Objectives We sought to determine the association of aortic atherosclerosis, detected by calcific deposits in the ab- dominal aorta seen on lateral lumbar radiographs, with risk for congestive heart failure (CHF).

CHF was increased for the second (hazards ratio (HR) 1.5, 95% CI 0.9-2.5) and third (HR 2.2, 95% CI 1.3-3.7) tertiles compared with the lowest tertile. Similarly, in women, the multivariable-adjusted risk for CHF was increased for the sec- ond (HR 1.8, 95% CI 1.1-2.9) and third (HR 3.2, 95% CI 2.0-5.1) tertiles compared with the lowest tertile. After further adjustment for CHD occurring prior to the onset of CHF, risk remained significantly increased for both men and women. Conclusions Atherosclerosis of the abdominal aorta is an important risk factor for CHF, independent of CHD and other risk factors. Noninvasive detection and quantification of atherosclerosis may be useful in identifying high-risk individ- uals likely to benefit from strategies aimed at preventing CHF. The possibility of a link between AAC and vascular compli- ance deserves further study. (Am Heart J 2002;144:733-9.)