Lower Aorto-Iliac Bifurcation Position and Incident Cardiovascular Disease: A Multi-Ethnic Study of Atherosclerosis (MESA)

Aorta : Official Journal of the Aortic Institute at Yale-New Haven Hospital
Nketi I ForbangMichael H Criqui

Abstract

With increasing age, a downward shift of the aorto-iliac bifurcation relative to the lumbar spine occurs. A lower bifurcation position is an independent marker for adverse vascular aging and is associated with increased burden of cardiovascular disease (CVD) risk factors; however, the associations between lower bifurcation position and CVD events remain unknown. Abdominal computed tomography scans were used to measure the aorto-iliac bifurcation distance (AIBD, distance from the aorto-iliac bifurcation to the L5/S1 disc space). Cox proportional hazard analysis was used to determine the independent hazard of a lower bifurcation position (smaller AIBD) for incident coronary heart disease (CHD, defined as myocardial infarction, resuscitated cardiac arrest, or sudden cardiac death), CVD (CHD plus stroke or stroke death), and all-cause mortality (ACM). In the 1,711 study participants (51% male), the mean AIBD was 26 ± 15 mm. After a median follow-up of 10 years, 63 (3.7%) developed CHD, 100 (5.8%) developed CVD, and 129 (7.5%) were deceased. Compared to the 4th quartile of AIBD (highest bifurcation position), participants in the 1st quartile (lowest bifurcation position) had increased risk for CHD (hazard ratio (HR) = 1.5, 95% confi...Continue Reading

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