TABLE 1.
Characteristics of the cohort
| DISH | no DISH | p-value | |
|---|---|---|---|
| Age (years), mean (SD) | 67.3 ± 10.1 | 60.5 ± 12.2 | 0.029 |
| Gender (f/m), N | 5/12 | 99/103 | 0.120 |
| Weight (kg), mean (SD) | 96.6 ± 20.3 | 84.5 ± 17.5 | 0.008 |
| Height (cm), mean (SD) | 170.9 ± 6.5 | 171.0 ± 9.7 | 0.980 |
| BMI (kg/m2), mean (SD) | 32.8 ± 7.2 | 28.9 ± 5.3 | 0.011 |
| Family history of cardiovascular disease, N (%) | 11 (64.7%) | 119 (59.2%) | 0.657 |
| Diabetes, N (%) | 6 (35.3%) | 25 (12.4%) | 0.010 |
| Hypercholesterolemia, N (%) | 6 (35.3%) | 51 (25.4%) | 0.371 |
| Hypertension, N (%) | 12 (70.6%) | 110 (54.7%) | 0.206 |
| Current smoker, N (%) | 2 (11.8%) | 38 (18.9%) | 0.465 |
| Angina pectoris, N (%) | 4 (23.5%) | 92 (44%) | 0.076 |
| Metabolic syndrome, N (%) | 7 (43.8%) | 25 (13.0%) | 0.001 |
| EAT attenuation (HU), mean (SD) | -98.5 ± 11.8 | -101.7 ± 13.0 | 0.347 |
| NAFLD | 5 (29.4%) | 52 (26.0%) | 0.759 |
| CACS (au) = 0 | 2 (11.8%) | 68 (33.8%) | 0.063 |
| CACS (au), median (IQR) | 101.0 (4.7-569.0) | 27.3 (0-391.8) | 0.241 |
| Calcifications in proximal thoracic aorta, median (IQR) | 196.4 (12.3-759.5) | 14.3 (0-244.6) | 0.023 |
| Calcifications in aortic root, median (IQR) | 146.8 (8.3-758.0) | 1.8 (0-175.0) | 0.013 |
| Calcifications in ascending aorta, median (IQR) | 2.1 (0-35.2) | 0.0 (0-3.9) | 0.109 |
| Myocardial infarction, N (%) | 1 (6.0%) | 12 (6.0%) | 0.988 |
FIGURE 1.
A 68-year old male with diffuse idiopathic skeletal hyperostosis (DISH) coronary artery calcification score (CACS) > 400. (A) Typical appearance of DISH in thoracic spine, sagittal plane. (B) Calcifications in LAD = left anterior descending artery
TABLE 2.
Prevalence of diffuse idiopathic skeletal hyperostosis (DISH) among Agatson coronary artery calcification score (CACS) categories
| CACS = 0 (N = 70) | CACS > 0 and < 100 (N = 62) | CACS = 100–400 (N = 33) | CACS > 400 (N = 53) | |
|---|---|---|---|---|
| DISH | 2.8% | 10.3% | 6.6% | 13.3% |
| No DISH | 97.2% | 89.7% | 93.4% | 86.7% |
TABLE 3.
Association of epicardial adipose tissue (EAT) attenuation with conventional coronary artery disease (CAD) risk factors and CT parameters
| Variable | EAT attenuation (HU) | p-value |
|---|---|---|
| Gender | M - 98.3 ± 11.3 F - 105.4 ± 13.6 | < 0.001 |
| NAFLD | Y - 98.3 ± 12.8 N - 102.7 ± 12.8 | 0.022 |
| Family history of cardiovascular disease | Y - 100.1 ± 12.8 N - 104.5 ± 14.1 | 0.261 |
| Diabetes | Y - 104.2 ± 14.3 N - 101.3 ± 13.3 | 0.883 |
| Hypercholesterolemia | Y - 99.4 ± 13.5 N - 102.6 ± 13.3 | 0.402 |
| Hypertension | Y - 99.2 ± 12.4 N - 105.2 ± 14.1 | 0.129 |
| Smoking | Y - 97.8 ± 13.3 N - 102.9 ± 13.3 | 0.361 |
| Regular physical activity | Y - 101.6 ± 12.8 N - 101.9 ± 14.4 | 0.653 |
| Correlation coefficient | ||
| CACS (Agatson) | 0.306 | < 0.001 |
| CACS per vessel | ||
| LM | 0.159 | 0.018 |
| LAD | 0.247 | < 0.001 |
| LCX | 0.269 | < 0.001 |
| RCA | 0.289 | < 0.001 |
| Calcifications in proximal thoracic aorta | 0.110 | 0.103 |
| Calcifications in aortic root | 0.082 | 0.226 |
| Calcifications in ascending aorta | 0.172 | 0.011 |
| Age | 0.006 | 0.834 |
| BMI | 0.243 | < 0.001 |
FIGURE 2.
Epicardial fat attenuation in subjects with (A) different coronary artery calcium score and (B) different body mass index (BMI) categories. Data are presented as box plots, where boxes represent the interquartile range (IQR), the lines within the box represent the median, and the lines outside the boxes represent the upper quartile plus 1.5 times IQR or the lower quartile minus 1.5 times the IQR.
CACS = coronary artery calcification score
TABLE 4.
Univariate logistic regression analysis with diffuse idiopathic skeletal hyperostosis (DISH) status as the dependent factor
| Variable | units | OR | p-value |
|---|---|---|---|
| Age | + 1 year | 1.055 | 0.032 |
| Gender | Male vs. female | 2.307 | 0.129 |
| BMI | + 1 kg/m2 | 1.133 | 0.005 |
| Diabetes | Present vs. absent | 3.840 | 0.015 |
| Hypertension | Present vs. absent | 1.985 | 0.213 |
| Hypercholesterolemia | Present vs. absent | 0.623 | 0.375 |
| Smoking | Present vs. absent | 1.748 | 0.470 |
TABLE 5.
Multinomial multivariate logistic regression analysis on the association of diffuse idiopathic skeletal hyperostosis (DISH) and coronary artery calcification score (CACS) category
| CACS category | gender | age | hypertension | EAT attenuation | ||||
|---|---|---|---|---|---|---|---|---|
| OR | p-value | OR | p-value | OR | p-value | OR | p-value | |
| >0 and <100 | 3.515 | 0.008 | 1.087 | <0.001 | 3.956 | 0.001 | 0.980 | 0.225 |
| 100-400 | 7.583 | <0.001 | 1.156 | <0.001 | 5.023 | 0.003 | 1.005 | 0.804 |
| > 400 | 16.786 | <0.001 | 1.227 | <0.001 | 5.423 | 0.001 | 1.052 | 0.022 |