Subjects with diffuse idiopathic skeletal hyperostosis have an increased burden of coronary artery disease: An evaluation in the COPDGene cohort

• Published in: Atherosclerosis Vol. 287; pp. 24 - 29
• Main Authors: Oudkerk, Sytse F., Mohamed Hoesein, Firdaus A.A., PThM Mali, Willem, Öner, F. Cumhur, Verlaan, Jorrit-Jan, de Jong, Pim A., Kinney, Gregory L., Hokanson, John, Lynch, David, Silverman, Edwin K., Budoff, Matthew J., Regan, Elizabeth A.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.08.2019
• Subjects: Agatson score; Aged; Aged, 80 and over; Atherosclerosis; Calciumscore; Coronary artery disease; Coronary Artery Disease - diagnosis; Coronary Artery Disease - epidemiology; Coronary Artery Disease - etiology; DISH; Female; Follow-Up Studies; Humans; Hyperostosis - complications; Hyperostosis - diagnosis; Hyperostosis - epidemiology; Incidence; Male; Middle Aged; Multidetector Computed Tomography - methods; Retrospective Studies; Risk Assessment - methods; Risk Factors; United States - epidemiology; Vascular Calcification - diagnosis; Vascular Calcification - epidemiology; Vascular Calcification - etiology; United States; CT; Agatson score; DISH; Coronary artery disease; Calciumscore; Atherosclerosis
• ISSN: 0021-9150; 1879-1484; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2019.05.030

Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding on medical imaging and often thought to be benign. Our objective was to investigate whether DISH is associated with coronary artery disease as measured with the coronary artery calcification (CAC) score in a large cohort of current and former smokers. In a subset of subjects from the COPDGene study, DISH was scored by a minimum of two independent readers if there were four adjacent levels of flowing osteophytes and a third reader adjudicated discrepancies. CAC was calculated using a modified Agatston method. Associations of DISH with the presence and extent of CAC were analyzed with and without adjustment for COPD and known atherosclerotic risk factors, including age, sex, race, diabetes, hypertension, high cholesterol, body mass index and smoking. DISH was present in 361 subjects (13.2%) from a total group of 2728. Median (interquartile range) Agatston was 81 (0–329) in DISH subjects compared to 0 (0–94 in subjects without DISH (p < 0.001). DISH prevalence was 8.8% in CAC = 0, 12.8% in CAC1-100, 20.0% in CAC100-400 and 24.7% in CAC.400. Subjects with DISH had a significantly higher risk of having coronary artery calcifications; OR [CI95%] 1.37[1.05–1.78] (p=0.019) after correction for age, gender, race, COPD and atherosclerotic risk factors. Subjects with DISH, a common musculoskeletal disorder involving bone formation anterior to the spine, have an increased burden of coronary artery disease, and therefore DISH may be a more relevant incidental finding than commonly thought. •Diffuse idiopathic skeletal hyperostosis (DISH) is a common incidental finding on medical imaging and often thought to be benign.•Subjects with DISH have more CAC as a reflection of coronary atherosclerosis.•DISH is usually observed as an incidental finding on imaging and may be an important finding to stimulate assessment of occult cardiovascular disease.