Association between aortic calcification and total and cardiovascular mortality in older women

Objectives. To determine whether older women with abdominal aortic calcification had a greater cardiovascular and all-cause mortality, as such data are limited in older adults. Design. Prospective cohort study with a mean follow-up of 13 years Setting. Community-based sample with four US clinical centres. Subjects. A total of 2056 women aged ≥65 years with abdominal aortic calcification assessed on baseline radiographs. Main outcome measure. Mortality rate (all, cardiovascular, cancer or other cause) adjudicated from death certificates and hospital records. Results. The prevalence of abdominal aortic calcification increased with age, ranging from 60% at age 65-69 years to 96% at 85 years and older. Participants with aortic calcification were more likely to die during follow-up of any cause (47% vs. 27%) or a cardiovascular-specific cause (18% vs. 11%, both P < 0.001) than those without aortic calcification. In age-adjusted analyses, aortic calcification was associated with a greater rate of all-cause and cause-specific mortality (cardiovascular, cancer, and other, all P ≤ 0.01). In analyses adjusted for age and cardiovascular risk factors, aortic calcification was associated with an increased rate of all-cause mortality (HR: 1.37, 95% CI: 1.15-1.64), and noncardiovascular noncancer mortality (HR: 1.57, 95% CI: 1.17-2.11). The associations between aortic calcification and cancer mortality (HR: 1.44, 95% CI: 1.00-2.08) or cardiovascular mortality (HR: 1.18, 95% CI: 0.88-1.57) showed a similar pattern without reaching statistical significance, but was slightly stronger for mortality from coronary heart disease (HR: 1.53, 95% CI: 0.91-2.56). Conclusions. Abdominal aortic calcification in older women is associated with increased mortality. Future research should examine potential mechanisms for this association.