Title: Distribution, Size, Shape, Growth Potential and Extent of Abdominal Aortic Calcified Deposits Predict Mortality in Postmenopausal Women Distribution, Size, Shape, Growth Potential and Extent of Abdominal Aortic Calcified Deposits Predict Mortality in Postmenopausal Women

Aims: Aortic calcification is a major risk factor for death from cardiovascular disease. We investigated the relationship between mortality and the composite markers of number, size, morphology and distribution of calcified plaques in the lumbar aorta. Methods: 308 postmenopausal women aged 48-76 were followed for 8.3±0.3 years, with deaths related to any cardiovascular disease,, cancer, or , and allother-causes deaths being recorded. From lumbar X-rays at baseline the number (NCD), size, morphology and distribution of aortic calcification lesions were scored and combined into one Morphological Atherosclerotic Calcification Distribution (MACD) index. The relative riskhazard ratio forof mortality was calculated for the MACD and for three other commonly used predictors: the SCOREEU SCORE card, the Framingham Coronary Heart Disease Risk Score (Framingham score), and the gold standard Aortic Calcification Severity score (AAC24AC24) developed from the Framingham Heart Study cohorts. triglyceride levels were the main predictors of mortality after adjustment for all other metabolic and physical parameters. The SCORE card and the Framingham sscore resulted in a mortality hazard ratio increase per standard deviation (HRR/SD) of 1.8 (1.51-2.13) and 2.6 (1.87-3.71), respectively. The number of calcified deposits (Of the morphological x-ray based measures, for example NCD) revealed a HR/SD >2 adjusted for SCORE/Framingham. The MACD index scoring the distribution, size, morphology and number of lesions revealed the best predictive power for identification of patients at risk of mortality , with for the 10% highest score, with an an odd hazard ratio of 15.6 (p<0.001) for the 10% at greatest risk of death. 3 Conclusion: This study shows that it is not just the extent of aortic calcification that predicts mortality risk,risk, but also the distribution, shape and size of calcified lesions. The MACD index may provide a more sensitive predictor of mortality from aortic calcification than the commonly used AAC24AC24 and SCORE/Framingham point card systems.