The prognostic relevance of aortic and iliac calcification for aortic dissection, aneurysm rupture, and major adverse limb events (MALEs) remains incompletely defined. This population-based prospective cohort study published in Circulation examined associations between segmental aortic calcification and vascular outcomes in screened participants of the Danish Cardiovascular Screening (DANCAVAS) trial.

All individuals undergoing thoracoabdominal computed tomography with recorded measurements of aortic and iliac calcification were included. Calcification was quantified using a five-segment model and categorized into quartiles; the ascending aorta was grouped into four exposure categories due to low prevalence of calcification. Participants were followed until aortic events (dissection or aneurysm rupture), MALEs (peripheral revascularization or lower limb amputation), death, or May 1, 2025. Competing risk regression models were adjusted for demographics, cardiovascular risk factors, aortic diameter, and ankle-brachial index.

Among 13,065 participants (94% men; mean age 67±4 years), followed for a mean of 8 years, 42 experienced aortic events and 311 experienced MALEs. Fourth-quartile calcification was associated with higher subdistribution hazard ratios (SHRs) for aortic events in the ascending aorta (SHR 3.06; 95% confidence interval [CI] 1.15-8.16) and abdominal aorta (SHR 7.61; 95% CI 1.44-40.22). Fourth-quartile calcification in all segments was associated with MALEs, including the iliac arteries (SHR 13.52; 95% CI 4.32-42.24).

Severe thoracoabdominal calcification was independently associated with higher rates of aortic and limb events. Quantification of aortic calcification may provide prognostic information in screened populations.