High Cardiovascular Risk in Older Men With Severe Peripheral Artery Calcification on High-Resolution Peripheral QCT Scans: The STRAMBO Study

Abstract

Objective: Arterial calcification is associated with high cardiovascular risk. Our aim was to assess the utility of peripheral arterial calcification (PAC) in distal forearm and distal leg for the prediction of acute coronary syndrome (ACS) and major adverse cardiovascular event in older men. Approach and Results: In 815 home-dwelling older men, PAC was assessed on the scans of distal forearm and leg obtained by high-resolution peripheral quantitative computed tomography. PAC score (0-12) was calculated on the basis of the number and severity in small peripheral arteries. The information on ACS and major adverse cardiovascular event was collected prospectively for 8 years. PAC severity increased with age and body mass index (P<0.001). Median PAC score was higher in men with ischemic heart disease or pharmacologically treated diabetes (P<0.001). After adjustment for confounders, the risk of ACS was higher in men with severe PAC (6+) versus men with lower PAC (0-5; hazard ratio, 3.86 [95% CI, 1.65-9.02], P<0.005). After adjustment for confounders, the risk of major adverse cardiovascular event was higher in men with severe PAC (6+) versus men with lower PAC (hazard ratio, 2.58 [95% CI, 1.41-4.72], P<0.005). In men who did not have cardiovascular risk factors, severe PAC was associated with higher risk of ACS, for example, in men who did not self-report ischemic heart disease (hazard ratio, 6.62 [95% CI, 2.16-20.23], P<0.001). Conclusions: Severe PAC is associated with higher risk of ACS and major adverse cardiovascular event in older home-dwelling men, also in men without known ischemic heart disease. Incidentally found severe PAC can be a serious warning indicating high cardiovascular risk.