Prevalent vertebral fracture (PVFx) and abdominal aortic calcification (AAC) independently predict incident atherosclerotic cardiovascular disease (ASCVD) events in older men.

Abstract

To estimate the associations of prevalent vertebral fracture (PVFx) and abdominal aortic calcification (AAC) with incident ASCVD (myocardial infarction, fatal or non-fatal cerebrovascular accident, or coronary heart disease death). 2799 older men (mean [SD] age 76.3 [5.5] years) enrolled in the MrOS sleep ancillary study had PVFx (SQ grade 2 or 3) assessed by human reader and AAC by automated convolutional neural networks on baseline lateral spine radiographs. Auto-AAC was categorized as low, moderate, or high (24-point scale score < 2, 2 to <6, or ≥ 6). Men were contacted every 4 months for ascertainment of possible ASCVD events over a mean (SD) follow-up of 8.4 (3.1) years. Associations of PVFx and auto-AAC category with incident ASCVD were estimated with modified proportional hazards models accounting for non-CVD mortality. PVFx was present in 7.3% of the cohort; 34.5% had moderate auto-AAC, 28.8% had high auto-AAC, and 396 (14.1%) had an incident ASCVD event. Compared to men with low auto-AAC, those with moderate (HR 1.34, 95% CI 1.01, 1.77) and high (HR 1.55, 95% CI 1.16, 2.06) auto-AAC had increased risk of ASCVD events adjusted for PVFx and other risk factors. Compared to men with no PVFx, those with PVFx had a higher risk of ASCVD events (HR 1.51, 95% CI 1.07, 2.14) adjusted for auto-AAC level and other risk factors. AAC assessed by automated methods and PVFx are independently associated with incident ASCVD events and may aid in ASCVD risk stratification in older men, but confirmatory studies are needed.