Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Tenielle Porter^{1

2

3}, Marc Sim^{4

5}, Richard L Prince^{4

5}, John T Schousboe^{6

7}, Catherine Bondonno^{4

5}, Wai H Lim^{5

8}, Kun Zhu^{5

9}, Douglas P Kiel¹⁰, Jonathan M Hodgson^{4

5}, Simon M Laws^{1

2

3}, Joshua R Lewis^{4

5

11}

Affiliations

¹ Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
² Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
³ School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia.
⁴ Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
⁵ Medical School, University of Western Australia, Crawley, WA, Australia.
⁶ Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA.
⁷ Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
⁹ Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia.
¹⁰ Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
¹¹ Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, NSW, Australia.

PMID: 36213133
PMCID: PMC9535408
DOI: 10.1016/j.lanwpc.2022.100502

Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Tenielle Porter et al. Lancet Reg Health West Pac. 2022.

. 2022 Jun 26:26:100502.

doi: 10.1016/j.lanwpc.2022.100502. eCollection 2022 Sep.

Authors

Affiliations

¹ Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia.
² Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
³ School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia.
⁴ Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
⁵ Medical School, University of Western Australia, Crawley, WA, Australia.
⁶ Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA.
⁷ Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA.
⁸ Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.
⁹ Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia.
¹⁰ Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
¹¹ Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, NSW, Australia.

PMID: 36213133
PMCID: PMC9535408
DOI: 10.1016/j.lanwpc.2022.100502

Abstract

Background: Dementia after the age of 80 years (late-life) is increasingly common due to vascular and non-vascular risk factors. Identifying individuals at higher risk of late-life dementia remains a global priority.

Methods: In prospective study of 958 ambulant community-dwelling older women (≥70 years), lateral spine images (LSI) captured in 1998 (baseline) from a bone density machine were used to assess abdominal aortic calcification (AAC). AAC was classified into established categories (low, moderate and extensive). Cardiovascular risk factors and apolipoprotein E (APOE) genotyping were evaluated. Incident 14.5-year late-life dementia was identified from linked hospital and mortality records.

Findings: At baseline women were 75.0 ± 2.6 years, 44.7% had low AAC, 36.4% had moderate AAC and 18.9% had extensive AAC. Over 14.5- years, 150 (15.7%) women had a late-life dementia hospitalisation (n = 132) and/or death (n = 58). Compared to those with low AAC, women with moderate and extensive AAC were more likely to suffer late-life dementia hospitalisations (9.3%, 15.5%, 18.3%, respectively) and deaths (2.8%, 8.3%, 9.4%, respectively). After adjustment for cardiovascular risk factors and APOE, women with moderate and extensive AAC had twice the relative hazards of late-life dementia (moderate, aHR 2.03 95%CI 1.38-2.97; extensive, aHR 2.10 95%CI 1.33-3.32), compared to women with low AAC.

Interpretation: In community-dwelling older women, those with more advanced AAC had higher risk of late-life dementia, independent of cardiovascular risk factors and APOE genotype. Given the widespread use of bone density testing, simultaneously capturing AAC information may be a novel, non-invasive, scalable approach to identify older women at risk of late-life dementia.

Funding: Kidney Health Australia, Healthway Health Promotion Foundation of Western Australia, Sir Charles Gairdner Hospital Research Advisory Committee Grant, National Health and Medical Research Council of Australia.

Keywords: AAC, abdominal aortic calcification; AAC24, abdominal aortic calcification 24 scale scores; AD, Alzheimer's disease; APOE, apolipoprotein E; ASVD, atherosclerotic vascular disease; AUC, area under the curve; Aging; CAC, coronary artery calcification; CVD, cardiovascular disease; DXA, dual-energy X-ray absorptiometry; Dementia; Epidemiology; FRS, Framingham General Cardiovascular Risk Scores; IDI, integrated discrimination improvement; Imaging; LSI, lateral spine imaging; NRI, net reclassification improvement; ROC, receiver operator characteristics; Vascular disease.

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Conflict of interest statement

DPK has received a grant from Solarea Bio, Amgen and royalties from Wolters Kluwer. DPK sits on the Scientific Advisory Boards of Solarea Bio, Pfizer and Reneo and has participated on the Data Safety Monitoring Board for the AgNovos Healthcare osteoporosis treatment trial. All other authors declare no conflicts of interest.

Figures

Fig. 1 — **Figure 1**
Kaplan Meier Survival curves for late-life dementia (A) hospitalisations and (B) deaths by severity of abdominal aortic calcification (AAC) categories. Black line- low AAC, grey line- moderate AAC and mustard line- extensive AAC.

Fig. 2 — **Figure 2**
Multivariable-adjusted Cox regression for late-life dementia events (hospitalisation and/or death) dichotomised by severity of abdominal aortic calcification (AAC) and the presence of the *APOE*_ℇ4 gene.

See this image and copyright information in PMC

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Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Affiliations

Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources