Zhan Qu,1,* Wenbo Yang,2,3,* Shijun Liu,2,3 Mingqing Wang,1 An Zheng,1 Caipeng Qin,2,3 Yiqing Du,2,3 Xiaodong Zhu,1 Tao Xu2,3 

1Department of Urology, Capital Medical University Electric Power Teaching Hospital (State Grid Corporation of China Beijing Electric Power Hospital), Beijing, 100073, People’s Republic of China; 2Department of Urology, Peking University People’s Hospital, Beijing, 100044, People’s Republic of China; 3The Institute of Applied Lithotripsy Technology, Peking University, Beijing, 100044, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Tao Xu, Email xutao@pkuph.edu.cn Xiaodong Zhu, Email atlanda@163.com

Objective: Arterial calcification (AC) is frequently observed in computed tomography (CT) scans of patients with upper urinary tract calculi (UUTC). This study aimed to investigate the relationship between AC detected by CT in UUTC patients and the risk of ischemic cardiovascular diseases (ICVD).
Methods: In this retrospective case-control study, clinical data of 596 patients were collected. Bone mineral density (BMD) of L1 vertebra and calcification of major/medium arteries were analyzed. Differences in clinical data, CT images and 10-year ICVD risk scores were compared between groups. Univariate analysis and multivariate logistic regression identified independent risk factors for AC in UUTC patients. A scoring system to assess concurrent AC risk in UUTC patients was developed and validated.
Results: A total of 396 UUTC patients and 200 controls were included. AC prevalence was higher in UUTC group (71.7% vs 63.5%, P = 0.041), remained valid after controlling for specific confounding factors. UUTC patients exhibited lower BMD of L1 vertebra. Their 10-year ICVD risk scores were elevated (male: OR = 2.450, 95% CI = 1.262– 4.758, P = 0.007; female: OR = 4.340, 95% CI = 2.203– 8.550, P < 0.001). Multivariate analysis confirmed L1 vertebra BMD < 160 Hounsfield units (OR = 3.660, 95% CI = 2.107– 6.358, P < 0.001) as an independent AC risk factor. The presence of AC was associated with a 13.7-fold increased odds of high-risk group classification (OR = 13.689, 95% CI = 8.021– 23.346, P < 0.001).
Conclusion: AC and the risk of ICVD are associated with UUTC. Our study establishes an innovative integration of UUTC with CT-based AC assessment and ICVD risk stratification, highlighting the need for cardiovascular surveillance in UUTC-affected individuals.

Keywords: upper urinary tract calculi, arterial calcification, ischemic cardiovascular diseases, computed tomography, bone mineral density