Calcification of the Aortic Arch

TLDR

Calcium deposits in coronary and extracoronary arteries signal atherosclerosis, but the incremental predictive value of vascular calcification beyond traditional risk factors remains unclear. The study aimed to evaluate risk factors for aortic arch calcification and its long‑term association with cardiovascular diseases in a large population‑based cohort. A prospective cohort of 116,309 adults (aged 30–89) from a Northern California health maintenance organization, followed from 1964–73 to 1997, assessed aortic arch calcification on chest radiographs and linked it to hospitalizations or deaths from coronary heart disease, stroke, or peripheral vascular disease. Calcification of the aortic arch, present in 1.9% of men and 2.6% of women, independently predicts coronary heart disease in both sexes (RR≈1.25) and, in women, also predicts ischemic stroke (RR≈1.46), after adjusting for traditional risk factors.

Abstract

ContextCalcium deposits in coronary and extracoronary arterial beds may indicate the extent of atherosclerosis. However, the incremental predictive value of vascular calcification, beyond traditional coronary risk factors, is not clearly established.ObjectiveTo evaluate risk factors for aortic arch calcification and its long-term association with cardiovascular diseases in a population-based sample.Design and SettingCohort study conducted at a health maintenance organization in northern California.ParticipantsA total of 60,393 women and 55,916 men, aged 30 to 89 years at baseline who attended multiphasic health checkups between 1964 and 1973 and for whom incidence of hospitalizations and/or mortality data were ascertained using discharge diagnosis codes and death records through December 31, 1997 (median follow-up, 28 years).Main Outcome MeasureHospitalization for or death due to coronary heart disease, ischemic stroke, hemorrhagic stroke, or peripheral vascular disease, as associated with aortic arch calcification found on chest radiograph at checkup from 1964-1973.ResultsAortic arch calcification was present in 1.9% of men and 2.6% of women. It was independently associated with older age, no college education, current smoking, and hypertension in both sexes, but it was inversely related to body mass index and family history of myocardial infarction. In women, aortic arch calcification was also associated with black race and elevated serum cholesterol level. After adjustment for age, educational attainment, race/ethnicity, cigarette smoking, alcohol consumption, body mass index, serum cholesterol level, hypertension, diabetes, and family history of myocardial infarction, aortic arch calcification was associated with an increased risk of coronary heart disease (in men, relative risk [RR], 1.27; 95% confidence interval [CI], 1.11-1.45; in women, RR, 1.22; 95% CI, 1.07-1.38). Among women, it was also independently associated with a 1.46-fold increased risk of ischemic stroke (95% CI, 1.28-1.67).ConclusionIn our population-based cohort, aortic arch calcification was independently related to coronary heart disease risk in both sexes as well as to ischemic stroke risk in women.