Risk factors

Coronary calcium scored can be derived from bone scans in 15 seconds

Abdominal aortic calcification (AAC) observed in women during bone densitometry is associated with atherosclerotic vascular disease-related hospitalisations and deaths.

The sub-study of the Perth Longitudinal Study of Aging in Women comprised more than 1,000 women over 70 years of age. AAC24 scores were calculated from bone densitometry and lateral spine images.

Over almost 15 years follow-up, 335 women had an atherosclerotic vascular disease-related hospitalisation and 206 died. Advanced or severe AAC was seen in almost one in five women.

Moderate and high AAC24 scores were associated with both atherosclerotic vascular disease-related hospitalisation and all-cause mortality.

High AAC24 scores were also associated with cerebrovascular disease hospitalisations and /or death and myocardial infarction or coronary heart disease death.

“As these older women are already undergoing routine bone densitometry, the addition of lateral spine images during bone density testing to assess AAC may help to inform future treatment decisions to prevent cardiovascular events in large numbers of older women,” the study said.

Dr Joshua Lewis, a NHMRC Career Development Fellow at Edith Cowan University, told the limbic the AAC24 scores required only one additional scan at the time of bone density testing.

“And with the newer machines, it takes about 15 seconds to get this additional scan done so it’s very low cost,” he said.

“This isn’t like a coronary artery calcification scan which is very accurate and taken to screen for cardiovascular risk in higher risk populations. But we’re saying that when they take a vertebral fracture assessment image and they see advanced calcification, then that should be reported to the treating physician.”

“It really highlights the utility of the bone density testing machines. We know that elderly women are at risk for both cardiovascular disease and fractures and so we can start to think about testing for both.”

“And unlike cardiovascular risk factors like blood pressure and lipids, this is actual evidence of disease rather than a risk factor for disease.”

Senior author Professor Richard Prince, an endocrinologist from Sir Charles Gairdner Hospital, told the limbic the findings underlined the importance of managing the comorbidities of both bone and vascular disease.

A high AAC24 score represented an additional risk compared to that calculated from more traditional risk factors based on Framingham data.

“In particular if the patient is receiving therapy appropriate to a lower risk individual, I advise an increase in adherence to lifestyle advice and an increase in medication. In Australia, cardiologists are more likely to be involved when symptoms such as chest pain or shortness of breath occur.”

Professor Prince said a health economic analysis was being considered to try and get a better understanding of the potential for economic benefit.

“Our experience is that combining bone density screening with CVD screening in a low cost, low radiation, efficient way is not seen as an attractive topic for funding when compared to research into high tech more sophisticated technology.”

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