Supine sagittal abdominal diameter (SAD), also known as abdominal height, has been proposed as a simple measure for assessing abdominal adiposity. We aimed to determine whether SAD from DXA performed for osteoporosis assessment predicts major adverse cardiovascular events (MACEs) using the population-based DXA registry for the Province of Manitoba, Canada. The study population comprised 72鈥�974 individuals aged 40聽yr and older with baseline DXA assessment between February 1999 and March 2018. Incident MACE (composite of all-cause mortality, acute myocardial infarction [MI], non-hemorrhagic stroke) was ascertained from linked healthcare databases. During mean 8.4聽yr follow-up (611鈥�862 person-years), 14鈥�457 (18.8%) individuals experienced incident MACE. Risk stratification was greatest with SAD/weight ratio, with area under the curve (AUC) for MACE and its components ranging from 0.582 for acute MI to 0.620 for death (all p聽<鈥�.001), all significantly better than with BMI (p聽<鈥�.001). In multivariable-adjusted models, each SD increase in SAD/weight was associated with increased risk for MACE (hazards ratio [HR] 1.20, 95% CI 1.18-1.22), death (HR 1.22, 95% CI 1.20-1.25), acute MI (HR 1.19, 95% CI 1.14-1.24), and stroke (HR 1.17, 95% CI 1.12-1.22). A linear gradient was seen across SAD/weight quintiles (all p-trend鈥�<鈥�.001), with adjusted HR for MACE 1.61 (95% CI 1.50-1.72) for highest vs lowest quintile. Results were similar when further adjusted for BMI in non-obese and obese individuals (p-interaction for obesity鈥�=鈥�.141) and in both women and men (p-interaction for sex鈥�=鈥�.471). In conclusion, SAD measured opportunistically at the time of DXA testing is predictive of death and major cardiovascular events in individuals undergoing osteoporosis assessment.
