Elsevier

American Heart Journal

Volume 144, Issue 4, October 2002, Pages 733-739
American Heart Journal

Clinical Investigations: Congestive Heart Failure
Abdominal aortic calcific deposits are associated with increased risk for congestive heart failure: The Framingham Heart Study,☆☆,

https://doi.org/10.1067/mhj.2002.124404Get rights and content

Abstract

Objectives We sought to determine the association of aortic atherosclerosis, detected by calcific deposits in the abdominal aorta seen on lateral lumbar radiographs, with risk for congestive heart failure (CHF). Background Although the association between atherosclerotic coronary heart disease (CHD) and CHF has been extensively studied, there are limited prospective data regarding the association of extracoronary atherosclerosis with CHF. Methods Lateral lumbar radiographs were obtained in 2467 Framingham Heart Study participants (1030 males and 1437 females) free of CHF in 1968. An abdominal aortic calcium (AAC) score was calculated for each subject based on the extent of calcium in the abdominal aorta. Proportional hazards models were used to test for associations between AAC score and CHF risk. Results There were 141 cases of CHF in men and 169 cases in women. In men, the multivariable-adjusted risk for CHF was increased for the second (hazards ratio [HR] 1.5, 95% CI 0.9-2.5) and third (HR 2.2, 95% CI 1.3-3.7) tertiles compared with the lowest tertile. Similarly, in women, the multivariable-adjusted risk for CHF was increased for the second (HR 1.8, 95% CI 1.1-2.9) and third (HR 3.2, 95% CI 2.0-5.1) tertiles compared with the lowest tertile. After further adjustment for CHD occurring prior to the onset of CHF, risk remained significantly increased for both men and women. Conclusions Atherosclerosis of the abdominal aorta is an important risk factor for CHF, independent of CHD and other risk factors. Noninvasive detection and quantification of atherosclerosis may be useful in identifying high-risk individuals likely to benefit from strategies aimed at preventing CHF. The possibility of a link between AAC and vascular compliance deserves further study. (Am Heart J 2002;144:733-9.)

Section snippets

Study sample

The Framingham Heart Study is a prospective epidemiologic cohort study that was established in 1948 to evaluate potential risk factors for CHD. The original cohort consisted of 5209 residents of Framingham, Mass, aged 28 to 62 years who have undergone follow-up evaluations every 2 years. The study design and entry criteria have been detailed elsewhere.19 As part of an osteoporosis survey, subjects had lateral lumbar radiographs performed at biennial examination 10 (1966-1970). Subjects with

Baseline characteristics

The clinical characteristics of our study population are summarized in Table II.

. Baseline characteristics of the study males and females (1966-1970)

VariableMales (n = 1030)Females (n = 1437)
Age (y)60.4 ± 7.860.8 ± 8.0
Hypertension (%)24.529.0
SBP (mmHg)138.6 ± 21.6140.4 ± 24.5
DBP (mmHg)81.3 ± 11.380.1 ± 11.5
Pulse pressure (mmHg)57.2 ± 16.860.3 ± 19.2
Hypertension treatment (%)11.416.7
CHD (%)14.37.4
Diabetes (%)5.54.5
Total cholesterol (mmol/L)5.7 ± 1.06.3 ± 1.1
 [mg/dL][221.3 ± 39.9][243.3 ± 42.0]
HDL

Discussion

In our study, abdominal aortic calcific deposits on lateral lumbar radiographs, a measure of aortic atherosclerosis, were associated with increased risk for CHF, even after multivariable adjustment for CHF risk factors, including CHD, hypertension, diabetes, and electrocardiographic left ventricular hypertrophy. The presence of prevalent or intercurrent CHD did not explain the primary result.

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    Supported by the National Heart, Lung, and Blood Institute Framingham Heart Study, National Institutes of Health (NIH/NHLBI contract N01-HC-38038).

    ☆☆

    Reprint requests: Christopher J. O'Donnell, MD, MPH, Framingham Heart Study, 73 Mount Wayte Ave, Suite #2, Framingham, MA 01702.

    E-mail: [email protected]

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