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Background  The structure of the aorta is considered to influence exercise systolic blood pressure ( SBP ) response, which, in turn, might impact upon adverse outcomes. The current study sought to investigate the relationship of aortic calcification and exercise  SBP  with adverse outcomes among elderly individuals.    Methods and Results  We retrospectively reviewed 702 elderly individuals (>65 years of age) without obstructive coronary artery disease ( CAD ; luminal stenosis <50%) who underwent coronary computed tomography ( CT ) and exercise treadmill testing. Δ SBP  stage2  and Δ SBP  peak  were defined as the difference in systolic blood pressure ( SBP ) between rest and stage 2 or peak exercise, respectively. Thoracic aortic calcium score ( TACS ) and coronary artery calcium score ( CACS ) were measured using  CT  scanning procedures. The primary endpoints were defined as all‐cause death, admission for heart failure, obstructive  CAD  requiring coronary intervention, and stroke. In multivariable models, Δ SBP  stage2  and Δ SBP  peak  were positively related with  log ( TACS +1), even after adjusting for various clinical variables, baseline  SBP , and  CACS  ( P <0.001). During a median follow‐up period of 65 months, there were 59 events (8.4%). In a multivariate Cox regression model, independent predictors for all events were age (hazard ratio [ HR ], 1.12; 95%  CI , 1.05–1.19;  P <0.001), dyslipidemia ( HR , 1.96; 95%  CI , 1.14–3.37;  P =0.015), and the 4th quartile of  TACS  ( HR , 1.24; 95%  CI , 1.03–1.49;  P =0.024). Among individual events, the 4th quartile of  TACS  was the only independent predictor for stroke ( HR , 2.15; 95%  CI , 1.09–5.13;  P =0.044), whereas  CACS  ≥400 mm 3  was an independent predictor for obstructive  CAD  requiring intervention ( HR , 7.04; 95%  CI , 1.58–31.36;  P =0.010).    Conclusions  Aortic calcification was related to  SBP  response during exercise and was an independent predictor for outcomes, especially stroke, regardless of resting  SBP  or  CACS .

journal of the american heart association

Association of Thoracic Aorta Calcium Score With Exercise Blood Pressure Response and Clinical Outcomes in Elderly Individuals: Differential Impact of Aorta Calcification Compared With Coronary Artery Calcification