Carotid artery plaque screening using abdominal aortic calcification on lumbar radiographs

AIM: Arteriosclerotic disease is increasing due to aging of the population, and is associated with diabetes, hypertension, hyperlipidemia, obesity, and smoking. This disease may result in fatal cerebrovascular disease, and especially cardiogenic cerebral embolism caused by artery plaque-based atherothrombotic cerebral infarction. The study was performed to examine the relationship of abdominal aortic calcification (AAC) on lumbar radiographs with carotid intima-media complex thickness (IMT), factors associated with carotid artery plaque, and cutoff values in middle-aged and elderly people. PATIENTS AND METHODS: The subjects were 309 healthy volunteers (average age 63 years) who attended a health checkup supported by a local government in 2015. The AAC-24 score was determined on lumbar lateral standing radiographs and was categorized as 0 (54% of subjects),1–4 (31%), and ≥5 (severe, 15%). Carotid ultrasonography was used to evaluate IMT of the common carotid artery. Carotid artery plaque was defined as IMT >1.1 mm. Body mass index (BMI), hypertension, diabetes mellitus (DM), dyslipidemia, smoking, alcohol intake, and osteoporosis were examined. RESULTS: Of 309 cases, 142 (46%) had AAC and 104 (34%) had carotid artery plaque. Thus, 15% (n = 45) had severe AAC. Age, prevalence of DM and carotid artery plaque increased with severity of AAC. In patients with carotid artery plaque (n = 104), age (67.8±7.5 vs. 61.0±10.1 years), % male (56% vs. 39%), BMI (22.9±2.8 vs. 23.7±3.5), AAC rate (58% vs. 40%) and AAC-24 score (3 (0, 8) vs. 0 (0, 2)) were all significantly higher than in those (n = 205) without carotid artery plaque. In multivariate analysis, age (OR 1.172), male gender (OR 1.654), AAC (OR 1.352), and AAC-24 ≥5 (OR 4.191) were significantly associated with carotid artery plaque. Combining AAC-24 with age significantly increased the AUC from 0.632 to 0.834 (p<0.05). CONCLUSION: There was a significant relationship between AAC on lumbar radiographs and carotid IMT.