australia, Perth, Western Australia, Australia
  2. 2Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  3. 3Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  4. 4Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
  5. 5Park Nicollet Osteoporosis Center and Health Partners Institute, Minneapolis, Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota, USA
  6. 6INSERM UMR1033, University of Lyon, Hôpital Edouard Herriot, Lyon, France
  7. 7Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  8. 8Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
  9. 9Department of Cardiology, Royal Perth Hospital Campus, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
  10. 10Department of Cardiovascular Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
  11. 11Harry Perkins Institute of Medical Research, Nedlands, Western Australia, Australia
  12. 12Centre for Kidney Research, Sydney Medical School, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Joshua R Lewis, The University of Western Australia, Perth, Western Australia 6027, Australia; joshua.lewis{at}ecu.edu.au

Abstract

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.

Trial registration number ACTRN12617000640303.

  • biomarkers
  • diagnostic imaging
  • epidemiology

Data availability statement

Data are available on reasonable request. Data used for this paper are available on reasonable request from the corresponding author or through the study website http://www.lsaw.com.au/.

Statistics from Altmetric.com

Data availability statement

Data are available on reasonable request. Data used for this paper are available on reasonable request from the corresponding author or through the study website http://www.lsaw.com.au/.

View Full Text

Footnotes

  • Contributors RT, MS, RLP and JRL conceived and designed the study; JTS, DPK, RLP and JRL collected the data; RT, MS and JRL analysed the data; RT prepared the manuscript with input from all authors, and is the guarantor for the study; RT and MS had the primary responsibility for the final content. WDR, PS, WHL, JMH, KZ, CS and and PLT provided intellectual input and edited the paper. All authors read and approved the final manuscript.

  • Funding This study was funded by National Health and Medical Research Council (254627, 303169 and 572604). The effort of DPK was supported by a grant from the National Institute of Arthritis, Musculoskeletal and Skin Diseases R01 AR 041398. The Salary of MS is supported by a Royal Perth Hospital Career Advancement Fellowship (RPH CAF 130/2020). The salary of JMH is supported by an NHMRC of Australia Senior Research Fellowship (ID: 1116973). The salary of JRL is supported by a National Heart Foundation of Australia Future Leader Fellowship (ID: 102817). None of these funding agencies had any role in the conduct of the study; collection, management, analysis or interpretation of the data; or preparation, review or approval of the manuscript. None of the authors have relationships with industry.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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.