Aortic and Iliac Calcifications as Predictors of Aortic Events and MALEs: A DANCAVAS Prospective

In this prospective, population-based cohort derived from the Danish Cardiovascular Screening (DANCAVAS) trials, researchers evaluated whether thoracoabdominal aortic and iliac calcifications predict aortic events (dissection or aneurysm rupture) and major adverse limb events (MALEs: peripheral revascularization and lower-limb amputation). Participants underwent full thoracoabdominal CT with calcification quantified in a 5-segment model (ascending aorta categorized differently due to low calcification prevalence) and followed for up to about eight years for outcomes, until death or end of follow-up.

Analyses used competing risk hazard regression adjusted for demographics, cardiovascular risk factors, aortic diameter, and ankle–brachial index. Findings show that severe calcification, defined as the fourth quartile or exposure group, was associated with markedly higher relative hazards for both aortic events and MALEs.

Specifically, ascending and abdominal aorta calcifications carried elevated SHRs for aortic events (e.g., ascending SHR 3.06; abdominal SHR 7.61). For MALEs, calcifications in all segments—ascending, aortic arch, descending, abdominal aorta, and iliac arteries—showed strong associations, with the highest risk observed in the iliac arteries (SHR 13.52).