Author Identifier (ORCID)
Abadi K. Gebre: https://orcid.org/0000-0002-1975-0085
Marc Sim: https://orcid.org/0000-0001-5166-0605
Cassandra Smith: https://orcid.org/0000-0002-2517-2824
Syed Zulqarnain Gilani: https://orcid.org/0000-0002-7448-2327
Joshua R. Lewis: https://orcid.org/0000-0003-1003-8443
Abstract
BackgroundSagittal abdominal diameter (SAD), a measure of visceral adiposity, has been linked to major adverse cardiovascular events (MACE). However, the relationship between SAD and abdominal aortic calcification (AAC), a marker of subclinical vascular disease, and whether they independently and jointly predict MACE remains unclear.ObjectiveTo investigate whether weight-normalized SAD and AAC scored using a validated machine learning algorithm (ML-AAC24) are independently and jointly associated with incident MACE.MethodsSAD and ML-AAC24 were measured from dual-energy X-ray absorptiometry (DXA) posteroanterior and lateral spine images, respectively, from the Manitoba Bone Density registry.ResultsAmong 8806 individuals (mean age 75.1 ± 6.6 years, 93.9% women), 11.3% experienced MACE during a mean follow-up of 3.8 years. SAD/weight and ML-AAC24 were positively correlated (Spearman r = 0.11, P < 0.001). Individuals with moderate and high ML-AAC24 had 1.1% and 3.0% higher mean SAD/weight, respectively, than those with low ML-AAC24. Both ML-AAC24 and SAD/weight were independently associated with higher risk of MACE. Adjusted hazard ratios [HRs] for MACE were 1.45, 95%CI 1.24–1.71 and 1.99, 95%CI 1.67–2.35 for moderate and high ML-AAC24, respectively, vs. low. The HR for the highest vs. lowest tertile of SAD/weight was 1.37, 95%CI 1.16–1.61. Individuals who had both high ML-AAC24 and were in the highest SAD/weight tertile had the highest MACE risk (HR 2.63, 95% CI 2.02–3.44).ConclusionHigher baseline SAD/weight was associated with higher ML-AAC24 scores. Both measures independently and jointly associated with MACE. Their combined use may potentially help identify individuals at high risk for cardiovascular disease during routine bone density testing.
Keywords
Body composition, cardiovascular events, dual-energy x-ray absorptiometry, machine learning, metabolic health, obesity, vascular calcification
Document Type
Journal Article
Date of Publication
7-1-2026
Volume
208
PubMed ID
41903786
Publication Title
Bone
Publisher
Elsevier
School
Nutrition and Health Innovation Research Institute / School of Medical and Health Sciences / School of Science
RAS ID
94348
Funders
Rady Innovation Fund, University of Manitoba / Medical Research Future Fund 2022 Cardiovascular Health Mission Grant (MRF2024225) / Western Australian Future Health Research and Innovation / National Heart Foundation Heart Foundation (107194, 102817) / Canada Research Chair (CRC-2023-00349)
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.
Comments
Abraha, H. N., Gebre, A. K., Sim, M., Smith, C., Gilani, S. Z., Ilyas, Z., Zarzour, F., Schousboe, J. T., Lix, L. M., Binkley, N., Reid, S., Monchka, B. A., Kimelman, D., Lewis, J. R., & Leslie, W. D. (2026). Sagittal abdominal diameter and abdominal aortic calcification are associated with incident major adverse cardiovascular events: The Manitoba Bone Density Registry. Bone, 208, 117865. https://doi.org/10.1016/j.bone.2026.117865