Association between pulse pressure and aortic calcification: Findings from the National Health and Nutrition Examination Survey 2013-2014

Dual-energy X-ray absorptiometry (DXA) is a low-cost, minimal radiation technique commonly used to assess bone density and body composition that can also provide a measure of abdominal aortic calcification (AAC). We examined the association between pulse pressure (PP) and DXA-derived AAC in a nationally representative sample of US adults. Analyses were performed in 2,478 adults from the 2013-2014 NHANES cycle. AAC scores were calculated using a validated 24-point scale from thoraco-lumbar spine images (scored 1-6 across four vertebral heights from L1-L4 for both anterior and posterior aortic walls). We examined PP as a predictor of both the presence (dichotomous) and magnitude (continuous) of AAC in age-stratified analyses (<60 years of age and ≥60 years of age) adjusting for traditional cardiovascular disease risk factors, sex, mean arterial pressure and additionally for age and antihypertensive medication. The prevalence of AAC was 25.5%. PP was a predictor of the presence of AAC in fully adjusted models in adults <60 years of age (OR 1.31, P <.05) and ≥60 years of age (OR 1.33, P <.05). PP was also associated with the magnitude of AAC in the overall sample but did not retain significance after separating by age-groups and additionally adjusting for antihypertensive medication. In conclusion, PP is associated with the presence of AAC as measured by DXA in a nationally representative sample of US adults.