1
|
Porter T, Sim M, Prince RL, Schousboe JT, Bondonno C, Lim WH, Zhu K, Kiel DP, Hodgson JM, Laws SM, Lewis JR. Abdominal aortic calcification on lateral spine images captured during bone density testing and late-life dementia risk in older women: A prospective cohort study. Lancet Reg Health West Pac 2022; 26:100502. [PMID: 36213133 PMCID: PMC9535408 DOI: 10.1016/j.lanwpc.2022.100502] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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.
Collapse
Key Words
- 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
Collapse
Affiliation(s)
- Tenielle Porter
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Marc Sim
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Richard L. Prince
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - John T. Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Minneapolis, MN, USA
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Catherine Bondonno
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Wai H. Lim
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Kun Zhu
- Medical School, University of Western Australia, Crawley, WA, Australia
- Department of Endocrinology and Diabetes, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Douglas P. Kiel
- Marcus Institute for Aging Research, Hebrew SeniorLife, Department of Medicine Beth, Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jonathan M. Hodgson
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
| | - Simon M. Laws
- Centre for Precision Health, Edith Cowan University, Joondalup, WA, Australia
- Collaborative Genomics and Translation Group, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin Health Innovation Research Institute, Curtin University, Bentley, WA, Australia
| | - Joshua R. Lewis
- Nutrition & Health Innovation Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
- Medical School, University of Western Australia, Crawley, WA, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, School of Public Health, Sydney Medical School, the University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
2
|
Bristow SM, Gamble GD, Horne AM, Reid IR. Longitudinal changes in bone mineral density, bone mineral content and bone area at the lumbar spine and hip in postmenopausal women, and the influence of abdominal aortic calcification. Bone Rep 2019; 10:100190. [PMID: 30766896 PMCID: PMC6360344 DOI: 10.1016/j.bonr.2018.100190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 11/17/2022] Open
Abstract
Longitudinal studies often report that spine bone mineral density (BMD), measured by DXA, is stable in older adults, which has been attributed to osteophyte development and the presence of aortic calcification. A decline in projected spine area as a result of loss of intervertebral disc height might also contribute to higher BMD. We utilised data from 297 postmenopausal women (mean 73 years) who had DXA measurements of the lumbar spine, total hip and femoral neck 5 years apart, and abdominal aortic calcification scoring from vertebral morphometry. BMD declined by -4.4% at the total hip and -3.9% at the femoral neck (p < 0.001), but did not change at the spine (-0.5%, p = 0.12). In contrast, bone mineral content (BMC) declined by -4.0% at the total hip, -2.5% at the femoral neck and -1.7% at the spine (all p < 0.001). Bone area increased by 0.5% at the hip and 1.6% at the femoral neck but declined by -1.2% at the spine (all p < 0.001). 43% of the cohort had abdominal aortic calcification (AAC) present at baseline. The presence of AAC at baseline was not related to changes in BMD or BMC at the total hip or femoral neck, nor to BMD at the spine. However, women with AAC present had a smaller loss of BMC at the spine than those without (-0.8% versus -2.4%, p = 0.03). AAC score increased more over 5 years among those with AAC at baseline than those without (0.28 versus 0.16, p = 0.036). Thus, the stability of spine BMD is the result of both a loss of projected bone area (as a result of intervertebral disc changes and/or a decrease in projected area of the vertebral bodies) and the effects of aortic calcification. Future clinical trials should consider assessing changes in spine BMC as a more informative index of spine mineral status.
Collapse
Affiliation(s)
- Sarah M Bristow
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Greg D Gamble
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Anne M Horne
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Ian R Reid
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland 1142, New Zealand.,Department of Endocrinology, Auckland District Health Board, Auckland, New Zealand
| |
Collapse
|