Prognostic significance of abdominal aortic calcification scores on dual-energy X-ray absorptiometry scans for mortality in cancer survivors: NHANES-based cohort study (2013-2019).

Aims: 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 and results: Using 7 years of data from the National Health and Nutrition Examination Survey (NHANES, 2013-2019), we analysed a nationally representative cohort of US 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. 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 one-unit increase in AAC-24 score was associated with higher risks of all-cause mortality and CV mortality [adjusted hazard ratio, 95% confidence interval of 1.04 (1.00-1.09) and subdistribution hazard ratio 1.07 (1.02-1.12); Conclusion: 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.