Progression of aortic calcification among Japanese in Japan and white and Japanese Americans: a prospective cohort study.

AIMS: Continued low mortality from coronary heart disease in Japan, despite deleterious changes in traditional risk factors, remains unexplained. Since aortic calcification (AC) was an early predictor of cardiovascular mortality, we compared the progression and incidence of AC between Japanese in Japan, white Americans, and third-generation Japanese Americans in the ERA JUMP cohort. We examined whether higher blood levels of marine-derived n-3 fatty acids (FAs) in Japanese than in Americans accounted for the difference. METHODS AND RESULTS: Men (n=700) aged 40-49 years (252 Japanese in Japan, 238 white, and 210 Japanese Americans) were examined at baseline and 4-7 years later. AC was evaluated from the aortic arch to the iliac bifurcation with computed tomography and quantified by the Agatston method. Robust linear regression and linear mixed models were used to compare the progression of AC. Multivariable logistic regression models were fitted to compare the incidence of AC (AC≥50 at follow-up) among those with baseline AC<50. Japanese in Japan had a significantly slower progression of AC than white and Japanese Americans after adjusting for age, baseline AC, follow-up time, and traditional risk factors. White Americans had a significantly higher incidence of AC than Japanese in Japan (OR=4.61 [95%CI, 1.27-16.82]). Additional adjustment for blood levels of n-3 FAs accounted for the difference in AC incidence but not progression. CONCLUSION: Japanese in Japan had a significantly slower progression and lower incidence of AC than white Americans. High levels of marine-derived n-3 FAs in Japanese in Japan partly accounted for the difference in incidence.

A systematic review evaluating the association of atherosclerosis and lumbar degenerative disc disease.

Introduction: Lumbar disc herniation (LDH) and disc degeneration (DD) are associated with low back pain (LBP) and sciatica, which are common health problems. Emerging evidence suggests a link between vascular health, specifically abdominal aortic calcification (AAC) and systemic lipid profiles, and these spinal conditions. Research question: This study investigates the associations between AAC, systemic lipid profiles, lumbar Modic Changes (MC), DD/LDH, and the occurrence of LBP or sciatica. Material and methods: A literature search was performed (up to August 2023) in PubMed, Embase, Web of Science, Emcare, Cochrane Library, and Academic Search Premier utilizing a sensitive search strategy. Studies were chosen based on predefined criteria and assessed for bias using an adapted Cochrane checklist. Specifically, studies exploring the relationship between AAC or lipid status and DD/LDH and/or LBP/Sciatica were included. Results: Twenty-seven studies were included. Eight studies assessed the association between atherosclerosis or lipid status and clinical LBP/sciatica, with four showing a positive association between AAC/lumbar artery stenosis and these conditions. Twenty-one studies assessed atherosclerosis and DD/LDH, with seven showing a positive association between AAC and DD/LDH. Eight trials found a positive association between lipid status and DD/LDH, and two trails identified ApoL1 as a biomarker for LDH recovery. Discussion and conclusion: Evidence supports the hypothesis that inadequate blood supply contributes to disc degeneration, inflammation and clinical symptoms. Both local vascular issues and systemic lipid profiles appear to influence lumbar degeneration, highlighting the need for further research to better understand these relationships and develop preventive and therapeutic strategies.

Association between oxidative balance score and abdominal aortic calcification among middle-aged and elderly population.

BACKGROUND: The Oxidative Balance Score (OBS) was created to evaluate an individual's overall antioxidant status. The objective of this study was to examine the association between OBS and abdominal aortic calcification (AAC) among individuals aged ≥ 40 years. METHODS: This population-based cross-sectional study used data from the National Health and Nutrition Examination Survey in 2013-2014 and included adults aged ≥ 40 years. Survey-weighted multivariable logistic and restricted cubic spline models were used to assess the association between OBS and AAC. RESULTS: Among 2520 participants, 744 were diagnosed with AAC (weighted percentage, 28.13%). Survey-weighted multivariable logistic revealed an inverse association between OBS and AAC [0.98 (0.96, 1.00)], and the nonlinear dose-response relationship was observed. Subgroup analysis and interaction tests revealed that this inverse relationship was consistent across different populations (all P for interaction > 0.05). CONCLUSIONS: OBS was inversely associated with the prevalence of AAC among individuals aged ≥ 40 years. Maintaining a higher OBS may be beneficial in reducing the burden of AAC.

Gender-specific correlations between remnant cholesterol and severe abdominal aortic calcification in American adults.

Background: Remnant cholesterol (RC) predicts cardiovascular risk and is associated with a range of diseases, including asthma, hypertension, depression, periodontitis, and alcoholic fatty liver disease. However, its correlation with abdominal aortic calcification (AAC) has not been reported. Methods: Using a cross-sectional approach, this study examined data from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Multiple logistic regression, generalized summation models, and subgroup analyses were used in examining the correlation between RC and the prevalence of severe AAC. Results: The mean age of participants in this study was 57.70 ± 11.73 years, with 142 individuals (9.67%) suffering from severe AAC. The median RC was 0.52 mmol/L (Q1-Q3, 0.36-0.75 mmol/L). Among female participants, a significant positive correlation was observed between RC and severe AAC (per natural log [RC] increment: 2.14; 95% CI, 1.07-4.27). Smooth curve fitting and threshold effect analysis revealed a saturation effect at an RC level of 0.57 mmol/L. Conversely, in male participants, no significant correlation was found between RC and the prevalence of severe AAC (per natural log [RC] increment: 0.88; 95% CI, 0.43-1.78). Our findings suggest a significant interaction between gender and RC in relation to severe AAC (P for interaction = 0.0042). Conclusions: Higher RC levels were significantly associated with an increased prevalence of severe AAC in women.

Association between serum estradiol levels and abdominal aortic calcification in postmenopausal woman: a cross-sectional study.

Background: The association between Estradiol (E2) levels and abdominal aortic calcification (AAC) in postmenopausal women remains unclear. Methods: 614 postmenopausal women from the 2013-2014 NHANES survey cycle were included in this study. The study population was divided into 3 groups according to E2 tertiles: Tertile1 (2.12-3.57pg/mL), Tertile2 (3.60-7.04pg/mL), and Tertile3 (7.06-38.4pg/mL). Estrogen concentration data were natural logarithmically transformed. A Kauppila score > 5 was regarded as prominent arterial calcification and was used to define (EAAC). Logistic regression models were used to assess the association between E2 levels and EAAC prevalence. Subgroup analyses were performed to test whether the association between E2 levels and EAAC prevalence was consistent in different groups. Sensitivity analyses tested the stability of the model in women older than 45 years. Results: EAAC prevalence was significantly higher in Tertile1 (16.6%) than in Tertile2 (9.8%) and Tertile3 (8.3%). On a continuous scale, the adjusted model showed a 58% [OR (95%CI), 1.58 (1.02, 2.54)] increase in the risk of EAAC prevalence for per unit decrease in ln(E2). On a categorical scale, the adjusted model showed that Tertile1 and Tertile2 were 2.55 [OR (95%CI), 2.55 (1.10, 5.92)] and 1.31[OR (95%CI), 1.31(1.03, 2.57)] times higher risk of suffering from EAAC than Tertile3, respectively. Conclusion: This study found that a higher prevalence of AAC in postmenopausal women is closely associated with lower serum E2 levels. Our research further underscores the importance of E2 in maintaining cardiovascular health in postmenopausal women and suggests that monitoring E2 levels may aid in the early prevention and management of AAC and related cardiovascular diseases.

Association Between Ward's Triangle Bone Mineral Density Levels and Abdominal Aortic Calcification: Data from the National Health and Nutrition Examination Survey 2013-2014.

BACKGROUND & AIMS: Despite extensive research into the cardiovascular implications of abdominal aortic calcification (AAC), there is a scarcity of robust studies exploring its association with Ward's triangle bone mineral density (BMD). This study aimed to evaluate this relationship in a nationally representative sample and compare the predictive value with femoral neck BMD and total femur BMD. METHODS: We conducted a cross-sectional analysis of 2013-2014 National Health and Nutrition Examination Survey (NHANES) data, utilizing a complex, stratified, multistage, cluster sampling design. BMD measurements at Ward's triangle, femoral neck, and total femur were assessed using DXA scans. AAC severity was defined by a Kauppila score of ≥5. Predictors of AAC-24 scores were identified through correlation and linear regression models. Stratified regression and restricted cubic splines were applied to explore subgroup and dose-response relationships. RESULTS: Of the 2,965 participants representing 116,562,500 individuals in the U.S., 11% had severe AAC. Ward's triangle BMD showed a significant negative association with AAC-24 scores (ß = -1.90, 95% CI: -2.80 to -1.00, P < 0.002) and a reduced risk of severe AAC (OR = 0.85, 95% CI: 0.76 to 0.95, P = 0.010). Non-linear associations were observed between Ward's triangle BMD and AAC outcomes. Ward's triangle BMD outperformed femoral neck and total femur BMD in predicting AAC. CONCLUSIONS: Higher Ward's triangle BMD is linked to lower odds of severe AAC, highlighting its potential for improved early detection of AAC over femoral neck and total femur BMD. Healthcare providers should consider the implications of reduced Ward's triangle BMD for systemic atherosclerosis and recommend early AAC screening for enhanced cardiovascular risk management.

Functional and prognostic impacts of serum albumin with thoracic arterial calcification among asymptomatic individuals.

Although several studies have demonstrated the cardiovascular (CV) implication of hypoalbuminemia and arterial calcification among hemodialysis patients, little is known regarding their cardiac correlates and relevant CV outcomes in asymptomatic individuals. We assessed the potential CV interrelation between serum albumin (SA) and aortic calcification. Among 2,723 asymptomatic individuals underwent cardiovascular health check-up, we assessed serum albumin (SA) level, thoracic aortic calcification (TAC) and coronary artery calcification (CAC) by multi-detector computed tomography, and ultrasound-determined carotid plaque burden. We related these measures to cardiac structure/function and CV outcomes. Lower SA level was associated with higher TAC score and volume rather than carotid plaque or coronary calcification burden in fully adjusted models. By categorizing the study population into 4 groups by SA (>, ≤ 4.6 mg/dL) and presence of TAC, subjects classified into low SA/TAC(+) category were oldest with highest prevalent CV disease. Both lower SA and TAC(+) were independently associated with impaired myocardial systolic/diastolic mechanics and higher CV events during a median of 6.6 years (IQR: 5.1, 6.8 years) follow-up. Participants classified into low SA/TAC(+) category showed highest risk for CV events (adjusted HR: 3.78 [95% CI: 2.11, 6.77], high SA/TAC[-] as reference) in fully adjusted Cox model. Among symptom-free individuals, TAC was closely associated with low SA concentration in relation to unfavorable cardiac mechanics and may serve as a useful prognosticator for adverse CV events.

Composite dietary antioxidant index and abdominal aortic calcification: a national cross-sectional study.

PURPOSE: The Composite Dietary Antioxidant Index (CDAI) is a novel, inclusive measure for evaluating the antioxidant potential of diets. We aim to explore the link between the CDAI and abdominal aortic calcification (AAC) in U.S. adults aged ≥ 40 years. METHODS: This cross-sectional study collected dietary and AAC data for individuals aged ≥ 40 years from the 2013-2014 National Health and Nutrition Examination Survey (NHANES) database. The CDAI was calculated using six dietary antioxidants. AAC was evaluated using a semi-quantitative scoring system known as AAC-24, with an AAC score greater than 6 as severe AAC (SAAC). To examine the association between CDAI and AAC, including SAAC, liner/logistic regression analyses and smooth curve fitting were applied. RESULTS: A total of 2,640 participants were included in this study, and significant decreases in AAC score and SAAC prevalence were observed with ascending CDAI levels (P < 0.01). After adjusting for confounding factors, a clear link was established between the CDAI and both AAC score (ß = -0.083, 95% CI -0.144-0.022, P = 0.008) and SAAC (OR = 0.883, 95% CI 0.806-0.968, P = 0.008), respectively. Further smooth curve fitting indicated a negative correlation between CDAI and both AAC score and SAAC. CONCLUSIONS: Dietary antioxidant consumption, as quantified by the CDAI, shows an inverse relationship with AAC risk. Additional longitudinal and intervention studies are essential.

Preoperative Chest Computed Tomography Screening Reduces the Perioperative Stroke Rate in Patients at Risk of Aortic Calcification.

OBJECTIVES: We evaluated the effect of preoperative chest computed tomography (CT) screening on the perioperative stroke rate in cardiosurgical patients at risk of aortic calcification. METHODS: Between May 2019 and April 2020, 129 patients at risk of aortic calcification underwent non-contrast chest CT screening before their procedure. They were assigned to Group 1 and compared with a historical Group 2, who were treated the previous year without a preoperative CT scan. The primary endpoint was to determine postoperative stroke occurrence. The secondary outcomes were the rate reintubation/tracheostomy, the length of hospital stay, and any change in surgical strategy based on the CT findings. RESULTS: Groups 1 and 2 comprised 129 and 261 patients, respectively. Group 1 had a lower left ventricular ejection fraction, less carotid stenosis, a history of carotid endarterectomy, and a longer cross-clamp time. The surgical strategy was changed for 6 patients in Group 1. Group 1 had a significantly lower stroke rate. No significant differences were observed in reintubation and tracheostomy rates, or length of hospital stay. Lack of CT screening, age, aortic valve surgery, aortic surgery, and rethoracotomy were identified as independent risk factors for a stroke. CONCLUSIONS: Preoperative non-contrast chest CT screening of patients at risk of aortic calcification reduces postoperative stroke through adaptation of the surgical approach and should be used routinely in these patients.

Long sleep duration is associated with abdominal aortic calcification among male adults with chronic kidney disease: NHANES 2013-2014.

There are no studies exploring the correlation between sleep duration and abdominal aortic calcification (AAC). This study aims to investigate this relationship and its significance. Additionally, given the higher prevalence of sleep disorders and AAC in patients with chronic kidney disease (CKD), we conducted further studies in this population. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2013-2014. Sleep duration was assessed by a sleep questionnaire and categorized into 2-5, 6-8, and ≥ 9 h. The AAC-24 score is determined using the Kauppila scoring system and used for AAC assessment. Multivariable linear and logistic regression analysis were used to explore the relationship between sleep duration and AAC. Among the 2,996 participants, 14.29% reported nightly short sleep (2-5 h), 77.64% reported intermediate sleep (6-8 h), and 8.08% reported long sleep (≥ 9 h). After adjusting for potential confounding factors, among male participants with CKD, long sleep (≥ 9 h) significantly increased AAC-24 scores compared with intermediate sleep (6-8 h) (ß: 2.12; 95% CI: 0.75, 3.50), and the risk of severe AAC (SAAC) was increased by 1.55 times (OR: 2.55; 95% CI: 1.02, 6.36). And among female CKD and non-CKD participants, sleep duration was not associated with AAC. Long sleep duration increases the risk of AAC among male adults with CKD. Prospective studies are needed to confirm this finding.

Association between the atherogenic index of plasma and abdominal aortic calcification in adults: a cross-sectional study.

BACKGROUND: Atherogenic index of plasma (AIP) index is an important marker of insulin resistance and a significant risk factor for cardiovascular disease. Abdominal aortic calcification (AAC) is significantly associated with subclinical atherosclerotic disease. However, there are no studies that have examined the relationship between AIP index and AAC, so we investigated the potential association between them in the general population. METHODS: This was a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES, 2013-2014). The association of AIP with AAC was estimated by multivariable regression analysis. RESULTS: After adjusting for confounders, the odds of extensive AAC doubled per unit increase in the AIP index (OR = 2.00, 95% CI: 1.05, 3.83; P = 0.035). The multivariable OR and 95% CI of the highest AIP index tertile compared with the lowest tertile was significantly different. (OR = 1.73, 95% CI: 1.05, 2.83; P = 0.031). The subgroup analyses indicated that the association was consistent irrespective of age, sex, hypertension, diabetes, smoking status, eGFR and hypercholesteremia. CONCLUSIONS: The AIP index was independently associated with the presence of extensive AAC in the study population. Further studies are required to confirm this relationship.

The essential role of dual-energy x-ray absorptiometry in the prediction of subclinical cardiovascular disease.

Subclinical cardiovascular disease (Sub-CVD) is an early stage of cardiovascular disease and is often asymptomatic. Risk factors, including hypertension, diabetes, obesity, and lifestyle, significantly affect Sub-CVD. Progress in imaging technology has facilitated the timely identification of disease phenotypes and risk categorization. The critical function of dual-energy x-ray absorptiometry (DXA) in predicting Sub-CVD was the subject of this research. Initially used to evaluate bone mineral density, DXA has now evolved into an indispensable tool for assessing body composition, which is a pivotal determinant in estimating cardiovascular risk. DXA offers precise measurements of body fat, lean muscle mass, bone density, and abdominal aortic calcification, rendering it an essential tool for Sub-CVD evaluation. This study examined the efficacy of DXA in integrating various risk factors into a comprehensive assessment and how the application of machine learning could enhance the early discovery and control of cardiovascular risks. DXA exhibits distinct advantages and constraints compared to alternative imaging modalities such as ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography. This review advocates DXA incorporation into cardiovascular health assessments, emphasizing its crucial role in the early identification and management of Sub-CVD.

Association of Life's Essential 8 with abdominal aortic calcification and mortality among middle-aged and older individuals.

AIM: To assess the association of Life's Essential 8 (LE8) and the presence of abdominal aortic calcification (AAC) with mortality among middle-aged and older individuals. METHODS: Participants aged older than 40 years were enrolled from the National Health and Nutrition Examination Survey 2013-2014. AAC was assessed using dual-energy X-ray absorptiometry. Mortality data were ascertained through linkage with the National Death Index until 31 December 2019. The LE8 score incorporates eight components: diet, physical activity, nicotine exposure, sleep health, body mass index, blood lipids, blood glucose and blood pressure. The total LE8 score, an unweighted average of all components, was categorized into low (0-49), medium (50-79) and high (80-100) scores. RESULTS: This study included 2567 individuals, with a mean LE8 score of 67.28 ± 0.48 and an AAC prevalence of 28.28%. Participants with low LE8 scores showed a significantly higher prevalence of AAC (odds ratio = 2.12 [1.12-4.19]) compared with those with high LE8 scores. Over a median 6-year follow-up, there were 222 all-cause deaths, and 55 cardiovascular deaths occurred. Participants with AAC had an increased risk of all-cause (hazard ratio [HR] = 2.17 [1.60-2.95]) and cardiovascular (HR = 2.35 [1.40-3.93]) mortality. Moreover, individuals with AAC and low or medium LE8 scores exhibited a 137% (HR = 2.37 [1.58-3.54]) and 119% (HR = 2.19 [1.61-2.99]) higher risk of all-cause mortality, as well as a 224% (HR = 3.24 [1.73-6.04]) and 125% (HR = 2.25 [1.24-4.09]) increased risk of cardiovascular mortality, respectively. CONCLUSIONS: The LE8 score correlates with AAC prevalence in middle-aged and older individuals and serves as a valuable tool for evaluating the risk of all-cause and cardiovascular mortality in individuals with AAC.

Association between oxidative balance scores and severe abdominal aortic calcification in American adults: National health and nutrition examination survey.

BACKGROUND AND AIM: Abdominal aortic calcification (AAC) is a key predictor of cardiovascular diseases (CVDs). The Oxidative Balance Score (OBS) served as a tool to evaluate the systemic status of oxidative stress. However, evidence on the link between OBS and severe abdominal aortic calcification (SAAC) is currently inadequate. This study aims to establish this correlation in the US adult population, contributing valuable insights to the understanding of cardiovascular health. METHODS AND RESULTS: In our study with 2745 participants from the 2013-2014 National Health and Nutrition Examination Survey (NHANES), we analyzed both OBS and AAC score data. Logistic regression and smooth curve fitting were used to investigate the relationship between OBS and SAAC. The overall prevalence of severe abdominal aortic calcification disease was 9.1%. Multivariable logistic regression revealed that higher oxidative balance scores were associated with a lower risk of SAAC. After adjusting for potential confounders (model III), for every 1-point increase in oxidative balance scores, the odds of SAAC decreased by 3% [OR = 0.97, 95% CI= (0.95,0.99), P = 0.03]. The dose-response relationship demonstrated a negative correlation between oxidative balance scores and SAAC (p for nonlinear = 0.368). CONCLUSIONS: This study reveals a negative association between oxidative balance scores and severe abdominal aortic calcification in US adults. The implications of these findings merit careful consideration and should be taken into account in the formulation of clinical guidelines and updates.

Deep learning for automatic calcium detection in echocardiography.

Cardiovascular diseases are the main cause of death in the world and cardiovascular imaging techniques are the mainstay of noninvasive diagnosis. Aortic stenosis is a lethal cardiac disease preceded by aortic valve calcification for several years. Data-driven tools developed with Deep Learning (DL) algorithms can process and categorize medical images data, providing fast diagnoses with considered reliability, to improve healthcare effectiveness. A systematic review of DL applications on medical images for pathologic calcium detection concluded that there are established techniques in this field, using primarily CT scans, at the expense of radiation exposure. Echocardiography is an unexplored alternative to detect calcium, but still needs technological developments. In this article, a fully automated method based on Convolutional Neural Networks (CNNs) was developed to detect Aortic Calcification in Echocardiography images, consisting of two essential processes: (1) an object detector to locate aortic valve - achieving 95% of precision and 100% of recall; and (2) a classifier to identify calcium structures in the valve - which achieved 92% of precision and 100% of recall. The outcome of this work is the possibility of automation of the detection with Echocardiography of Aortic Valve Calcification, a lethal and prevalent disease.

Prognostic impact of abdominal aortic calcification in patients who underwent hepatectomy for intrahepatic cholangiocarcinoma.

PURPOSE: Abdominal aortic calcification (AAC), an indicator of systemic arteriosclerosis, is associated with short- and long-term outcomes in malignancies. We investigated the prognostic impact of AAC in patients who underwent hepatectomy for intrahepatic cholangiocarcinoma (IHCC). METHODS: The study cohort comprised 46 patients who underwent hepatectomy for IHCC between January 2008 and September 2020. The AAC volume measured by preoperative computed tomography was used to construct a model of the calcified segment from the renal artery to the common iliac artery bifurcation. We investigated the relationship between AAC and the long-term outcomes. The AAC volume cutoff value was calculated from a receiver-operating characteristic curve based on the three-year survival. RESULTS: According to our cutoff AAC volume of 3,700 mm3, 11 patients (24%) had high AAC volumes. The high-AAC group was significantly older than the low-AAC group (73 vs. 62 years old, p < 0.01). A multivariate analysis of the cancer-specific survival showed that a high serum carbohydrate antigen 19-9 concentration (hazard ratio [HR] 5.57, p = 0.01), high AAC volume (HR 3.03, p = 0.04), and [high?] T3 or T4 levels (HR 9.05, p < 0.01) were independently associated with a poor prognosis. CONCLUSION: AAC is a useful predictor of the oncological prognosis in patients undergoing hepatectomy for IHCC.

The Predictive Value of Aortic Calcification on Computed Tomography for Major Cardiovascular Events.

As the prevalence of cardiovascular disease continues to increase, early identification of patients at high risk of major adverse cardiovascular events (MACE) using reliable diagnostic modalities is important. Transcatheter aortic valve implantation (TAVI) is a minimally invasive percutaneous procedure used to replace the aortic valve with a bioprosthetic one, often without the need for surgery. Extra coronary calcification in the ascending and/or descending thoracic aorta, aortic arch, and abdominal aorta has recently been identified as a method to quantify the extent of atherosclerotic cardiovascular disease. However, its definitive role in the prediction of MACE remains unclear. We performed a comprehensive review to summarize the current literature on the diagnostic and predictive value of thoracic and abdominal aortic calcification, as quantified in computed tomography, for the association, risk stratification, and prediction of MACE and after TAVI procedures. Despite increasing evidence, the predictive role of thoracic calcification still remains unproven, with a need for carefully tailored studies to confirm these findings.

Association of Abdominal Aortic Calcification and Clinical Outcomes in LDH Patients Treated with Endoscopic Lumbar Discectomy.

INTRODUCTION: To determine any significant associations between abdominal aortic calcification (AAC) and clinical manifestations of pain symptoms following endoscopic lumbar discectomy. METHODS: Patients sequentially presenting with a history of unilateral radiculopathy with or without back pain, and with magnetic resonance imaging (MRI)-confirmed diagnosis of posterolateral disc herniation between August 2021 and December 2023 were eligible for inclusion in the study. All patients underwent endoscopic discectomy at our center during the study period. AAC stages were classified based on the Kauppila classification system using lateral lumbar radiographs. RESULTS: Between August 2021 and December 2023 a total of 120 patients were included in the study for analysis, of whom 82 (68.3%) exhibited mild AAC and 38 (31.7%) had moderate-severe AAC. Analyses using the multivariate linear regression model revealed a significant correlation between AAC comorbidity and postoperative clinical outcomes. At 1 year post-surgery, the mean change in leg pain following endoscopic lumbar discectomy was significantly less for patients with moderate-severe AAC (5.0 points) than for patients with mild ACC (p < 0.001). Even after adjusting for relevant confounders, this difference remained significant. Similar results were also observed in the postoperative improvement of back pain, the Oswestry Disability Index score, and the physical functioning, role physical, and bodily pain components of the 36-item Short Form Health Survey questionnaire. There was no significant difference in the rate of repeat surgery or post-surgical new-onset back pain between patients with different levels of severity of AAC at 1 year post-surgery. CONCLUSIONS: There is a significant association between the severity of AAC and clinical outcomes among patients with lumbar disk herniation who underwent endoscopic lumbar discectomy. AAC may serve as a prognostic factor in predicting surgical outcomes and guiding management strategies for patients with lumbar disk herniation following endoscopic lumbar discectomy.

Abdominal aortic calcification volume as a preoperative prognostic predictor for pancreatic cancer.

PURPOSE: Atherosclerosis and cancer may progress through common pathological factors. This study was performed to investigate the association between the abdominal aortic calcification (AAC) volume and outcomes following surgical treatment for pancreatic cancer. METHODS: The subjects of this retrospective study were 194 patients who underwent pancreatic cancer surgery between 2007 and 2020. The AAC volume was assessed through routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of the AAC volume on oncological outcomes. RESULTS: A higher AAC volume (≥ 312 mm3) was identified in 66 (34%) patients, who were significantly older and had a higher prevalence of diabetes and sarcopenia. Univariate analysis revealed several risk factors for overall survival (OS), including male sex, an AAC volume ≥ 312 mm3, elevated carbohydrate antigen 19-9, prolonged operation time, increased intraoperative bleeding, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy. Multivariate analysis identified an AAC volume ≥ 312 mm3, prolonged operation time, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy as independent OS risk factors. The OS rate was significantly lower in the high AAC group than in the low AAC group. CONCLUSION: The AAC volume may serve as a preoperative prognostic indicator for patients with pancreatic cancer.

Aortic mineralization triggers the risk of acute type B aortic dissection.

BACKGROUND AND AIMS: The role of aortic mineralization in the pathogenesis of acute type B aortic dissection (TBAD) is unclear. Whether thoracic aortic calcification (TAC) and circulating alkaline phosphatase (ALP) activity are associated with acute TBAD risk remains elusive. METHODS: Observational and Mendelian randomization (MR) studies were conducted sequentially. Using propensity score matching (1:1) by age and sex, patients with acute TBAD (n = 125) were compared with control patients (n = 125). Qualitative (score) and quantitative (volume) analyses of the TAC burden on different thoracic aortic segments were conducted using non-enhanced computed tomography. Univariate and multivariate analyses were used to identify significant independent risk factors for TBAD and TAC burden, respectively. MR was finally used to determine the causal relationship between elevated ALP activity and TBAD risk. RESULTS: The qualitative and quantitative analyses revealed that TAC burden was significantly higher in the TBAD group, except for in the ascending aortic segment (both p < 0.05). Preoperative circulating ALP was significantly elevated in the TBAD group (p < 0.001). The elevated TAC burden score on the descending thoracic aortic segment (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.31-8.37) and increased ALP activity (OR 1.03, 95% CI 1.01-1.06) was independently associated with TBAD risk. Interestingly, ALP was significantly positively associated with TAC burden, and MR analyses confirmed that ALP genetically predicted TBAD risk. CONCLUSIONS: Elevated ALP may trigger TBAD risk via the increased volume of TAC. Aortic mineralization may not protect the aorta itself.