Background The prognostic importance of abdominal aortic calcification (AAC) viewed on noninvasive imaging modalities remains uncertain. Methods and Results We searched electronic databases (MEDLINE and Embase) until March 2018. Multiple reviewers identified prospective studies reporting AAC and incident cardiovascular events or all‐cause mortality. Two independent reviewers assessed eligibility and risk of bias and extracted data. Summary risk ratios (RRs) were estimated using random‐effects models comparing the higher AAC groups combined (any or more advanced AAC) to the lowest reported AAC group. We identified 52 studies (46 cohorts, 36 092 participants); only studies of patients with chronic kidney disease (57%) and the general older‐elderly (median, 68 years; range, 60–80 years) populations (26%) had sufficient data to meta‐analyze. People with any or more advanced AAC had higher risk of cardiovascular events (RR, 1.83; 95% CI, 1.40–2.39), fatal cardiovascular events (RR, 1.85; 95% CI, 1.44–2.39), and all‐cause mortality (RR, 1.98; 95% CI, 1.55–2.53). Patients with chronic kidney disease with any or more advanced AAC had a higher risk of cardiovascular events (RR, 3.47; 95% CI, 2.21–5.45), fatal cardiovascular events (RR, 3.68; 95% CI, 2.32–5.84), and all‐cause mortality (RR, 2.40; 95% CI, 1.95–2.97). Conclusions Higher‐risk populations, such as the elderly and those with chronic kidney disease with AAC have substantially greater risk of future cardiovascular events and poorer prognosis. Providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better.

Background Abdominal aortic calcification (AAC) has been inconsistently associated with skeletal health. We aimed to investigate the association of AAC with bone mineral density (BMD) and fracture risk by pooling the findings of observational studies. Methods Medline, EMBASE, Web of Science and Google Scholar were searched (August 2021). All clinical studies that assessed the association between AAC and BMD or fracture were included. AAC was categorized into any/advanced (all higher reported groups) vs no/less advanced (lowest reported group). Pooled standardized mean differences (SMDs) and risk ratios (RRs) with 95% confidence intervals (CI) were determined for BMD and fracture, respectively, using random-effects models. Results Of 2,192 articles screened, 86 (61,553 participants) were included in the review, while 42 provided data for meta-analysis. AAC was associated with lower BMD at the total hip [SMD=-1.05 (95%CI: -1.47 to -0.63); 16 studies], femoral neck [-0.25 (-0.46 to - 0.04); 10] and lumbar spine [-0.67 (-1.21 to -0.12); 20]. AAC was associated with a greater risk of any fracture [RR= 1.73 (95%CI: 1.48 to 2.02); 27]. AAC was also associated with vertebral, non-vertebral and hip fractures. In dose-response analysis, the highest AAC group had greater risks of any, vertebral and non-vertebral fractures. Conclusions AAC is associated with lower BMD and increased fracture risk at multiple sites, underscoring the potential importance of vascular disease on skeletal health. Detection of AAC at the time of BMD testing may provide clinicians with prognostic information about bone health to enhance osteoporosis screening programs and fracture risk prediction.

S371 mobility status on long-term outcomes in elderly patients with NSTEMI is unknown. Methods: A retrospective analysis included 956 consecutive patients aged >85 years presenting with NSTEMI between 2010-2018. Mobility status was classified as independent, single point stick (SPS), 4-wheel frame (4WF) or wheelchair dependent. Guideline-directed medical therapy (GDMT) included aspirin, beta-blockers and statins. The primary outcome was all-cause mortality. Results: Of 956 patients, 304 (33.7%) had independent mobility, 161 (17.9%) used a SPS and 402 (44.6%) used a 4WF. GDMT adherence did not vary significantly between the SPS and independent groups. However, adherence to GMDT was significantly lower in 4WF users (p < 0.001). Independent patients had higher rates of coronary angiography (19.5% vs 10% SPS vs 2% 4WF, p < 0.001) and had improved long-term survival (HR 0.68, 0.55-0.84, p < 0.001). SPS users did not experience reduced long-term survival (p = 0.3, whereas 4WF users had significantly greater long-term mortality (HR 1.5, 1.2-1.9, p < 0.001). This risk remained significant, albeit reduced (HR 1.3 1.1-1.7, p = 0.02) after Cox-proportional hazard modelling. Conclusion: There is an association between mobility status and prescription of GDMT and coronary angiography in elderly patients. Using a 4WF, but not a SPS, was associated with higher mortality.