Prognostic Significance of Abdominal Aortic Calcification Scores on DXA Scans for Mortality in Cancer Survivors: NHANES-based cohort study (2013-2019)

Background Abdominal aortic calcification (AAC) is a marker of systemic atherosclerosis associated with adverse cardiovascular (CV) outcomes in the general population. This study aimed to evaluate the association of AAC with all-cause and CV mortality in cancer survivors. Methods Using 7 years of data from the National Health and Nutrition Examination Survey (NHANES, 2013-2019), we analysed a nationally representative cohort of U.S. cancer survivors. AAC burden was quantified using the Kauppila AAC-24 scores on dual-energy X-ray absorptiometry (DXA) scans. Kaplan-Meier curves and multivariable Cox models were used to assess the associations between AAC and all-cause mortality, while Fine and Gray models assessed associations between AAC and CV mortality, accounting for non-CV mortality as a competing risk. Results A total of 23,126,424 cancer survivors (aged ≥40 years) were analysed, recording 4,199,131 (114 unweighted) all-cause deaths and 1,160,618 (34 unweighted) CV deaths over a 69-month median follow-up. AAC was present in 46%, with 19.5% of the cohort showing severe AAC (AAC-24 >6). Each 1-unit increase in AAC-24 score was associated with higher risks of all-cause mortality and CV mortality (aHR, 95% CI of 1.04 [1.00–1.09] and sHR 1.07 [1.02–1.12], respectively, p = 0.047 and p = 0.002) after adjustment for demographic, socioeconomic, traditional CV risk factors, baseline comorbidities, and cancer-specific characteristics. Conclusions AAC detected on DXA scans is independently associated with increased all-cause and CV mortality in cancer survivors aged 40 years and older. DXA-based AAC assessment may serve as a valuable tool for risk stratification in cardio-oncology.