Abstract
Background: Visceral adiposity has a crucial Pathophysiological role in the development and progression of cardiovascular disease, the major cause of death globally. Sagittal abdominal diameter (SAD) has been proposed as a simple measure for determining visceral adiposity and has previously shown to predict major cardiovascular events (MACE). However, it remains unclear whether SAD is associated with abdominal aortic calcification (AAC), a marker of subclinical cardiovascular disease, or whether it predicts MACE independent of AAC.
Aims: We sought to investigate the association between SAD adjusted for weight with validated machine learning AAC 24-point score (ML-AAC24), and their joint association with MACE.
Methods: SAD and ML-AAC24 were obtained using Dual-energy X-ray Absorptiometry (DXA) during routine vertebral fracture assessment in the Manitoba BMD Registry. Incident MACE (composite of all-cause mortality, acute myocardial infarction [MI], non-hemorrhagic stroke) was ascertained from linked healthcare databases. Cox proportional hazards models examined the simultaneous relationships of SAD/weight and ML-AAC24 with incident MACE.
Results: The study population comprised 8806 individuals (mean age ± SD 75.1 ± 6.6 years, 93.9% women). ML-AAC24 scores were categorised (low <2, moderate 2<6 and high ≥6). Compared to low, those with moderate and high ML-AAC24 had 1.5% and 3.3% higher mean SAD/weight, respectively. Over follow-up of 3.8 (SD 2.2) years, 993 people (11.3%) experienced a MACE. Each increase in SD of SAD/weight was associated higher relative hazard for incident MACE (HR 1.14, 95%CI 1.07-1.21). The hazard ration (HR) of highest compared with lowest tertile of SAD/weight was 1.37 (95%CI 1.16-1.61). Compared to low ML-AAC24 the hazard ratio for moderate and high ML-AAC24 was 1.45 (95% CI 1.24-1.71) and 1.98 (95CI 1.67-2.35), respectively.
Conclusion: SAD/weight is positively associated with ML-AAC24 in older adults attending routine osteoporosis screening. Both measures were associated with incident MACE independent of each other and multiple cardiovascular risk factors.