Aortic and Iliac Calcifications Predict Aortic Events and MALEs: DANCAVAS Cohort Study

02 Mar 20265 min read0 viewsJournal Feed

GIST

Circulation, Ahead of Print. BACKGROUND:There is limited evidence of the relationship between aortic and iliac calcification and aortic events (aortic dissection or aneurysm rupture) and major adverse limb events (MALEs; peripheral revascularization and lower limb amputation).

The aim of this population-based prospective cohort study was to investigate the association of aortic and iliac calcifications with aortic events and MALEs.METHODS:All participants from the DANCAVAS (Danish Cardiovascular Screening) trials who received a full thoracoabdominal aortic computed tomography scan with recorded measurements of aortic and iliac calcification were included. The aorta and iliac artery calcifications were measured in a 5-segment model and categorized into quartiles, apart from the ascending aorta, which was categorized into 4 exposure groups, as the majority of participants had no calcification in the ascending aorta.

The participants were followed from inclusion in the DANCAVAS trial until aortic events, MALE, death, or end of follow-up on May 1, 2025.

Clinical Editorial

Key design and scope

Prospective cohort derived from the Danish Cardiovascular Screening (DANCAVAS) trials, including participants who underwent a full thoracoabdominal CT scan with calcification measurements in a 5-segment model for the aorta and iliac arteries.
Exposure data were organized into quartiles for most segments, while the ascending aorta was categorized into four groups due to a predominance of noncalcified individuals.
Follow-up spanned from trial inclusion to the occurrence of an aortic event, MALE, death, or May 1, 2025, with competing risk regression used to adjust for potential confounders (demographics, cardiovascular risk factors, aortic diameter, and ankle–brachial index).

Population and events

Study population included 13,065 participants (94% men; mean age 67 ± 4 years).
Mean follow-up duration was about 8 years.
Observed outcomes included 42 aortic events and 311 major adverse limb events (MALEs).

Associations with aortic events

For the ascending and abdominal aorta, the highest calcification category (quartile 4) was linked to markedly higher subdistribution hazard for aortic events:
Ascending aorta: SHR approximately 3.06 (95% CI 1.15–8.16).
Abdominal aorta: SHR approximately 7.61 (95% CI 1.44–40.22).
The data indicate a positive, dose-responsive relationship between higher calcification burden and risk of aortic events, particularly in the abdominal aorta.

Associations with MALEs

Severe calcification across all measured segments showed strong associations with MALEs:
Ascending aorta: SHR around 2.20 (95% CI 1.56–3.10).
Aortic arch: SHR around 6.49 (95% CI 3.10–13.56).
Descending aorta: SHR around 2.43 (95% CI 1.45–4.08).
Abdominal aorta: SHR around 7.89 (95% CI 2.95–21.15).
Iliac arteries: SHR around 13.52 (95% CI 4.32–42.24).
Across segments, the strongest signal for MALE risk appeared in the iliac arteries, with markedly elevated SHRs in the highest calcification category.

Context and implications

The findings suggest that extensive calcification of the aorta and iliac arteries signals higher risk for both critical aortic events and limb-related adverse outcomes.
Quantifying aortic and iliac calcification may enhance prognostic assessment and risk stratification in individuals with known aortic aneurysm or peripheral artery disease.
The study supports a potential role for imaging-based plaque burden to inform clinical risk evaluation, though operational integration and thresholds would require further validation.
Limitations include the observational design, potential residual confounding, and relatively small number of aortic events despite a large cohort, which may affect precision for some estimates.