Abstract
Osteoporosis and cardiovascular disease often coexist. Vertebral fractures incidentally imaged in the course of routine care might be able to contribute to the prediction of cardiovascular events. Following a case-cohort design, 5,679 patients undergoing chest CT were followed for a median duration of 4.4 years. Cases were defined as patients who subsequently developed a cardiovascular event (n = 493). The presence and severity of vertebral fractures, as well as aortic, coronary and valvular calcifications on CT were investigated. Cases were more likely to be male (69 vs 60 %) and older (66 vs 61 years old). Prevalent vertebral fractures conferred an elevated risk of cardiovascular events after adjustment for age and gender [hazard ratio (HR) of 1.28, 95 % confidence interval (CI) 1.07 to 1.54]. This effect remained moderate after correction for cardiovascular calcifications (HR 1.20, CI 0.99–1.44). However, in terms of discrimination, vertebral fractures did not have substantial incremental prognostic value after correction (C-index was 0.683 vs 0.682 for models with and without vertebral fractures respectively). Prevalent vertebral fractures on routine clinical chest CT are related to future cardiovascular events but do not have additional prognostic value to models that already include age, gender and cardiovascular calcifications.
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Acknowledgments
The PROVIDI Study Group consists of J. Laméris (Department of Radiology, Academic Medical Center, Amsterdam), C. van Kuijk (Department of Radiology, VU University Medical Center Amsterdam), W. ten Hove (Department of Radiology, Gelre Hospitals, Apeldoorn), M. Oudkerk (Department of Radiology, University Medical Center Groningen), Ay L. Oen (Department of Radiology, Elkerliek Hospital, Helmond), J. Wildberger (Department of Radiology, Academic Hospital Maastricht), J. van Heesewijk (Department of Radiology, St Antonius Hospital, Nieuwegein), W. Mali (Department of Radiology, University Medical Center Utrecht), and Y. van der Graaf (Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht). This study was funded by a program Grant from the Netherlands Organization for Scientific Research-Medical Sciences (NWO-MW); Grant 40-00812-98-07-005. The funder had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. Substudies from the PROVIDI cohort have been previously published, including substudies using cardiovascular endpoints. These patient groups partly overlap with the current manuscript. The current manuscript includes a different subset of patients from the previous studies and investigates a different set of covariates, most notably vertebral fractures.
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Buckens, C.F., de Jong, P.A., Verkooijen, H.M. et al. Vertebral fractures on routine chest computed tomography: relation with arterial calcifications and future cardiovascular events. Int J Cardiovasc Imaging 31, 437–445 (2015). https://doi.org/10.1007/s10554-014-0567-9
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DOI: https://doi.org/10.1007/s10554-014-0567-9