Calcification and Disease-Related Mortality.

Objective —Arterial calcification is highly correlated with underlying atherosclerosis. Arterial calcification of the thoracic aorta is evident in many older individuals at high susceptibility to aging-related diseases and non-cardiovascular disease (CVD)–related mortality. In this study, we evaluated the association of thoracic aorta calcification (TAC) with non-CVD morbidity and mortality. data from participants in the Multi-Ethnic Study of Atherosclerosis, a prospective cohort study of subclinical atherosclerosis, in which participants underwent cardiac computed tomography at baseline and were followed longitudinally for incident CVD events and non-CVD events. Using modified proportional hazards models accounting for the competing risk of CVD death and controlling for demographics, CVD risk factors, coronary artery calcium, and CVD events, we evaluated whether TAC was independently associated with non-CVD morbidity and mortality. Among 6765 participants (mean age, 62 years), 704 non-CVD deaths occurred for a median follow-up of 12.2 years. Compared with no TAC, the highest tertile of TAC volume was associated with a higher risk of non-CVD mortality (hazard ratio, 1.56; 95% confidence interval, 1.23–1.97), as well as several non-CVD diagnoses, including hip fracture (2.14; 1.03–4.46), chronic obstructive pulmonary disease (2.06; 1.29–3.29), and pneumonia (1.79; 1.30–2.45), with magnitudes of association that were larger than for those of coronary artery calcium. Conclusions —TAC is associated with non-CVD morbidity and non-CVD mortality, potentially through a pathway that is unrelated to atherosclerosis. TAC may be a general marker of biological aging and an indicator of increased risk of non-CVD and death. ( Arterioscler Thromb Vasc Biol . 2018;38:00-00. DOI: 10.1161/ATVBAHA.118.310850.) calcification through a parallel pathway. Although atherosclerosis leads to CVD events, biological aging may lead to an increased susceptibility to non-CVD events (eg, cancer), leading to non-CVD–related mortality. Aging is also a risk factor for atherosclerosis, which in turn leads to CVD events that can also increase an individual’s susceptibility to non-CVD mortality (eg, heightened cancer mortality among individuals with a history of clinical CVD). HDL cholesterol, systolic blood pressure, hypertension medication, smoking, diabetes mellitus, statin medication, body mass index, and C-reactive protein. Nonfatal CVD events were defined as incident coronary heart disease (CHD) events (definite and probable myocardial infarction, resuscitated cardiac arrest, and definite angina) and stroke (nonfatal). CAC indicates coronary artery calcium; CVD, cardiovascular disease; HDL, high-density lipoprotein; and TAC, thoracic aorta calcium. diagnosis or non-fatal CVD event. Non-CVD morbidity diagnoses were abstracted from inpatient medical records via ICD-9 codes. Nonfatal CVD events were adjudicated by physician committee and defined as incident coronary heart disease (CHD) events (definite and probable myocardial infarction, resuscitated cardiac arrest, and definite angina) and stroke.