High AAC, hs-cTnI Linked to ASCVD, All-Cause Mortality in Older Women

senior woman. sitting alone
Researchers sought to determine whether 2 measures of atherosclerotic cardiovascular disease could provide insights on increased mortality at 10 years in older women.

Elevated abdominal aortic calcification (AAC) and high-sensitivity cardiac troponin I (hs-cTnI) levels are associated with higher risk for atherosclerotic cardiovascular disease (ASCVD)-related mortality and all-cause mortality among older women, according to a study published in Heart.

Researchers reviewed data from 908 community-dwelling women (mean age 79.4±2.6 years) living in Western Australia, none of whom had prevalent ASCVD. Follow-up occurred between 2003 and 2013, with initial plasma hs-cTnI and AAC measurements recorded in 2003. Lateral, single-energy images of the thoracolumbar spine were used to assess AAC via a semiquantitative method (AAC24), and mortality outcomes were identified using linked health records. The study population was stratified by AAC24 and hs-cTnI as follows:

  • Group 1: Low AAC24, less than median hs-cTnI (reference group)
  • Group 2: Moderate to extensive AAC24 and less than median hs-cTnI
  • Group 3: Low AAC24 and median or greater hs-cTnI
  • Group 4: Moderate to extensive AAC24 and median or greater hs-cTnI

Compared with Group 1, relative hazard ratios (HR) for ASCVD-related death increased for Group 2 (HR, 2.39; 95% CI, 1.05-5.46; P =.039), Group 3 (HR, 3.18; 95% CI, 1.35-7.79; P =.008), and Group 4 (HR, 5.38; 95% CI, 2.44-11.85; P <.001).

The risk for all-cause mortality compared with Group 1 increased for Group 2 (HR, 1.58; 95% CI, 0.99-2.52; P =.057), Group 3 (HR, 2.38; 95% CI, 1.46-3.89; P =.001), and Group 4 (HR, 3.02; 95% CI, 1.93-4.72; P <.001).

Among the study population, ASCVD-related mortality showed independent associations with AAC24 (P =.002) and hs-cTnI (P <.001), as did all-cause mortality (AAC24: P =.006; hs-cTnI: P <.001). 

Limitations to this study included potential variation in plasma hs-cTnI concentrations after long-term storage, as well as a lack of data for systolic blood pressure, medical history, and data on women who moved from Western Australia. As the majority of the study population was White women, there was also potential lack of reproducibility among other ethnic groups.

The study authors noted, “We have demonstrated, for the first time, that [2] simple and quick measures are robustly associated with 10-year [ASCVD]-related and all-cause mortality in older women, independent of each other.”


Teh R, Prince RL, Sim M, et al. Abdominal aortic calcification, cardiac troponin I and atherosclerotic vascular disease mortality in older women. Heart. Published online December 24, 2021. doi:10.1136/heartjnl-2021-319879