News | Computed Tomography (CT) | October 12, 2018

Abdominal Aortic Calcification May Signal Future Heart Attack

CT-based measurement of calcification may improve risk assessment for individuals in indeterminate range with traditional risk scores

Abdominal Aortic Calcification May Signal Future Heart Attack

Image from computed tomography (CT) colonography shows segmented abdominal aortic calcification measured with semiautomated CT tool on coronal image. Within region of interest over aorta selected by user, tool automatically segments and quantifies aortic calcification (shown in blue). 

Image Credit: O’Connor S D, Graffy P M, Zea R, et al. Does nonenhanced CT-based quantification of abdominal aortic calcification outperform the Framingham Risk Score in predicting cardiovascular event sin asymptomatic adults? Radiology doi: 10.1148/radiol.2018180562. Published online Oct. 2, 2018. © RSNA.

October 12, 2018 — Computed tomography (CT)-based measures of calcification in the abdominal aorta are strong predictors of heart attacks and other adverse cardiovascular events — stronger even than the widely used Framingham risk score. These assertions are according to a new study published in the journal Radiology.1

Cardiovascular diseases are the leading cause of death worldwide. Of these deaths, heart disease and stroke are the deadliest. Effective measures of cardiovascular disease risk are crucial in predicting which patients are most in need of early interventions like diet and lifestyle changes, or medications to lower cholesterol.

“We found a strong association between abdominal aortic calcification and future cardiovascular events,” said lead author Stacy D. O’Connor, M.D., MPH, assistant professor of radiology at the Medical College of Wisconsin in Milwaukee. “With heart disease being a leading cause of death, anything we can do to make our patients more aware of their risk is going to help.”

The Framingham risk score is a well-known and widely used prediction model for cardiovascular disease based on traditional risk factors like age, cholesterol and blood pressure. However, many patients evaluated by the Framingham risk score fall into an indeterminate risk category and could benefit from additional noninvasive tools for refining risk assessment like measures of atherosclerosis, which is narrowing of the arteries due to plaque buildup. CT is commonly used to measure calcium, a component of plaque, in the coronary arteries.

CT can also measure calcium in the abdominal aorta, the large vessel that carries oxygenated blood to the lower extremities. The abdominal aorta can be seen on abdominal imaging exams like CT colonography, also known as virtual colonoscopy, and in the diagnostic workup for acute cholecystitis, an inflammation of the gallbladder often caused by gallstones.

For the new study, conducted at the University of Wisconsin School of Medicine and Public Health in Madison, researchers assessed the relationship between abdominal aortic calcification on CT and cardiovascular events in 829 asymptomatic patients with a mean age of approximately 58 years. The patients had undergone non-enhanced screening CT colonography between April 2004 and March 2005. The researchers were able to follow the patients for an average of 11 years to see if they had developed adverse cardiovascular events like heart attack, stroke, death or congestive heart failure.

Of the 829 patients, 156 (18.8 percent) had a major cardiovascular event. The events occurred almost seven years after CT, on average, and included heart attack in 39 and death in 79. CT-based abdominal aortic calcification was a strong predictor of future cardiovascular events, outperforming the Framingham risk score. Abdominal aortic calcification was more than five times higher, on average, among those who had a cardiovascular event than those who did not.

The results point to the potential of abdominal aortic calcification assessment as an opportunistic screening tool — something that could be added to other exams without the need for additional patient time or radiation dose. Patients could be assigned to preventive treatment regimens based on their cardiovascular risk categories.

“There are thousands of CT scans performed every day across the United States, so this gives us an opportunity to reach a lot of people,” O’Connor said. “For instance, if someone is getting a scan for cholecystitis and we see abdominal aortic calcification on the CT, we can address things like blood pressure and cholesterol with the patient.”

The researchers plan to build on their results by studying larger groups of patients. They also intend to move toward a fully-automated protocol for more widespread implementation of the assessment.

“It’s our hope that these opportunistic measures can be added to reports for patients undergoing routine abdominal CT, regardless of the imaging indication,” O’Connor said.

For more information: www.pubs.rsna.org/journal/radiology

Reference

1. O’Connor S.D., Graffy P.M., Zea R., Pickhardt P.J. Does Nonenhanced CT-based Quantification of Abdominal Aortic Calcification Outperform the Framingham Risk Score in Predicting Cardiovascular Events in Asymptomatic Adults? Radiology, Oct. 2, 2018. https://doi.org/10.1148/radiol.2018180562

Related Content

FDA Warns Troponin Tests Impacted by Biotin Dietary Supplement
Feature | Cardiac Diagnostics | November 05, 2019 | Dave Fornell, Editor
November 5, 2019 — The U.S.
Videos | Cardiac Diagnostics | October 29, 2019
Doctor Clyde Yancy was a keynote speaker and said doctors need to check their assumptions about patients at the door...
79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event

79-year-old Tony Marovic had a right carotid endarterectomy shortly after discovering a 95 percent blockage of his carotid artery at a health and wellness screening event. Image courtesy of University Hospitals.

News | Cardiac Diagnostics | October 16, 2019
Health and wellness screenings are more than just nice events for the community – they can save lives. A Mentor, Ohio,...
Pesticide Exposure May Increase Heart Disease and Stroke Risk

Image courtesy of zefe wu from Pixabay

News | Cardiac Diagnostics | October 15, 2019
On-the-job exposure to high levels of pesticides raised the risk of heart disease and stroke in a generally healthy...
World Heart Federation Launches Global Roadmap on Cardiovascular Disease Prevention Among Diabetics
News | Cardiac Diagnostics | September 04, 2019
At the European Society of Cardiology (ESC) Congress 2019 together with the World Congress of Cardiology, the World...
Insomnia Tied to Higher Risk of Heart Disease and Stroke

Image courtesy of the American Heart Association

News | Cardiac Diagnostics | August 19, 2019
People suffering from insomnia may have an increased risk of coronary artery disease, heart failure and stroke,...
Evolutionary Gene Loss May Help Explain Human Predisposition to Heart Attacks
News | Cardiac Diagnostics | July 29, 2019
The loss of a single gene two to three million years ago in our ancestors may have resulted in a heightened risk of...
U.S. Soldiers Have Worse Heart Health Than Civilians
News | Cardiac Diagnostics | June 06, 2019
Active duty Army personnel have worse cardiovascular health compared to people of similar ages in the civilian...
Late Dinner and No Breakfast Worsens Outcomes After Heart Attack
News | Cardiac Diagnostics | May 23, 2019
People who skip breakfast and eat dinner near bedtime have worse outcomes after a heart attack, according to research...
HRS Releases New Expert Consensus Statement on Arrhythmogenic Cardiomyopathy
News | Cardiac Diagnostics | May 14, 2019
The Heart Rhythm Society (HRS) released a first-of-its-kind consensus statement with guidance on the evaluation and...
Overlay Init