Severe aortic and iliac calcification was associated with a significantly higher risk of major adverse limb events (MALEs) and aortic events, according to a prospective cohort study from the DANCAVAS trials published March 2 in Circulation. These results suggest that quantifying aortic calcification may provide valuable prognostic information and improve the risk stratification in patients with peripheral artery disease or aortic aneurysm.

All participants from the DANCAVAS trials who underwent a full thoracoabdominal aortic CT scan with recorded measurements of aortic and iliac calcification were included in this large, population-based study. Calcifications in the aorta and iliac arteries were assessed using a five‑segment model and categorized into quartiles, except for the ascending aorta, which was divided into four exposure groups because most participants did not calcification in that segment.

A total of 13,065 participants (94% men, mean age of 67 years) were followed from the time of DANCAVAS trials enrollment until the occurrence of aortic events, MALEs, death or the end of follow‑up on May 1, 2025. Analyses were conducted using a competing‑risk hazard regression model adjusted for demographics, cardiovascular risk factors, aortic diameter and ankle‑brachial index.

During a mean follow-up of eight years, 42 participants experienced an aortic event and 311 experienced a MALE.

Analyses of the aortic event outcome showed that participants with calcification scores in the fourth group or quartile for both the ascending and abdominal aorta had significantly higher subdistribution hazard rates (SHRs), with SHRs of 3.06 and 7.61, respectively. Furthermore, calcification scores in the fourth group or quartile were all strongly associated with MALEs: ascending aorta (SHR 2.20), aortic arch (SHR 6.49), descending aorta (SHR 2.43), abdominal aorta (SHR 7.89) and iliac arteries (SHR 13.52).

In what they believe is the first study of its kind, Cecilie Skov Petersen, BSc, Med, et al., write that their findings “may offer important prognostic information about the risk of aortic dissection, aortic aneurysm rupture and MALEs.” Despite encouraging results, “…further research is needed to determine whether systematic reporting of aortic calcification should be integrated into standard radiology workflows to support earlier identification and management of high-risk patients.”