Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications

Objectives. DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity. Methods. This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure. Results. A total of 442 patients (9.4%) had evidence of DISH and 1789 (38%) patients had TAC. The prevalence of DISH increased from 6.6% in the no TAC group to 10.8% in the mild, 14.3% in the moderate and 17.1% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95% CI 1.19, 2.36)]. Conclusions. Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications. Lay Summary Diffuse idiopathic skeletal hyperostosis (DISH) is a common condition of the spine characterized by the formation of new bone and the fusion of spinal segments. Patients with DISH have a large heart disease burden, as DISH has been associated with high blood pressure, a high BMI and the presence of diabetes. Recently a large study found that patients with DISH have an increased risk for developing ischaemic strokes. Ischaemic strokes typically occur when a blood clot forms as a result of blocked arteries. The blood clot then prevents flow of oxygen and blood to the brain. The exact cause of the association between DISH and ischaemic strokes is still unknown. We studied the severity of vascular calcification in the aorta in the same group of patients as the previous study. Vascular calcifications are mineral deposits in blood vessels that can stick to fatty deposits and increase the risk of stroke. We found that DISH is associated with more severe vascular calcification in the aorta, which may explain the relation with strokes. We provide further evidence for DISH as a marker for heart disease and highlight the importance of heart disease prevention in patients with DISH.