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Sample records for artery calcification score

  1. Arterial calcifications

    PubMed Central

    Rennenberg, Roger J M W; Schurgers, Leon J; Kroon, Abraham A; Stehouwer, Coen D A

    2010-01-01

    Abstract Arterial calcifications as found with various imaging techniques, like plain X-ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP-2], RANKL) and inhibitory (matrix Gla protein, BMP-7, osteoprotegerin, fetuin-A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk. PMID:20716128

  2. Application of a Novel CT-Based Iliac Artery Calcification Scoring System for Predicting Renal Transplant Outcomes.

    PubMed

    Davis, Bradley; Marin, Daniele; Hurwitz, Lynne M; Ronald, James; Ellis, Matthew J; Ravindra, Kadiyala V; Collins, Bradley H; Kim, Charles Y

    2016-02-01

    The objective of our study was to assess whether the degree and distribution of iliac artery calcifications as determined by a CT-based calcium scoring system correlates with outcomes after renal transplant. A retrospective review of renal transplant recipients who underwent CT of the pelvis within 2 years before surgery yielded 131 patients: 75 men and 56 women with a mean age of 52 years. Three radiologists assigned a separate semiquantitative score for calcification length, circumferential involvement, and morphology for the common iliac arteries and for the external iliac arteries. The operative and clinical notes were reviewed to determine which iliac arterial segment was used for anastomosis, the complexity of the operation, and whether delayed graft function (DGF) occurred. Renal allograft survival and patient survival were calculated using the Kaplan-Meier technique. Excellent interobserver agreement was noted for each calcification score category. The common iliac arteries showed significantly higher average calcification scores than the external iliac arteries for all categories. Advanced age and diabetes mellitus were independently predictive of higher scores in each category, whereas hypertension, cigarette smoking, hyperlipidemia, and sex were not. Based on multivariate analysis, only the calcification morphology score of the arterial segment used for anastomosis was independently predictive of a higher rate of surgical complexity and of DGF. None of the scores was predictive of graft or patient survival. However, patients with CT evidence of iliac arterial calcification had a lower 1-year survival after transplant than those who did not (92% vs 98%, respectively; p = 0.05). Only the calcification morphology score of the arterial segment used for anastomosis was significantly predictive of surgical complexity and of DGF. Routine pretransplant CT for calcification scoring in patients of advanced age or those with diabetes mellitus may enable selection

  3. Middle Cerebral Artery Calcification

    PubMed Central

    Kao, Hung-Wen; Liou, Michelle; Chung, Hsiao-Wen; Liu, Hua-Shan; Tsai, Ping-Huei; Chiang, Shih-Wei; Chou, Ming-Chung; Peng, Giia-Sheun; Huang, Guo-Shu; Hsu, Hsian-He; Chen, Cheng-Yu

    2015-01-01

    Abstract Calcification of the middle cerebral artery (MCA) is uncommon in the healthy elderly. Whether calcification of the MCA is associated with cerebral ischemic stroke remains undetermined. We intended to investigate the association using Agatston calcium scoring of the MCA. This study retrospectively included 354 subjects with ischemic stroke in the MCA territory and 1518 control subjects who underwent computed tomography (CT) of the brain. We recorded major known risk factors for ischemic stroke, including age, gender, hypertension, diabetes mellitus, smoking, hyperlipidemia, and obesity, along with the MCA calcium burden, measured with the Agatston calcium scoring method. Univariate and modified logistic regression analyses were performed to examine the association between the MCA calcification and ischemic stroke. The univariate analyses showed significant associations of ischemic stroke with age, hypertension, diabetes mellitus, smoking, total MCA Agatston score, and the presence of calcification on both or either side of the MCA. Subjects with the presence of MCA calcification on both or either side of the MCA were 8.46 times (95% confidence interval, 4.93–14.53; P < 0.001) more likely to have a cerebral infarct than subjects without MCA calcification after adjustment for the major known risk factors, including age, hypertension, diabetes mellitus, and smoking. However, a higher degree of MCA calcification reflected by the Agatston score was not associated with higher risk of MCA ischemic stroke after adjustment for the confounding factors and presence of MCA calcification. These results suggest that MCA calcification is associated with ischemic stroke in the MCA territory. Further prospective studies are required to verify the clinical implications of the MCA calcification. PMID:26683969

  4. Higher coronary artery calcification score is associated with adverse prognosis in patients with stable angina pectoris

    PubMed Central

    Wang, Renrong; Liu, Xiaoxiao; Wang, Chunxia; Ye, Xinhe; Xu, Xin

    2017-01-01

    Background Coronary artery calcification (CAC) indicates the presence of atherosclerotic lesions and serves as a marker of prognosis in patients with coronary artery disease (CAD). This study evaluated the value of the CAC score for determining the prognosis of patients with stable angina pectoris (SAP). Methods A total of 106 consecutive patients with SAP were enrolled in this study from January 2011 to June 2014; from these patients, 640 multi-slice computer tomography (MSCT) samples were used to obtain CAC scores. The CAC scores were calculated according to the standard Agatston calcium scoring algorithm. All subjects were divided into a lower CAC score group (CAC score, ≤300) and a higher CAC score group (CAC score, >300). Major adverse cardiac events (MACE) were followed-up, and the non-event survival time was recorded. The relationships between the CAC score and both clinical characteristics and MACE were then analysed. Results The CAC positively correlated with age and the creatinine (Cr) level. Compared with patients who received lower CAC scores, the rates of percutaneous coronary intervention (PCI), MACE and multi-vessel disease were significantly higher in patients who received higher CAC scores. The Cox regression analysis results showed that the CAC score [pre-standard deviation (SD)] was a risk factor for the no-event survival time [hazard ratio (HR), 3.06; 95% confidence interval (CI), 1.47–6.38; P<0.05 for all]. However, the Kaplan-Meier analysis suggested that the rates of MACE did not differ between patients who were treated with PCI plus medical therapy and those who were treated with optimal medical therapy alone in both the higher and lower CAC score groups. Conclusions The CAC scores (per-SD) and MACE strongly and positively correlated in patients with SAP, and PCI was not related to the clinical prognosis of patients with SAP in either group. PMID:28449466

  5. Higher coronary artery calcification score is associated with adverse prognosis in patients with stable angina pectoris.

    PubMed

    Wang, Renrong; Liu, Xiaoxiao; Wang, Chunxia; Ye, Xinhe; Xu, Xin; Yang, Chengjian

    2017-03-01

    Coronary artery calcification (CAC) indicates the presence of atherosclerotic lesions and serves as a marker of prognosis in patients with coronary artery disease (CAD). This study evaluated the value of the CAC score for determining the prognosis of patients with stable angina pectoris (SAP). A total of 106 consecutive patients with SAP were enrolled in this study from January 2011 to June 2014; from these patients, 640 multi-slice computer tomography (MSCT) samples were used to obtain CAC scores. The CAC scores were calculated according to the standard Agatston calcium scoring algorithm. All subjects were divided into a lower CAC score group (CAC score, ≤300) and a higher CAC score group (CAC score, >300). Major adverse cardiac events (MACE) were followed-up, and the non-event survival time was recorded. The relationships between the CAC score and both clinical characteristics and MACE were then analysed. The CAC positively correlated with age and the creatinine (Cr) level. Compared with patients who received lower CAC scores, the rates of percutaneous coronary intervention (PCI), MACE and multi-vessel disease were significantly higher in patients who received higher CAC scores. The Cox regression analysis results showed that the CAC score [pre-standard deviation (SD)] was a risk factor for the no-event survival time [hazard ratio (HR), 3.06; 95% confidence interval (CI), 1.47-6.38; P<0.05 for all]. However, the Kaplan-Meier analysis suggested that the rates of MACE did not differ between patients who were treated with PCI plus medical therapy and those who were treated with optimal medical therapy alone in both the higher and lower CAC score groups. The CAC scores (per-SD) and MACE strongly and positively correlated in patients with SAP, and PCI was not related to the clinical prognosis of patients with SAP in either group.

  6. Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

    PubMed

    Osugi, Naohiro; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Hayashi, Mutsuharu; Yasuda, Yoshinari; Ishii, Hideki; Shimizu, Atsuya; Murohara, Toyoaki

    2017-06-01

    Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score ≥8 (high CAC group); and CAC score <8 (low CAC group). CIN was defined as an increase of >10 % in the baseline serum cystatin C level at 24 h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1 mL/min/1.73 m(2), and the mean contrast dose administered was 37.5 mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2 %, p < 0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95 % confidence interval 1.28-2.21, p < 0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p = 0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.

  7. Genetics in Arterial Calcification

    PubMed Central

    Rutsch, Frank; Nitschke, Yvonne; Terkeltaub, Robert

    2011-01-01

    Artery calcification reflects an admixture of factors such as ectopic osteochondral differentiation with primary host pathological conditions. We review how genetic factors, as identified by human genome-wide association studies, and incomplete correlations with various mouse studies, including knockout and strain analyses, fit into “pieces of the puzzle” in intimal calcification in human atherosclerosis, and artery tunica media calcification in aging, diabetes mellitus, and chronic kidney disease. We also describe in sharp contrast how ENPP1, CD73, and ABCC6 serve as “cogs in a wheel” of arterial calcification. Specifically, each is a minor component in the function of a much larger network of factors that exert balanced effects to promote and suppress arterial calcification. For the network to normally suppress spontaneous arterial calcification, the “cogs” ENPP1, CD73, and ABCC6 must be present and in working order. Monogenic ENPP1, CD73, and ABCC6 deficiencies each drive a molecular pathophysiology of closely related but phenotypically different diseases (generalized arterial calcification of infancy (GACI), pseudoxan-thoma elasticum (PXE) and arterial calcification caused by CD73 deficiency (ACDC)), in which premature onset arterial calcification is a prominent but not the sole feature. PMID:21852556

  8. [Pathology of coronary arterial calcification].

    PubMed

    Yutani, Chikao

    2007-03-01

    Calcification is an invariable component of advanced coronary artery atherosclerosis. Recent study showed that genetic variations such as matrix inhibitory proteins, polymorphisms for tumor necrosis factor, and inflammatory cytokines may influence coronary artery calcification. And also there have been numerous studies on screening patients for coronary artery disease using electron beam computed tomography, but details of mechanism on calcification have still been unclear. An example of coronary calcification in diabetic patients disclosed that its diffuse distribution might be metabolic on calcification mechanism.

  9. A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients.

    PubMed

    Adragão, Teresa; Pires, Ana; Birne, Rita; Curto, Jose Dias; Lucas, Carlos; Gonçalves, Margarida; Negrão, Acácio Pita

    2009-03-01

    Vascular calcifications are highly prevalent in dialysis patients and are associated with arterial stiffness and mortality. The use of simple and inexpensive methods to evaluate arterial stiffness and vascular calcifications is desired. The objective of this study was to evaluate the relationship of a simple vascular calcification score (SVCS) with pulse wave velocity (PWV) and pulse pressure (PP) and to evaluate their association with all-cause mortality. 101 haemodialysis patients (71 men; 19% diabetic) were evaluated. At baseline, arterial stiffness was measured by PP and by PWV with Complior. SVCS was evaluated in plain X-ray of pelvis and hands. During a 43-month observational period, 31 patients died. By Kaplan-Meier analysis, SVCS >3 (P = 0.001), PP > 70 mmHg (P = 0.001) and PWV > 10.5 m/s (P < 0.001) were found to be associated with lower cumulative survival. Adjusting for multiple variables, association with mortality was maintained for SVCS >3 (HR = 3.308, P = 0.032) and PP > 70 mmHg (HR = 3.227, P = 0.031) in all patients and for PWV > 10.5 m/s (HR = 2.981, P = 0.047) in non-diabetic patients. Age (P < 0.001), systolic pressure (P = 0.004) and SVCS > 3 (P = 0.032) were associated with PWV. Diabetes (P = 0.031), calcium carbonate dose (P = 0.009) and SVCS > 3 (P = 0.012) were associated with PP. Higher SVCS, PWV and PP were associated with higher mortality in this population. SVCS was associated with arterial stiffness. Simple and inexpensive methods such as PP or SVCS may be used to detect mortality risk and to provide important information that may be relevant for guiding therapeutic intervention in dialysis patients.

  10. Associations of Framingham Risk Score Profile and Coronary Artery Calcification with Sleep Characteristics in Middle-aged Men and Women: Pittsburgh SleepSCORE Study

    PubMed Central

    Matthews, Karen A.; Strollo, Patrick J.; Hall, Martica; Mezick, Elizabeth J.; Kamarck, Thomas W.; Owens, Jane F.; Buysse, Daniel J.; Reis, Steven E.

    2011-01-01

    Background: Short and less efficient sleep may be risk factors for atherosclerosis. Few studies have investigated the associations between sleep characteristics and early cardiovascular disease (CVD) risk. Objective: Evaluate the associations between coronary artery calcification (CAC) and Framingham risk score profile with sleep characteristics in middle-aged men and women with no history of diagnosed myocardial infarction, interventional cardiology procedures, stroke, diabetes, or sleep disorders. Method: 224 participants enrolled in an epidemiological study of disparities in CVD risk were recruited for a 9-night assessment of sleep, with 2 nights of polysomnography (PSG) and 9 nights of actigraphy and sleep diaries. Of the 224 participants, 110 had high/moderate Framingham risk scores and 114 had low scores; 195 had computed tomography measures of CAC. Results: Individuals who had any CAC or higher Framingham risk scores had elevated apnea/hypopnea index (AHI) values, independent of age, race, and gender. The AHI association with CAC was nonsignificant in analyses adjusting for body mass index (BMI). Those with higher Framingham risk score profiles had shorter PSG sleep duration and less percent stage 3-4 and delta power sleep. High blood pressure and left ventricular hypertrophy were related to AHI and sleep duration, independent of BMI. Neither sleep duration nor efficiency was associated with CAC. Conclusions: CAC was not associated with AHI, independent of BMI in a community-based sample of middle-aged men and women. Framingham risk score profiles were related to poor sleep. Sleep duration may not be related to early plaque burden in relatively healthy individuals. Citation: Matthews KA; Strollo PJ; Hall M; Mezick EJ; Kamarck TW; Owens JF; Buysse DJ; Reis SE. Associations of Framingham risk score profile and coronary artery calcification with sleep characteristics in middle-aged men and women: Pittsburgh sleepSCORE study. SLEEP 2011;34(6):711-716. PMID

  11. Arterial calcification: friend or foe?

    PubMed

    Nicoll, Rachel; Henein, Michael Y

    2013-07-31

    There is a significant relationship between the presence, extent and progression of coronary artery calcification (CAC) and cardiovascular (CV) events and mortality in both CV and renal patients and CAC scoring can provide improved predictive ability over risk factor scoring alone. There is also a close relationship between CAC presence and atherosclerotic plaque burden, with angiography studies showing very high sensitivity but poor specificity of CAC score for predicting obstructive disease. Nevertheless, there are objections to CAC screening because of uncertainties and lack of studies showing improved outcome. Furthermore, histopathology studies indicate that heavily calcified plaque is unlikely to result in a CV event, while the vulnerable plaque tends to be uncalcified or 'mixed', suggesting that calcification may be protective. This scenario highlights a number of paradoxes, which may indicate that the association between CAC and CV events is spurious, following from the adoption of CAC as a surrogate for high plaque burden, which itself is a surrogate for the presence of vulnerable plaque. Since studies indicate that arterial calcification is a complex, organised and regulated process similar to bone formation, there is no particular reason why it should be a reliable indicator of either the plaque burden or the risk of a future CV event. We suggest that it is time to divorce arterial calcification from atherosclerosis and to view it as a distinct pathology in its own right, albeit one which frequently coexists with atherosclerosis and is related to it for reasons which are not yet fully understood. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  12. The ability of the 2013 American College of Cardiology/American Heart Association cardiovascular risk score to identify rheumatoid arthritis patients with high coronary artery calcification scores.

    PubMed

    Kawai, Vivian K; Chung, Cecilia P; Solus, Joseph F; Oeser, Annette; Raggi, Paolo; Stein, C Michael

    2015-02-01

    Patients with rheumatoid arthritis (RA) have increased risk of atherosclerotic cardiovascular disease that is underestimated by the Framingham Risk Score (FRS). We undertook this study to test the hypothesis that the 2013 American College of Cardiology/American Heart Association (ACC/AHA) 10-year risk score would perform better than the FRS and the Reynolds Risk Score (RRS) in identifying RA patients known to have elevated cardiovascular risk based on high coronary artery calcification (CAC) scores. Among 98 RA patients eligible for risk stratification using the ACC/AHA risk score, we identified 34 patients with high CAC (defined as ≥300 Agatston units or ≥75th percentile of expected coronary artery calcium for age, sex, and ethnicity) and compared the ability of the 10-year FRS, RRS, and ACC/AHA risk scores to correctly assign these patients to an elevated risk category. All 3 risk scores were higher in patients with high CAC (P < 0.05). The percentage of patients with high CAC correctly assigned to the elevated risk category was similar among the 3 scores (FRS 32%, RRS 32%, ACC/AHA risk score 41%) (P = 0.223). The C statistics for the FRS, RRS, and ACC/AHA risk score predicting the presence of high CAC were 0.65, 0.66, and 0.65, respectively. The ACC/AHA 10-year risk score does not offer any advantage compared to the traditional FRS and RRS in the identification of RA patients with elevated risk as determined by high CAC. The ACC/AHA risk score assigned almost 60% of patients with high CAC to a low risk category. Risk scores and standard risk prediction models used in the general population do not adequately identify many RA patients with elevated cardiovascular risk.

  13. Arterial calcification: A new perspective?

    PubMed

    Nicoll, R; Henein, M

    2017-02-01

    Arterial calcification is commonly seen in atherosclerosis, chronic kidney disease (CKD) and diabetes and has long been considered a natural progression of atherosclerosis. Yet it is a systemic condition, occurring in a wide and diverse range of disease states and no medical treatment for cardiovascular disease has yet found a way to regress it; on the contrary, lipid-lowering therapy may worsen its progression. Although numerous studies have found associations between calcification and biomarkers, none has yet found a unifying mechanism that explains the calcification found in atherosclerosis, CKD or diabetes and many of the biomarkers are equally associated with atheroma development and cardiovascular events. Furthermore, both presence and absence of coronary artery calcification appear predictive of plaque rupture and cardiovascular events, indicating that the association is not causal. This suggests that we are no further forward in understanding the true nature of arterial calcification or its pathogenesis, other than noting that it is 'multifactorial'. This is because most researchers view arterial calcification as a progressive pathological condition which must be treated. Instead, we hypothesise that calcification develops as an immune response to endothelial injury, such as shear stress or oxidative stress in diabetics, and is consequently part of the body's natural defences. This would explain why it has been found to be protective of plaque rupture and why it is unresponsive to lipid-lowering agents. We propose that instead of attempting to treat arterial calcification, we should instead be attempting to prevent or treat all causes of endothelial injury.

  14. Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

    PubMed

    Zhang, Kun; Cheng, Gang; Cai, Xue; Chen, Jie; Jiang, Ying; Wang, Tong; Wang, Jingfeng; Huang, Hui

    2013-03-18

    Arterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear. 68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods. 66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP. Malnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients.

  15. Malnutrition, a new inducer for arterial calcification in hemodialysis patients?

    PubMed Central

    2013-01-01

    Background Arterial calcification is a significant cardiovascular risk factor in hemodialysis patients. A series of factors are involved in the process of arterial calcification; however, the relationship between malnutrition and arterial calcification is still unclear. Methods 68 hemodialysis patients were enrolled in this study. Nutrition status was evaluated using modified quantitative subjective global assessment (MQSGA). Related serum biochemical parameters were measured. And the radial artery samples were collected during the arteriovenous fistula surgeries. Hematoxylin/eosin stain was used to observe the arterial structures while Alizarin red stain to observe calcified depositions and classify calcified degree. The expressions of bone morphogenetic protein 2 (BMP2) and matrix Gla protein (MGP) were detected by immunohistochemistry and western blot methods. Results 66.18% hemodialysis patients were malnutrition. In hemodialysis patients, the calcified depositions were mainly located in the medial layer of the radial arteries and the expressions of BMP2 and MGP were both increased in the calcified areas. The levels of serum albumin were negatively associated with calcification score and the expressions of BMP2 and MGP. While MQSGA score, serum phosphorus and calcium × phosphorus product showed positive relationships with calcification score and the expressions of BMP2 and MGP. Conclusions Malnutrition is prevalent in hemodialysis patients and is associated with arterial calcification and the expressions of BMP2 and MGP in calcified radial arteries. Malnutrition may be a new inducer candidate for arterial calcification in hemodialysis patients. PMID:23506394

  16. Identifying Small Coronary Calcification in Non-Contrast 0.5-mm Slice Reconstruction to Diagnose Coronary Artery Disease in Patients with a Conventional Zero Coronary Artery Calcium Score

    PubMed Central

    Urabe, Yoji; Kitagawa, Toshiro; Utsunomiya, Hiroto; Tsushima, Hiroshi; Tatsugami, Fuminari; Awai, Kazuo; Kihara, Yasuki

    2016-01-01

    Aims: In a new-generation computed tomography (CT) scanner, coronary artery calcium (CAC) scores were measured using 3.0-mm slice reconstruction images originally acquired with 0.5 mm thickness scans in a single beat. This study investigated the usefulness of thin-slice (0.5 mm) reconstruction for identifying small calcifications in coronary arteries and evaluated the association with coronary plaques and stenosis compared to conventional 3.0-mm reconstruction images. Methods: We evaluated 132 patients with zero CAC scores in conventional 3.0-mm Agatston method using a 320-slice CT. Then, 0.5-mm slice reconstruction was performed to identify small calcifications. The presence of stenosis and coronary plaques was assessed using coronary CT angiography. Results: In total, 22 small calcifications were identified in 18 patients. There were 28 (21%) patients with any (≥ 25%) stenosis (34 lesions). Forty-seven coronary plaques were found in 33 patients (25%), including 7 calcified plaques in 7 patients (5%), 34 noncalcified plaques in 27 patients (20%), and 6 partially calcified plaques in 5 patients (4%). Patients with small calcifications had a significantly higher prevalence of noncalcified or partially calcified plaques (83% vs 14%; p < 0.001) and obstructive stenosis (33% vs 5.2%; p < 0.001) compared to those without small calcifications. The addition of small calcifications to the coronary risk factors when diagnosing stenosis significantly improved the diagnostic value. Conclusion: Small calcifications detected by thin-slice 0.5-mm reconstruction are useful for distinguishing coronary atherosclerotic lesions in patients with zero CAC scores from conventional CT reconstruction. PMID:27397477

  17. Increased IL-37 concentrations in patients with arterial calcification.

    PubMed

    Yu, Kunwu; Min, Xiaohong; Lin, Yingzhong; Huang, Ying; Huang, Song; Liu, Ling; Peng, Yudong; Meng, Kai; Li, Dazhu; Ji, Qingwei; Zeng, Qiutang

    2016-10-01

    Our previous study indicates that IL-37 plays a critical role in both atherosclerosis and arterial calcification. However, whether IL-37 concentrations are significantly changed in patients with arterial calcification has not yet been investigated. Anterior tibial arterial wall specimens were obtained from 8 patients with type 2 diabetes mellitus and 8 patients who experienced a traffic accident. IL-37 expression was measured by immunohistochemistry in the calcified and the normal samples. In addition, plasma IL-37 concentrations were measured in 75 patients with coronary artery calcification (CAC) and 50 patients without coronary artery calcification (NCAC). High concentrations of IL-37 were detected in calcified samples, whereas low concentrations of IL-37 were detected in the normal arteries. Macrophages and vascular smooth muscle cells were the main source of IL-37. Plasma IL-37 concentrations were significantly increased in CAC patients compared with NCAC patients. A correlation analysis showed that IL-37 was positively correlated with age, fasting glucose, alkaline phosphatase, IL-6, TNF-α, C-reactive protein and Agatston scores. Binary logistic regression analyses demonstrated that fasting glucose and IL-37 were independently associated with the presence of CAC. Increased IL-37 concentrations are associated with the onset of arterial calcification. Copyright © 2016 Elsevier B.V. All rights reserved.

  18. The Role of Epigenetics in Arterial Calcification

    PubMed Central

    Wu, Shan-Shan; Lin, Xiao; Yuan, Ling-Qing; Liao, Er-Yuan

    2015-01-01

    Arterial calcification is highly prevalent and correlated with cardiovascular mortality, especially in patients with ESRD or diabetes. The pathogenesis of arterial calcification is multifactorial, with both genetic and environmental factors being implicated. In recent years, several mechanisms contributing to arterial calcification have been proposed. However, these can only explain a small proportion of the variability in arterial calcification, which is a major obstacle for its prevention and management. Epigenetics has emerged as one of the most promising areas that may fill in some of the gaps in our current knowledge of the interaction between the environmental insults with gene regulation in the development of diseases. Epigenetics refers to heritable and acquired changes in gene transcription that occur independently of the DNA sequence. Well-known components of epigenetic regulation include DNA methylation, histone modifications, and microRNAs. Epigenetics research in the regulation of arterial calcification has only recently been elucidated. In this review, we will summarise recent progress in epigenetic pathways involved in arterial calcification and discuss potential therapeutic interventions based on epigenetic mechanisms. PMID:26221588

  19. [Multidetector row CT in assessment of coronary artery calcification on hemodialisis].

    PubMed

    Caro, P; Delgado, R; Dapena, F; Núñez, A

    2007-01-01

    Vascular calcification is a strong predictor of cardiovascular and all-cause mortality. Coronary artery calcification is more frequent, more extensive and progresses more rapidly in CKD than in general population. They are also considered a marker of coronary heart disease, with high prevalence and functional significance. It suggests that detection and surveillance may be worthwhile in general clinical practice. New non-invasive image techniques, like Multi-detector row CT, a type of spiral scanner, assess density and volume of calcification at multiple sites and allow quantitative scoring of vascular calcification using calcium scores analogous to those from electron-beam CT. We have assessed and quantified coronary artery calcification with 16 multidetector row CT in 44 patients on hemodialysis and their relationship with several cardiovascular risk factors. Coronary artery calcification prevalence was of 84 % with mean calcium score of 1580 +/- 2010 ( r 0-9844) with calcium score > 400 in 66% of patients. It was usually multiple, affecting more than two vessels in more than 50%. In all but one patient, left anterior descending artery was involved with higher calcium score level at right coronary artery. Advanced age, male, diabetes, smoking, more morbidity, cerebrovascular disease previous, and calcium-binders phosphate and analogous vitamin D treatment would seem to be associated with coronary artery calcification. Coronary artery calcification is very frequent and extensive, usually multiple and associated to modifiable risk factors in hemodialysis patients. Multi-detector-row CT seems an effective, suitable, readily applicable method to assess and quantify coronary artery calcification.

  20. Coronary artery calcification correlates with the presence and severity of valve calcification.

    PubMed

    Koulaouzidis, G; Nicoll, R; MacArthur, T; Jenkins, P J; Henein, M Y

    2013-10-15

    To investigate the prevalence of coronary artery calcification (CAC) in symptomatic individuals with CT evidence for left heart valve calcification, aortic valve (AVC), mitral valve (MAC) or both. This is a retrospective study of 282 consecutive patients with calcification in either the aortic valve or mitral annulus. Calcium scoring of the coronary artery, aortic and mitral valve was measured using the Agatston score. AVC was more prevalent than MAC (64% vs. 2.5%, p < 0.001), with 34% having both. Absence of CAC was noted in 12.7% of the study population. AVC + CAC were observed in 53.5%, MAC and CAC in 2.1%, and combined AVC, MAC and CAC in 31.6%. The median CAC score was higher in individuals with combined AVC+MAC, followed by those with AVC and lowest was in the MAC group. The majority (40%) of individuals with AVC had CAC score >400, and only in 16% had CAC = 0. The same pattern was more evident in individuals with AVC + MAC, where 70% had CAC score >400 and only 6% had CAC score of 0. These results were irrespective of gender. There was no correlation between AVC and MAC but there was modest correlation between CAC score and AVC score (r = 0.28, p = 0.0001), MAC (r = 0.36, p = 0.0001) and with combined AVC + MAC (r = 0.5, p = 0.0001). AVC score of 262 had a sensitivity of 78% and specificity of 92% for the prediction of presence of CAC. The presence and extent of calcification in the aortic valve or/and mitral valves are associated with severe coronary artery calcification. © 2013.

  1. Idiopathic Arterial Calcification of Infancy: Case Report.

    PubMed

    Attia, Tarek Hamed; Abd Alhamed, Mohamed Maisara; Selim, Mohamed Fouad; Haggag, Mohamed Salah; Fathalla, Diaa

    2015-11-01

    Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. Here we are reporting a case of idiopathic arterial calcification of infancy in a Saudi female newborn of non-consanguineous pregnant woman who had polyhydramnios. The newborn baby had severe respiratory distress, systemic hypertension and persistent pulmonary hypertension of newborn. She was admitted to Neonatal Intensive Care Unit, where she was ventilated and proper treatment was provided. Molecular genetic testing was positive for mutations of ectonucleotide pyrophosphatase/phosphodiesterase1 gene which is reported in 80% of cases of Idiopathic arterial calcification of infancy. The baby died at about 5 month of age because of myocardial ischemia and cardiorespiratory arrest. Idiopathic Arterial Calcification of Infancy should be considered in any newborn who presented with persistent pulmonary hypertension of newborn, severe systemic hypertension and echogenic vessels on any radiological study. Calcifications of large and medium-sized arteries are important diagnostic finding.

  2. Idiopathic Arterial Calcification of Infancy: Case Report

    PubMed Central

    Attia, Tarek Hamed; Abd Alhamed, Mohamed Maisara; Selim, Mohamed Fouad; Haggag, Mohamed Salah; Fathalla, Diaa

    2015-01-01

    Idiopathic arterial calcification of infancy is a rare autosomal recessive disease, characterized by deposition of calcium along the internal elastic membrane of arteries, accompanied by fibrous thickening of the intima which causes luminal narrowing. Here we are reporting a case of idiopathic arterial calcification of infancy in a Saudi female newborn of non-consanguineous pregnant woman who had polyhydramnios. The newborn baby had severe respiratory distress, systemic hypertension and persistent pulmonary hypertension of newborn. She was admitted to Neonatal Intensive Care Unit, where she was ventilated and proper treatment was provided. Molecular genetic testing was positive for mutations of ectonucleotide pyrophosphatase/phosphodiesterase1 gene which is reported in 80% of cases of Idiopathic arterial calcification of infancy. The baby died at about 5 month of age because of myocardial ischemia and cardiorespiratory arrest. Idiopathic Arterial Calcification of Infancy should be considered in any newborn who presented with persistent pulmonary hypertension of newborn, severe systemic hypertension and echogenic vessels on any radiological study. Calcifications of large and medium-sized arteries are important diagnostic finding. PMID:27252793

  3. Extensive thoracic aortic calcification is an independent predictor of development of coronary artery calcium among individuals with coronary artery calcium score of zero.

    PubMed

    Brodov, Yafim; Gransar, Heidi; Rozanski, Alan; Hayes, Sean W; Friedman, John D; Thomson, Louise E J; Dey, Damini; Slomka, Piotr J; Min, James K; Shaw, Leslee J; Shah, P K; Germano, Guido; Berman, Daniel S

    2015-01-01

    The predictive value of thoracic aortic calcium (TAC) scores for coronary artery calcium (CAC) conversion (CAC>0) has not been fully evaluated. We studied 1648 asymptomatic subjects (mean age 52 ± 9 years, 54% male) with baseline CAC = 0 who underwent repeat CAC scanning 5 years later (range 3-14 years). TAC was assessed in the ascending and descending aorta. CAC and TAC were measured using Agatston scores. The cohort was categorized by baseline TAC scores: TAC = 0 (n = 1381 subjects), TAC 1-9 (n = 54), TAC 10-99 (n = 132) and TAC≥100 (n = 81). Logistic regression was used to examine the predictive value of baseline TAC scores for CAC>0 on repeat scans. On repeat scanning, 380 subjects (23%) developed CAC>0. The frequency of CAC>0 increased progressively across baseline TAC (TAC = 0, TAC 1-9, TAC 10-99 and TAC≥100) 22%, 26%, 26% and 37%, respectively (P for trend = 0.0025). Univariate analysis showed baseline TAC ≥100 was a significant predictor of CAC>0 in repeat scans, while either TAC 1-9 or TAC 10-99 were not, OR 2.10 [CI 1.32-3.36], P = 0.002; OR 1.25 [CI 0.67-2.33], P = 0.5; OR 1.24 [CI 0.82-1.87], P = 0.3, respectively. In multivariable analysis, TAC ≥100 OR 1.90 [CI 1.08-3.33], P = 0.026, was a significant predictor of CAC>0, along with age, male gender, diabetes, hypertension, hypercholesterolemia and time between scans. The likelihood of conversion to CAC>0 increases with increasing TAC scores. TAC ≥ 100 is an independent predictor of CAC conversion. Subjects with CAC = 0 and extensive TAC (TAC ≥ 100) may merit earlier repeat scanning than those with no TAC or lower TAC scores. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  4. Mammographically Detectable Breast Arterial Calcification and Atherosclerosis

    PubMed Central

    Shah, Neeraj; Chainani, Vinod; Delafontaine, Patrice; Abdo, Abir; Lafferty, James; Rafeh, Nidal Abi

    2014-01-01

    Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience. PMID:23584424

  5. Risk factors for coronary artery calcification in Japanese patients.

    PubMed

    Shikada, Tomoki; Washio, Masakazu; Nishizaki, Akiko; Kakino, Takamori; Ooe, Kensuke; Ishibashi, Yuuji; Sagara, Shuuichirou; Morishige, Kunio; Tashiro, Hideki

    2015-07-01

    Because the prevalence of coronary artery calcification is lower among Japanese than among Western individuals, aspects of the Japanese lifestyle might be related to the development of calcification. We aimed to clarify the relationship between coronary artery calcium scores in Japanese patients and various lifestyle factors among the Japanese population. Study subjects were patients aged ≥20 years who underwent multidetector-row computed tomography. A total of 201 patients agreed to take part in this study and answered a questionnaire regarding lifestyle, medical history, and other factors. Old age, current and former smoking, sedentary work, short sleep time, coronary artery stenosis, treatment with statins, medical history of cerebrovascular disease, medical history of angina pectoris, medical history of ischemic heart disease, and medical history of dyslipidemia were associated with higher odds ratios than the other factors examined, while the Japanese-style breakfast (e.g. boiled rice, miso soup, grilled fish) was associated with lower odds ratios. In this study, smoking, sedentary work, short sleep time, and the Japanese-style breakfast were lifestyle factors related to coronary artery calcification. The lifestyle of Japanese people may be related to coronary calcification. Copyright © 2014 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  6. Peripheral artery calcifications evaluated by histology correlate to those detected by CT: relationships with fetuin-A and FGF-23.

    PubMed

    Coen, Giorgio; De Paolis, Paolo; Ballanti, Paola; Pierantozzi, Andrea; Pisanò, Stefania; Sardella, Daniela; Mantella, Daniela; Pellegrino, Luigi; Silvestrini, Giuliana; Iappelli, Massimo; Di Giulio, Salvatore

    2011-01-01

    Calcification of arteries is a frequent occurrence in hemodialysis (HD) patients and is linked to mortality. This study was conducted to evaluate the correspondence between coronary calcification scores and calcifications observed histologically in peripheral arteries in HD patients. In addition the association of humoral parameters including fetuin-A and fibroblast growth factor 23 (FGF-23) with arterial calcifications was studied. HD patients (n=44) were studied with multislice computed tomography (CT) and histological quantification of arterial calcifications in the lower epigastric artery sampled at the time of renal transplant. In addition, humoral assays were performed including fetuin-A and FGF-23. There was a significant correlation between medial calcification of the artery and Agatston scores. Natural logarithm (Ln) FGF-23 significantly correlated to Ln Agatston score but not to Ln medial calcification. A significant negative correlation between fetuin-A and Ln FGF-23 was observed, changing to borderline significance after correction for age and Ln HD age. Ln Agatston score in a multiregression analysis was predicted by Ln FGF-23 and age. The association found between histologically evaluated calcification of the media of a peripheral artery in HD and the multislice CT Agatston scores is in favor of a generalized arterial calcification, either intimal or of tunica media, when calcium deposits are found in the coronary arteries. The association of FGF-23 with coronary calcification score, already reported, and less so with histological medial calcification is in favor of a link between the protein and intimal more than the medial calcification. FGF-23 may be considered a potential biomarker of arterial calcification in HD patients. The negative association between fetuin-A and FGF-23 may suggest a linkage between these humoral substances, vascular calcifications and mortality. The nature of this linkage requires further studies.

  7. Intracranial Carotid Calcification on Cranial Computed Tomography: Visual Scoring Methods, Semiautomated Scores, and Volume Measurements in Patients With Stroke.

    PubMed

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin; Wardlaw, Joanna

    2015-09-01

    Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R(2)=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. © 2015 The Authors.

  8. NT5E mutations and arterial calcifications.

    PubMed

    St Hilaire, Cynthia; Ziegler, Shira G; Markello, Thomas C; Brusco, Alfredo; Groden, Catherine; Gill, Fred; Carlson-Donohoe, Hannah; Lederman, Robert J; Chen, Marcus Y; Yang, Dan; Siegenthaler, Michael P; Arduino, Carlo; Mancini, Cecilia; Freudenthal, Bernard; Stanescu, Horia C; Zdebik, Anselm A; Chaganti, R Krishna; Nussbaum, Robert L; Kleta, Robert; Gahl, William A; Boehm, Manfred

    2011-02-03

    Arterial calcifications are associated with increased cardiovascular risk, but the genetic basis of this association is unclear. We performed clinical, radiographic, and genetic studies in three families with symptomatic arterial calcifications. Single-nucleotide-polymorphism analysis, targeted gene sequencing, quantitative polymerase-chain-reaction assays, Western blotting, enzyme measurements, transduction rescue experiments, and in vitro calcification assays were performed. We identified nine persons with calcifications of the lower-extremity arteries and hand and foot joint capsules: all five siblings in one family, three siblings in another, and one patient in a third family. Serum calcium, phosphate, and vitamin D levels were normal. Affected members of Family 1 shared a single 22.4-Mb region of homozygosity on chromosome 6 and had a homozygous nonsense mutation (c.662C→A, p.S221X) in NT5E, encoding CD73, which converts AMP to adenosine. Affected members of Family 2 had a homozygous missense mutation (c.1073G→A, p.C358Y) in NT5E. The proband of Family 3 was a compound heterozygote for c.662C→A and c.1609dupA (p.V537fsX7). All mutations found in the three families result in nonfunctional CD73. Cultured fibroblasts from affected members of Family 1 showed markedly reduced expression of NT5E messenger RNA, CD73 protein, and enzyme activity, as well as increased alkaline phosphatase levels and accumulated calcium phosphate crystals. Genetic rescue experiments normalized the CD73 and alkaline phosphatase activity in patients' cells, and adenosine treatment reduced the levels of alkaline phosphatase and calcification. We identified mutations in NT5E in members of three families with symptomatic arterial and joint calcifications. This gene encodes CD73, which converts AMP to adenosine, supporting a role for this metabolic pathway in inhibiting ectopic tissue calcification. (Funded by the National Human Genome Research Institute and the National Heart, Lung

  9. NT5E Mutations and Arterial Calcifications

    PubMed Central

    St. Hilaire, Cynthia; Ziegler, Shira G.; Markello, Thomas C.; Brusco, Alfredo; Groden, Catherine; Gill, Fred; Carlson-Donohoe, Hannah; Lederman, Robert J.; Chen, Marcus Y.; Yang, Dan; Siegenthaler, Michael P.; Arduino, Carlo; Mancini, Cecilia; Freudenthal, Bernard; Stanescu, Horia C.; Zdebik, Anselm A.; Chaganti, R. Krishna; Nussbaum, Robert L.; Kleta, Robert; Gahl, William A.; Boehm, Manfred

    2011-01-01

    BACKGROUND Arterial calcifications are associated with increased cardiovascular risk, but the genetic basis of this association is unclear. METHODS We performed clinical, radiographic, and genetic studies in three families with symptomatic arterial calcifications. Single-nucleotide-polymorphism analysis, targeted gene sequencing, quantitative polymerase-chain-reaction assays, Western blotting, enzyme measurements, transduction rescue experiments, and in vitro calcification assays were performed. RESULTS We identified nine persons with calcifications of the lower-extremity arteries and hand and foot joint capsules: all five siblings in one family, three siblings in another, and one patient in a third family. Serum calcium, phosphate, and vitamin D levels were normal. Affected members of Family 1 shared a single 22.4-Mb region of homozygosity on chromosome 6 and had a homozygous nonsense mutation (c.662C→A, p.S221X) in NT5E, encoding CD73, which converts AMP to adenosine. Affected members of Family 2 had a homozygous missense mutation (c.1073G→A, p.C358Y) in NT5E. The proband of Family 3 was a compound heterozygote for c.662C→A and c.1609dupA (p.V537fsX7). All mutations found in the three families result in nonfunctional CD73. Cultured fibroblasts from affected members of Family 1 showed markedly reduced expression of NT5E messenger RNA, CD73 protein, and enzyme activity, as well as increased alkaline phosphatase levels and accumulated calcium phosphate crystals. Genetic rescue experiments normalized the CD73 and alkaline phosphatase activity in patients’ cells, and adenosine treatment reduced the levels of alkaline phosphatase and calcification. CONCLUSIONS We identified mutations in NT5E in members of three families with symptomatic arterial and joint calcifications. This gene encodes CD73, which converts AMP to adenosine, supporting a role for this metabolic pathway in inhibiting ectopic tissue calcification. (Funded by the National Human Genome Research

  10. Oral calcium supplements do not affect the progression of aortic valve calcification or coronary artery calcification.

    PubMed

    Bhakta, Mayurkumar; Bruce, Charles; Messika-Zeitoun, David; Bielak, Lawrence; Sheedy, Patrick F; Peyser, Patricia; Sarano, Maurice

    2009-01-01

    The use of oral calcium supplementation among the elderly for prevention and treatment of osteoporosis and osteopenia is increasing. The incidence of aortic valve disease and coronary artery disease also is increasing. No study thus far has been done to demonstrate whether this affects the progression of calcification in both the valves and vasculature. We sought to determine whether ingestion of oral calcium supplementation has an effect on aortic valve calcification (AVC) and coronary artery calcification (CAC). We performed an independent assessment of AVC, CAC, and calcium supplementation among patients enrolled in the Epidemiology of Coronary Artery Calcification study who were >60 years of age and had baseline and 4-year follow-up AVC data. In this population-based study of Olmsted County (Minnesota) residents, AVC and CAC scores were determined prospectively by electron beam computed tomography. We evaluated baseline demographic data and analyzed whether those patients using calcium supplementation had a higher rate of progression of both AVC and CAC. We identified 257 patients (mean age, 67.8+/-5.2 years), 144 of whom were women. Twenty-five patients (all women) reported using calcium supplements. Analysis of the 144 women (25 taking calcium supplementation) showed there was no difference in the progression of AVC (mean difference in baseline and follow-up AVC score; no supplement versus supplement, 30+/-9 vs 39+/-28; P=.73) or CAC (mean difference in baseline and follow-up CAC score; no supplement vs supplement, 47+/-15 vs 112+/-22; P=.154). There were no significant differences between the 2 groups with regard to baseline AVC, serum calcium, renal function, diabetes, hypertension, cholesterol, or body mass index. In this community-based observational study with a 4-year follow-up, no significant increased progression of AVC or CAC was found in women taking oral calcium supplementation. Larger prospective, randomized studies are needed to confirm these

  11. Coronary Artery Disease Risk Factors, Coronary Artery Calcification and Coronary Bypass Surgery

    PubMed Central

    Ulusoy, Fatih Rifat; Ipek, Emrah; Korkmaz, Ali Fuat; Gurler, Mehmet Yavuz; Gulbaran, Murat

    2015-01-01

    Introduction Atherosclerosis is an intimal disease which affects large and medium size arteries including aorta and carotid, coronary, cerebral and radial arteries. Calcium accumulated in the coronary arterial plaques have substantial contribution to the plaque volume. The aim of our study is to investigate the relationship between coronary artery disease (CAD) risk factors and coronary arterial calcification, and to delineate the importance of CACS in coronary artery bypass surgery. Materials and Methods The current study is retrospective and 410 patients admitted to our clinic with atypical chest pain and without known CAD were included. These individuals were evaluated by 16 slice electron beam computed tomography with suspicion of CAD and their calcium scores were calculated. Detailed demographic and medical history were obtained from all of the patients. Results In our study, we employed five different analyses using different coronary arterial calcification score (CACS) thresold levels reported in previous studies. All of the analyses, performed according to the previously defined thresold levels, showed that risk factors had strong positive relationship with CACS as mentioned in previous studies. Conclusion Coronary arterial calcification is part of the athero-sclerotic process and although it can be detected in atherosclerotic vessel, it is absent in a normal vessel. It can be concluded that the clinical scores, even they are helpful, have some limitations in a significant part of the population for cardiovascular risk determination. It is important for an anastomosis region to be noncalcified in coronary bypass surgery. In a coronary artery, it will be helpness for showing of calcific field and anostomosis spot. PMID:26155507

  12. Deficiencies of physiologic calcification inhibitors and low-grade inflammation in arterial calcification: lessons for cartilage calcification.

    PubMed

    Rutsch, Frank; Terkeltaub, Robert

    2005-03-01

    Apart from clinical parallels, similarities in the pathogenesis of arterial and articular cartilage calcification have come to light in recent years. These include the roles of aging, of chronic low-grade inflammation and of genetic and acquired dysregulation of inorganic pyrophosphate (PP(i)) metabolism. This review focuses on recent developments in understanding the pathogenesis of artery calcification pertinent to interpretation of the mechanistic basis for articular cartilage calcification in aging and osteoarthritis.

  13. Arterial ageing: from endothelial dysfunction to vascular calcification.

    PubMed

    Tesauro, M; Mauriello, A; Rovella, V; Annicchiarico-Petruzzelli, M; Cardillo, C; Melino, G; Di Daniele, N

    2017-05-01

    Complex structural and functional changes occur in the arterial system with advancing age. The aged artery is characterized by changes in microRNA expression patterns, autophagy, smooth muscle cell migration and proliferation, and arterial calcification with progressively increased mechanical vessel rigidity and stiffness. With age the vascular smooth muscle cells modify their phenotype from contractile to 'synthetic' determining the development of intimal thickening as early as the second decade of life as an adaptive response to forces acting on the arterial wall. The increased permeability observed in intimal thickening could represent the substrate on which low-level atherosclerotic stimuli can promote the development of advanced atherosclerotic lesions. In elderly patients the atherosclerotic plaques tend to be larger with increased vascular stenosis. In these plaques there is a progressive accumulation of both lipids and collagen and a decrease of inflammation. Similarly the plaques from elderly patients show more calcification as compared with those from younger patients. The coronary artery calcium score is a well-established marker of adverse cardiovascular outcomes. The presence of diffuse calcification in a severely stenotic segment probably induces changes in mechanical properties and shear stress of the arterial wall favouring the rupture of a vulnerable lesion in a less stenotic adjacent segment. Oxidative stress and inflammation appear to be the two primary pathological mechanisms of ageing-related endothelial dysfunction even in the absence of clinical disease. Arterial ageing is no longer considered an inexorable process. Only a better understanding of the link between ageing and vascular dysfunction can lead to significant advances in both preventative and therapeutic treatments with the aim that in the future vascular ageing may be halted or even reversed. © 2017 The Association for the Publication of the Journal of Internal Medicine.

  14. Both pelvic radiography and lateral abdominal radiography correlate well with coronary artery calcification measured by computed tomography in hemodialysis patients: A cross-sectional study.

    PubMed

    Hong, Daqing; Ruan, Yizhe; Pu, Lei; Zhong, Xiang; Zhang, Yuan; Zhang, Yue; Deng, Fei; Yang, Hongling; Li, Guisen; Wang, Li

    2016-07-01

    Introduction Lateral abdominal radiograph is suggested as an alternative to coronary artery computed tomography (CT) in evaluating vascular calcification. Simple scoring systems including pelvic radiograph scoring and abdominal scoring system were utilized to study their correlation with coronary artery calcification. Methods In 106 MHD patients, coronary artery CT, lateral abdominal, and pelvic radiograph were taken. The Agatston scoring system was applied to evaluate the degree of coronary artery calcification which was categorized according to Agatston coronary artery calcification score (CACS) ≥ 30, ≥100, ≥400, and ≥1000. Abdominal aortic calcification was scored by 4-scored and 24-scored systems. Pelvic artery calcification was scored by a 4-scored system. Sensitivities and specificities of abdominal aortic calcification scores and pelvic artery calcification scores to predict different categories of coronary artery calcification were analyzed. We studied the diagnostic capability of abdominal aorta calcification and pelvic artery calcification to predict different CACS categories by calculating likelihood ratios. Receiver operator characteristic curves were used to determine the area under the curve for each of these testing procedures. Findings The prevalence was 48(45.3%), 15 (14.2%), 11 (10.4%), 11 (10.4%), and 11 (10.4%) for CACs > 0, ≥30, ≥100, ≥400, and ≥1000, respectively. The degree of CACs was positively correlated with patient age, prevalence of diabetes, abdominal aorta scores, and pelvic calcification scores. The areas under the curves for different CACS by all X-ray scoring systems were above 0.70 except pelvic 4-scored system for diagnosing CACS ≥30, without significant difference (P > 0.05). Discussion Both lateral abdominal and pelvic plain radiographs were demonstrated as acceptable alternatives to CT in evaluating vascular calcification. © 2016 International Society for Hemodialysis.

  15. Association of pelvic arterial calcification with arteriovenous thigh graft failure in haemodialysis patients.

    PubMed

    Lockhart, Mark E; Robbin, Michelle L; McNamara, Michelle M; Allon, Michael

    2004-10-01

    Arterial calcification is a common problem in patients with chronic kidney disease, and has been associated with adverse clinical outcomes. The goal of the present study was to evaluate whether pelvic artery calcifications are associated with technical failure of arteriovenous thigh grafts in haemodialysis patients. From 1 January 1999 to 30 June 2002, thigh grafts were placed in 54 haemodialysis patients who had exhausted all options for permanent vascular access in the upper extremities. Perioperative computed tomography (CT) of the abdomen and pelvis was obtained in 32 of the patients for diagnostic purposes unrelated to vascular access planning. Two radiologists, who were blinded to the graft outcomes, scored the vascular calcifications on CT of the distal aorta, common iliac, external iliac and common femoral arteries on a semi-quantitative 5-point scale. The association between technical graft failure (inability to complete the anastomosis) and the vascular calcification score was analysed. There was a high inter-observer agreement in scoring vascular calcification (kappa = 0.801). Among 26 patients with absent or mild pelvic arterial calcifications (grade 1-2) on CT, none (0%) experienced technical graft failure. In contrast, three of six patients (50%) with moderate to severe calcification (grade 3-5) had technical graft failures (P = 0.004 by Fisher's exact test). The cumulative 1 year graft patency was lower in the group with grade 3-5 calcification (33 vs 81%, P = 0.09). The two groups were similar in age, gender, race, diabetes, duration of dialysis, serum calcium, serum phosphorus and serum parathyroid hormone. There is a strong association between pelvic artery calcifications and technical failure of thigh grafts. The presence of moderate to severe vascular calcification is predictive of poor cumulative 1 year graft patency.

  16. Intracranial Artery Calcification and Its Clinical Significance

    PubMed Central

    Wu, Xiao Hong; Wang, Li Juan; Wong, Ka Sing

    2016-01-01

    Intracranial arterial calcification (IAC) is an easily identifiable entity on plain head computed tomography scans. Recent studies have found high prevalence rates for IAC worldwide, and this may be associated with ischemic stroke and cognitive decline. Aging, traditional cardiovascular risk factors, and chronic kidney disease have been found to be associated with IAC. The severity of IAC can be assessed using different visual grading scales or various quantitative methods (by measuring volume or intensity). An objective method for assessing IAC using consistent criteria is urgently required to facilitate comparisons between multiple studies involving diverse populations. There is accumulating evidence from clinical studies that IAC could be utilized as an indicator of intracranial atherosclerosis. However, the pathophysiology underlying the potential correlation between IAC and ischemic stroke—through direct arterial stenosis or plaque stability—remains to be determined. More well-designed clinical studies are needed to explore the predictive values of IAC in vascular events and the underlying pathophysiological mechanisms. PMID:27165425

  17. [The hemodynamic characterization of the diabetic patient with arterial calcifications].

    PubMed

    Vega Gómez, M E; Ley Pozo, J; Aldama Figueroa, A; Lima Santana, B; Montalvo Diago, J; Bustillo, C; Fernández Boloña, A; Gutiérrez Jiménez, O; Ramirez Muñoz, O; Martínez Hernández, R

    1993-01-01

    This study was designed to describe the presence of calcifications according to the clinical features of the diabetic patient and the hemodynamics of the calcified arteries. With this purpose, 197 lower limbs from diabetic patients (type I and II) and carbon-hydrate intolerant patients, were studied. In all of the patients, the pressure ratio leg/arm was measured. On the same way, the arterial flow velocity was recorded using the Doppler ultrasonography on the pedia and postero-tibial arteries. The arterial calcifications, evident on the radiography of the foot, were more frequent between the type I patients and the neuro-infections diabetic foot. According to the hemodynamics point of view, we found a trend of association of more pathologic arterial flow velocity curves with the presence of calcifications (specially on the intima layer). It was also remarkable that an arterial incomprensibility was always associated with arterial calcifications.

  18. Computed Tomographic Distinction of Intimal and Medial Calcification in the Intracranial Internal Carotid Artery

    PubMed Central

    Vos, Annelotte; Van Hecke, Wim; Vink, Aryan; Bleys, Ronald L. A. W.; Verdoorn, Daphne; Mali, Willem P. Th. M.; Hendrikse, Jeroen; Koek, Huiberdina L.; de Jong, Pim A.; De Vis, Jill B.

    2017-01-01

    Background Intracranial internal carotid artery (iICA) calcification is associated with stroke and is often seen as a proxy of atherosclerosis of the intima. However, it was recently shown that these calcifications are predominantly located in the tunica media and internal elastic lamina (medial calcification). Intimal and medial calcifications are thought to have a different pathogenesis and clinical consequences and can only be distinguished through ex vivo histological analysis. Therefore, our aim was to develop CT scoring method to distinguish intimal and medial iICA calcification in vivo. Methods First, in both iICAs of 16 cerebral autopsy patients the intimal and/or medial calcification area was histologically assessed (142 slides). Brain CT images of these patients were matched to the corresponding histological slides to develop a CT score that determines intimal or medial calcification dominance. Second, performance of the CT score was assessed in these 16 patients. Third, reproducibility was tested in a separate cohort. Results First, CT features of the score were circularity (absent, dot(s), <90°, 90–270° or 270–360°), thickness (absent, ≥1.5mm, or <1.5mm), and morphology (indistinguishable, irregular/patchy or continuous). A high sum of features represented medial and a lower sum intimal calcifications. Second, in the 16 patients the concordance between the CT score and the dominant calcification type was reasonable. Third, the score showed good reproducibility (kappa: 0.72 proportion of agreement: 0.82) between the categories intimal, medial or absent/indistinguishable. Conclusions The developed CT score shows good reproducibility and can differentiate reasonably well between intimal and medial calcification dominance in the iICA, allowing for further (epidemiological) studies on iICA calcification. PMID:28060941

  19. Reliability analysis of visual ranking of coronary artery calcification on low-dose CT of the thorax for lung cancer screening: comparison with ECG-gated calcium scoring CT.

    PubMed

    Kim, Yoon Kyung; Sung, Yon Mi; Cho, So Hyun; Park, Young Nam; Choi, Hye-Young

    2014-12-01

    Coronary artery calcification (CAC) is frequently detected on low-dose CT (LDCT) of the thorax. Concurrent assessment of CAC and lung cancer screening using LDCT is beneficial in terms of cost and radiation dose reduction. The aim of our study was to evaluate the reliability of visual ranking of positive CAC on LDCT compared to Agatston score (AS) on electrocardiogram (ECG)-gated calcium scoring CT. We studied 576 patients who were consecutively registered for health screening and undergoing both LDCT and ECG-gated calcium scoring CT. We excluded subjects with an AS of zero. The final study cohort included 117 patients with CAC (97 men; mean age, 53.4 ± 8.5). AS was used as the gold standard (mean score 166.0; range 0.4-3,719.3). Two board-certified radiologists and two radiology residents participated in an observer performance study. Visual ranking of CAC was performed according to four categories (1-10, 11-100, 101-400, and 401 or higher) for coronary artery disease risk stratification. Weighted kappa statistics were used to measure the degree of reliability on visual ranking of CAC on LDCT. The degree of reliability on visual ranking of CAC on LDCT compared to ECG-gated calcium scoring CT was excellent for board-certified radiologists and good for radiology residents. A high degree of association was observed with 71.6% of visual rankings in the same category as the Agatston category and 98.9% varying by no more than one category. Visual ranking of positive CAC on LDCT is reliable for predicting AS rank categorization.

  20. Matrix Gla Protein polymorphisms are associated with coronary artery calcification

    USDA-ARS?s Scientific Manuscript database

    Matrix Gla Protein (MGP) is a key regulator of vascular calcification. Genetic variation at the MGP locus could modulate the development of coronary artery calcification (CAC). We examined the cross-sectional association between MGP SNPs [rs1800802 (T-138C), rs1800801 (G-7A),and rs4236 (Ala102Thr)...

  1. Heterogeneous susceptibility for uraemic media calcification and concomitant inflammation within the arterial tree

    PubMed Central

    Kirsch, Alexander H.; Kirsch, Andrijana; Artinger, Katharina; Schabhüttl, Corinna; Goessler, Walter; Klymiuk, Ingeborg; Gülly, Christian; Fritz, Gerald A.; Frank, Saša; Wimmer, Roxana; Brodmann, Marianne; Anders, Hans-Joachim; Pramstaller, Peter P.; Rosenkranz, Alexander R.; Eller, Kathrin; Eller, Philipp

    2015-01-01

    Background End-stage renal disease (ESRD) is strongly associated with arterial calcification of the tunica media, decreased vascular compliance and sudden cardiac death. Here, we analysed the distribution pattern of uraemic media calcification and concomitant inflammation in mice and men. Methods Uraemia was induced in DBA/2 mice with high-phosphate diet. Subsequently, we analysed arterial medial calcification using histology, mass spectrometry, and wire myography. Gene expression was quantified using a whole transcriptome array and quantitative PCR. In a cohort of 36 consecutive patients with CKD stage 4–5, we measured the calcium score of the coronary arteries, the ascending thoracic aorta and the infrarenal abdominal aorta using computed tomography scans. Results Uraemic DBA/2 mice showed only minor calcifications in thoracic aortas, whereas there was overt media calcification in abdominal aortas. The transcriptional profile and immunohistochemistry revealed induction of Vcam1 expression by vascular smooth muscle cells in uraemic abdominal aortas. Macrophages infiltrated the tunica media of the abdominal aorta. Anti-inflammatory treatment did not improve uraemic media calcification in our animal model. Arterial calcifications in ESRD patients showed a similar distribution pattern in computed tomography scans, with higher calcium scores of the abdominal aorta when compared with the thoracic aorta. Conclusion Taken together, there was a similar heterogeneous pattern of calcification in both mice and humans, where the abdominal aorta was more prone to media calcification when compared with the thoracic aorta. In uraemia, smooth muscle cells of the abdominal aorta showed a phenotypic switch to an inflammatory and osteoblastic phenotype. PMID:26185049

  2. A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients.

    PubMed

    Adragao, Teresa; Pires, Ana; Lucas, Carlos; Birne, Rita; Magalhaes, Luís; Gonçalves, Margarida; Negrao, Acácio Pita

    2004-06-01

    Cardiovascular morbidity and mortality are highly prevalent in haemodialysis (HD) patients and have been recently associated with vascular calcifications. The objective of our study was to assess the value of a simple vascular calcification score for the prediction of cardiovascular death, cardiovascular hospitalizations and fatal and non-fatal cardiovascular events in HD patients, and to correlate this score with cardiovascular disease and with other known predictors of vascular disease. In this observational, prospective study 123 chronic HD patients (75 males and 48 females; 20% diabetic) were included, who were on low-flux HD treatment for 46.6+/-52 months (mean+/-SD). We set up a simple vascular calcification score based on plain radiographic films of pelvis and hands. Brachial pulse pressure and mean arterial pressure (MAP) were measured and cardiovascular events and hospitalization episodes were assessed. During an observational period of 37 months there were 17 cardiovascular deaths; 28 patients needed cardiovascular hospitalizations and 32 patients suffered fatal and non-fatal cardiovascular events. Coronary artery disease was diagnosed in 43 patients (35%), peripheral arterial disease in 33 patients (26.8%), cerebrovascular disease in 16 patients (13%) and vascular disease (coronary artery disease or peripheral arterial disease or cerebral vascular disease) in 61 patients (49.6%). By binary logistic regression, diabetes (P = 0.01), male sex (P<0.001), age (P = 0.02), HD duration (P = 0.02) and MAP (P = 0.03) were independently associated with a vascular score > or =3. This score > or =3 was independently associated with coronary artery disease (P = 0.008), peripheral arterial disease (P<0.001) and vascular disease (P = 0.001). Patients with a vascular calcification score > or =3 had a 3.9-fold higher risk of cardiovascular mortality (P = 0.03), a 2.8-fold higher risk of cardiovascular hospitalizations (P = 0.02) and a 2.3-fold higher risk of fatal or non

  3. Gated cardiac tomographic visualization of coronary artery calcification

    SciTech Connect

    Markivee, C.R.; Hoyt, T.S.; Francis, R.A.; Burns, J.; Ruark, B.

    1984-07-01

    Coronary artery calcification (CAC) is usually detected by fluoroscopy or on cine films during coronary angiography, but measurement of the calcification is not possible. Gated tomography of the heart provides a full sized image with high contrast spatial resolution of 0.76 mm. The radiation exposure to the heart is between 1-5% of that experienced with coronary cinefluorography. Measurement of the diameter of calcium deposits is possible and calcium that could be related to arterial stenosis may be identified.

  4. Magnesium Intake Is Inversely Associated With Coronary Artery Calcification

    PubMed Central

    Hruby, Adela; O'Donnell, Christopher J.; Jacques, Paul F.; Meigs, James B.; Hoffmann, Udo; McKeown, Nicola M.

    2014-01-01

    OBJECTIVES The aim of this study was to examine whether magnesium intake is associated with coronary artery calcification (CAC) and abdominal aortic calcification (AAC). BACKGROUND Animal and cell studies suggest that magnesium may prevent calcification within atherosclerotic plaques underlying cardiovascular disease. Little is known about the association of magnesium intake and atherosclerotic calcification in humans. METHODS We examined cross-sectional associations of self-reported total (dietary and supplemental) magnesium intake estimated by food frequency questionnaire with CAC and AAC in participants of the Framingham Heart Study who were free of cardiovascular disease and underwent Multi-Detector Computed Tomography (MDCT) of the heart and abdomen (n = 2,695; age: 53 ± 11 years), using multivariate-adjusted Tobit regression. CAC and AAC were quantified using modified Agatston scores (AS). Models were adjusted for age, sex, body mass index, smoking status, systolic blood pressure, fasting insulin, total-to-high-density lipoprotein cholesterol ratio, use of hormone replacement therapy (women only), menopausal status (women only), treatment for hyperlipidemia, hypertension, cardiovascular disease prevention, or diabetes, as well as self-reported intake of calcium, vitamins D and K, saturated fat, fiber, alcohol, and energy. Secondary analyses included logistic regressions of CAC and AAC outcomes as cut-points (AS >0 and AS ≥90th percentile for age and sex), as well as sex-stratified analyses. RESULTS In fully adjusted models, a 50-mg/day increment in self-reported total magnesium intake was associated with 22% lower CAC (p < 0.001) and 12% lower AAC (p = 0.07). Consistent with these observations, the odds of having any CAC were 58% lower (p trend: <0.001) and any AAC were 34% lower (p trend: 0.01), in those with the highest compared to those with the lowest magnesium intake. Stronger inverse associations were observed in women than in men. CONCLUSIONS In

  5. The association of breast arterial calcification and metabolic syndrome

    PubMed Central

    Yildiz, Seyma; Toprak, Huseyin; Aydin, Sinem; Bilgin, Mehmet; Oktay, Veysel; Abaci, Okay; Kocas, Cuneyt

    2014-01-01

    OBJECTIVES: We investigated the relationship between metabolic syndrome and breast arterial calcification detected via mammography in a cohort of postmenopausal subjects. METHODS: Among 837 patients referred to our radiology department for mammographic screening, 310 postmenopausal females (105 patients with and 205 patients without breast arterial calcification) aged 40 to 73 (mean 55.9±8.4) years were included in this study. The groups were compared with respect to clinical characteristics and metabolic syndrome criteria. Univariate and multivariate analyses identified the factors related to breast arterial calcification. RESULTS: Age, postmenopausal duration and the frequencies of diabetes mellitus, hypertension and metabolic syndrome were significantly higher in the subjects with breast arterial calcification than in those without (p<0.05). Multivariate analysis indicated that age (OR = 1.3, 95% CI = 1.1–1.6, p = 0.001) and metabolic syndrome (OR = 4.0, 95% CI = 1.5−10.4, p = 0.005) were independent predictors of breast arterial calcification detected via mammography. The independent predictors among the features of metabolic syndrome were low levels of high-density lipoproteins (OR = 8.1, 95% CI = 1.0−64.0, p = 0.047) and high blood pressure (OR = 8.7, 95% CI = 1.5−49.7, p = 0.014). CONCLUSIONS: The likelihood of mammographic detection of breast arterial calcification increases with age and in the presence of hypertension or metabolic syndrome. For patients undergoing screening mammography who present with breast arterial calcification, the possibility of metabolic syndrome should be considered. These patients should be informed of their cardiovascular risk factors and counseled on appropriate lifestyle changes. PMID:25627997

  6. Magnesium intake is inversely associated with coronary artery calcification: the Framingham Heart Study

    USDA-ARS?s Scientific Manuscript database

    OBJECTIVES: The aim of this study was to examine whether magnesium intake is associated with coronary artery calcification (CAC) and abdominal aortic calcification (AAC). BACKGROUND: Animal and cell studies suggest that magnesium may prevent calcification within atherosclerotic plaques underlying c...

  7. Comparing different calcification scores to detect outcomes in chronic kidney disease patients with vascular calcification.

    PubMed

    NasrAllah, Mohamed M; Nassef, Amr; Elshaboni, Tarik H; Morise, Fadia; Osman, Noha A; Sharaf El Din, Usama A

    2016-10-01

    There is no consensus on the most appropriate technique to diagnose vascular calcification in chronic kidney disease. This is primarily because of the absence of direct comparisons of predictive values of the various calcification scores, especially outside the coronary vascular beds, to detect clinical outcomes. We included 93 haemodialysis patients and performed 6 vascular calcification scores: two scores utilised simple X-rays of abdominal aorta and peripheral vessels. CT scans of the thoracic, upper abdominal and lower abdominal aorta were performed to calculate the aortic calcification index and CT of the pelvis for calcification of iliac vessels. Patients were followed for 63months (mean 46.8months) for first major cardiovascular events and mortality. Nineteen cardiovascular events and 28 deaths occurred. Calcification was detected more sensitively in central and peripheral beds using CT scans compared to X-rays (p<0.001). CT scans detected calcification more frequently in distal than proximal vascular beds (p<0.001). Calcification of the pelvic vessels and lower abdominal aorta were most predictive of events including pre-existing cardiovascular disease O.R. 6.5 (95% C.I. 2-22; p=0.001) and O.R. 3 (95% C.I. 1.1-9; p=0.035); new major cardiovascular events H.R. 4.2 (95% C.I. 1.5-11; p=0.006) and H.R. 2 (95% C.I. 0.8-5.3; p=0.1) as well as mortality H.R. 2.8 (95% C.I. 1.3-6; p=0.01) and H.R. 2.2 (95% C.I. 1.04-5; p=0.04) respectively. CT based techniques are more sensitive than plain X-rays at detecting peripheral and aortic vascular calcifications. Distal CT scans of the aorta and pelvic vessels have the highest predictive value for cardiovascular events and mortality. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  8. Do breast arterial calcifications on mammography predict elevated risk of coronary artery disease?

    PubMed

    Chadashvili, Tamuna; Litmanovich, Diana; Hall, Ferris; Slanetz, Priscilla J

    2016-06-01

    To determine whether breast arterial calcifications (BAC) seen on mammography correlates with coronary artery calcium score on coronary CT as it may serve as a potential marker for increased risk of developing symptomatic coronary artery disease (CAD). Retrospective review of the imaging database at our institution identified 145 female patients who underwent coronary CT within a year of screening or diagnostic mammography. The coronary calcium score on CT was calculated by multiplying area of calcification by weighted value assigned to its highest Hounsfield unit and summed for all lesions and expressed as Agaston score. Calculated scores were risk stratified for developing CAD as follows: 0-no risk; 1-10-minimal; 11-100-mild; 101-400-moderate; >400-high risk. Percentile distribution of calcium score adjusted by age, gender and race was calculated based on results of the Multi-Ethnic Study of Atherosclerosis (MESA), which excluded patient with diabetes and chronic renal disease. The mammograms were reviewed by MQSA-certified breast radiologists who were blinded to patients' coronary calcium scores. Mammograms were interpreted for presence or absence of BAC. The calcium scores and corresponding percentiles were correlated with BAC on mammography. Cardiac risk factors such as, diabetes, hypertension, hyperlipidemia, family history of CAD and smoking, were recorded for each patient. BAC correlated with coronary calcium score of >11 (p=0.0001), corresponding to mild or greater risk of developing CAD. Specifically, coronary calcium score of >11 was seen in 68% (25/37) of patients with BAC and 31% (34/108) of patients without BAC. Accounting for race, gender and age, presence of BAC showed statistically significant correlation with percentile scores of >25. Namely, 70.4% (19/27) of patients with BAC vs. 44.6% (41/92) of patient without BAC showed percentile score of >25 for developing CAD. Statistically significant association was observed of BAC with diabetes (p=0

  9. Association of Big Endothelin-1 with Coronary Artery Calcification.

    PubMed

    Qing, Ping; Li, Xiao-Lin; Zhang, Yan; Li, Yi-Lin; Xu, Rui-Xia; Guo, Yuan-Lin; Li, Sha; Wu, Na-Qiong; Li, Jian-Jun

    2015-01-01

    The coronary artery calcification (CAC) is clinically considered as one of the important predictors of atherosclerosis. Several studies have confirmed that endothelin-1(ET-1) plays an important role in the process of atherosclerosis formation. The aim of this study was to investigate whether big ET-1 is associated with CAC. A total of 510 consecutively admitted patients from February 2011 to May 2012 in Fu Wai Hospital were analyzed. All patients had received coronary computed tomography angiography and then divided into two groups based on the results of coronary artery calcium score (CACS). The clinical characteristics including traditional and calcification-related risk factors were collected and plasma big ET-1 level was measured by ELISA. Patients with CAC had significantly elevated big ET-1 level compared with those without CAC (0.5 ± 0.4 vs. 0.2 ± 0.2, P<0.001). In the multivariate analysis, big ET-1 (Tertile 2, HR = 3.09, 95% CI 1.66-5.74, P <0.001, Tertile3 HR = 10.42, 95% CI 3.62-29.99, P<0.001) appeared as an independent predictive factor of the presence of CAC. There was a positive correlation of the big ET-1 level with CACS (r = 0.567, p<0.001). The 10-year Framingham risk (%) was higher in the group with CACS>0 and the highest tertile of big ET-1 (P<0.01). The area under the receiver operating characteristic curve for the big ET-1 level in predicting CAC was 0.83 (95% CI 0.79-0.87, p<0.001), with a sensitivity of 70.6% and specificity of 87.7%. The data firstly demonstrated that the plasma big ET-1 level was a valuable independent predictor for CAC in our study.

  10. Calcification of the external carotid arteries and their branches

    PubMed Central

    MacDonald, D S; Zhang, L; Gu, Y

    2012-01-01

    This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a “brown tumour”. Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant. PMID:22241884

  11. Calcification of the external carotid arteries and their branches.

    PubMed

    Macdonald, D S; Zhang, L; Gu, Y

    2012-10-01

    This patient had longstanding hypercalcaemia and hyperphosphataemia owing to chronic renal disease, then finally failure, inducing tertiary hyperparathyroidism. He also had long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. He then reported a painful expansile swelling of the anterior mandible which was diagnosed as a "brown tumour". Subsequent review of the CT data set by an oral and maxillofacial radiologist revealed two patterns of calcification of the carotid arteries. A pipestem pattern was observed bilaterally along almost the entire lengths of the external carotid artery, a muscular artery, and its branches whereas plaque-like calcification was observed in the common and internal carotid arteries (elastic arteries). The pipestem pattern, hitherto an unreported feature affecting the external carotid artery, may represent a metastatic calcified deposit owing to hypercalcaemia and hyperphosphataemia in the tunica media of muscular arteries, resulting in arteriosclerosis, which maintains a patent lumen. The plaque-like pattern is representative of lumen-occluding calcified atherosclerosis associated with the long histories of diabetes mellitus type II, hypertension and hypercholesterolaemia. As this patient did not have any symptoms and/or signs of myofacial pain, facial dysfunction or numbness, the calcification of his external carotid arteries and branches were considered as arteriosclerosis. The brown tumour responded to the parathyroidectomy and the renal transplant.

  12. Dietary potassium regulates vascular calcification and arterial stiffness.

    PubMed

    Sun, Yong; Byon, Chang Hyun; Yang, Youfeng; Bradley, Wayne E; Dell'Italia, Louis J; Sanders, Paul W; Agarwal, Anupam; Wu, Hui; Chen, Yabing

    2017-10-05

    Vascular calcification is a risk factor that predicts adverse cardiovascular complications of several diseases including atherosclerosis. Reduced dietary potassium intake has been linked to cardiovascular diseases such as hypertension and incidental stroke, although the underlying molecular mechanisms remain largely unknown. Using the ApoE-deficient mouse model, we demonstrated for the first time to our knowledge that reduced dietary potassium (0.3%) promoted atherosclerotic vascular calcification and increased aortic stiffness, compared with normal (0.7%) potassium-fed mice. In contrast, increased dietary potassium (2.1%) attenuated vascular calcification and aortic stiffness. Mechanistically, reduction in the potassium concentration to the lower limit of the physiological range increased intracellular calcium, which activated a cAMP response element-binding protein (CREB) signal that subsequently enhanced autophagy and promoted vascular smooth muscle cell (VSMC) calcification. Inhibition of calcium signals and knockdown of either CREB or ATG7, an autophagy regulator, attenuated VSMC calcification induced by low potassium. Consistently, elevated autophagy and CREB signaling were demonstrated in the calcified arteries from low potassium diet-fed mice as well as aortic arteries exposed to low potassium ex vivo. These studies established a potentially novel causative role of dietary potassium intake in regulating atherosclerotic vascular calcification and stiffness, and uncovered mechanisms that offer opportunities to develop therapeutic strategies to control vascular disease.

  13. Coronary artery calcification in Korean patients with incident dialysis.

    PubMed

    Bae, Eunjin; Seong, Eun Yong; Han, Byoung-Geun; Kim, Dong Ki; Lim, Chun Soo; Kang, Shin-Wook; Park, Cheol Whee; Kim, Chan-Duck; Shin, Byung Chul; Kim, Sung Gyun; Chung, Wookyung; Park, Jae Yoon; Lee, Joo Yeon; Kim, Yon Su

    2017-07-01

    Patients with chronic kidney disease have an extremely high risk of developing cardiovascular disease (CVD). In patients with end-stage renal disease (ESRD), coronary artery calcification (CAC) is associated with increased mortality from CVD. The present study aimed to investigate the risk factors for CAC in Korean patients with incident dialysis. Data on 423 patients with ESRD who started dialysis therapy between December 2012 and March 2014 were obtained from 10 university-affiliated hospitals. CAC was identified by using noncontrast-enhanced cardiac multidetector computed tomography. The CAC score was calculated according to the Agatston score, with CAC-positive subjects defined by an Agatston score >0. Patients' mean age was 55.6 ± 14.6 years, and 64.1% were men. The CAC-positive rate was 63.8% (270 of 423). Results of univariate analyses showed significant differences in age, sex, etiology of ESRD and comorbid conditions according to the CAC score. However, results of multiple regression analysis showed that only a higher age was significantly associated with the CAC score. Receiver operating characteristic curves showed that the sensitivity and specificity of L-spine radiography for diagnosing CAC were 56% and 91%, respectively, for diagnosing CAC (area under the curve, 0.735). CAC was frequent in patients with incident dialysis, and multiple regression analysis showed that only age was significantly associated with the CAC score. In addition, L-spine radiography could be a helpful modality for diagnosing CAC in patients with incident dialysis. © 2016 International Society for Hemodialysis.

  14. Cerebral Arterial Calcification Is an Imaging Prognostic Marker for Revascularization Treatment of Acute Middle Cerebral Arterial Occlusion

    PubMed Central

    Lee, Seong-Joon; Hong, Ji Man; Lee, Manyong; Huh, Kyoon; Choi, Jin Wook

    2015-01-01

    Background and Purpose To study the significance of intracranial artery calcification as a prognostic marker for acute ischemic stroke patients undergoing revascularization treatment after middle cerebral artery (MCA) trunk occlusion. Methods Patients with acute MCA trunk occlusion, who underwent intravenous and/or intra-arterial revascularization treatment, were enrolled. Intracranial artery calcification scores were calculated by counting calcified intracranial arteries among major seven arteries on computed tomographic angiography. Patients were divided into high (HCB; score ≥3) or low calcification burden (LCB; score <3) groups. Demographic, imaging, and outcome data were compared, and whether HCB is a prognostic factor was evaluated. Grave prognosis was defined as modified Rankin Scale 5-6 for this study. Results Of 80 enrolled patients, the HCB group comprised 15 patients, who were older, and more commonly had diabetes than patients in the LCB group. Initial National Institutes of Health Stroke Scale (NIHSS) scores did not differ (HCB 13.3±2.7 vs. LCB 14.6±3.8) between groups. The final good reperfusion after revascularization treatment (thrombolysis in cerebral infarction score 2b-3, HCB 66.7% vs. LCB 69.2%) was similarly achieved in both groups. However, the HCB group had significantly higher NIHSS scores at discharge (16.0±12.3 vs. 7.9±8.3), and more frequent grave outcome at 3 months (57.1% vs. 22.0%) than the LCB group. HCB was proven as an independent predictor for grave outcome at 3 months when several confounding factors were adjusted (odds ratio 4.135, 95% confidence interval, 1.045-16.359, P=0.043). Conclusions Intracranial HCB was associated with grave prognosis in patients who have undergone revascularization for acute MCA trunk occlusion. PMID:25692109

  15. Pericardial adipose tissue and coronary artery calcification in the Multi-ethnic Study of Atherosclerosis (MESA).

    PubMed

    McClain, Jill; Hsu, Fang; Brown, Elizabeth; Burke, Gregory; Carr, John; Harris, Tamara; Kritchevsky, Stephen; Szklo, Moyses; Tracy, Russell; Ding, Jingzhong

    2013-05-01

    To examine the relationship of pericardial adipose tissue (PAT) with coronary artery calcification in the Multi-Ethnic Study of Atherosclerosis. The baseline cohort comprised 6,814 Caucasian (38%), African-American (28%), Chinese American (12%), and Hispanic (22%) adults aged 45-84, without known clinical cardiovascular disease. Cardiac CT was used to measure PAT (cm(3) ) and calcification (Agatston score). We examined cross-sectional associations of PAT with the presence (score >0) and severity (continuous score if >0) of calcification using prevalence ratio (PR) (n = 6,672) and linear regression (n = 3,362), respectively. Main models were adjusted for age, age(2) , gender, race/ethnicity, field site, smoking, physical activity, alcohol, and education. PAT volume (adjusted for age, height, weight, and site) was greatest in Chinese males, whereas Black males had less PAT than all but Black females. PAT was associated with presence [PR per standard deviation (SD): 1.06 (95% CI: 1.04, 1.08)] and severity [difference in log Agatston score per SD: 0.15 (0.09, 0.21)] of calcification, but neither association varied by race/ethnicity. Adjustment for generalized adiposity attenuated but did not eliminate the associations. With further adjustment for traditional risk factors and inflammatory markers, only the association with severity remained statistically significant [PR: 1.02 (1.00, 1.04); difference: 0.10 (0.03, 0.17)]. Heterogeneity by sex was observed for the presence of calcification (PR in men: 1.04; in women: 1.08; P for interaction <0.0001). PAT was associated with the presence and severity of coronary artery calcification in this cohort, but neither association varied by race/ethnicity. Copyright © 2013 The Obesity Society.

  16. The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease

    PubMed Central

    Diouf, Momar; Temmar, Mohamed; Renard, Cédric; Choukroun, Gabriel; Massy, Ziad A.

    2015-01-01

    Background Although a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages. Methods We performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement. Results Vascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%. Conclusion The addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population. PMID:26181592

  17. Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study.

    PubMed

    Henein, Michael; Hällgren, Peter; Holmgren, Anders; Sörensen, Karen; Ibrahimi, Pranvera; Kofoed, Klaus Fuglsang; Larsen, Linnea Hornbech; Hassager, Christian

    2015-12-01

    The underlying pathology in aortic stenosis (AS) and coronary artery stenosis (CAS) is similar including atherosclerosis and calcification. We hypothesize that coronary artery calcification (CAC) is likely to correlate with aortic root calcification (ARC) rather than with aortic valve calcification (AVC), due to tissue similarity between the two types of vessel rather than with the valve leaflet tissue. We studied 212 consecutive patients (age 72.5 ± 7.9 years, 91 females) with AS requiring aortic valve replacement (AVR) in two Heart Centers, who underwent multidetector cardiac CT preoperatively. CAC, AVC and ARC were quantified using Agatston scoring. Correlations were tested by Spearman's test and Mann-Whitney U-test was used for comparing different subgroups; bicuspid (BAV) vs tricuspid (TAV) aortic valve. CAC was present in 92%, AVC in 100% and ARC in 82% of patients. CAC correlated with ARC (rho = 0.51, p < 0.001) but not with AVC. The number of calcified coronary arteries correlated with ARC (rho = 0.45, p < 0.001) but not with AVC. 29/152 patients had echocardiographic evidence of BAV and 123 TAV, who were older (p < 0.001) but CAC was associated with TAV even after adjusting for age (p = 0.01). AVC score was associated with BAV after adjusting for age (p = 0.03) but ARC was not. Of the total cohort, 82 patients (39%) had significant coronary stenosis (>50%), but these were not different in the pattern of calcification from those without CAS. CAC was consistently higher in patients with risk factors for atherosclerosis compared to those without. The observed relationship between coronary and aortic root calcification suggests a diffuse arterial disease. The lack of relationship between coronary and aortic valve calcification suggests a different pathology. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  18. Treatment of hypophosphatemic rickets in generalized arterial calcification of infancy (GACI) without worsening of vascular calcification.

    PubMed

    Ferreira, Carlos R; Ziegler, Shira G; Gupta, Ashutosh; Groden, Catherine; Hsu, Kevin S; Gahl, William A

    2016-05-01

    Patients with generalized arterial calcification of infancy (GACI) develop vascular calcifications early in life. About half of them die within the first 6 months despite optimal medical care. A subset of those who survive eventually develop hypophosphatemic rickets. Since hypophosphatemia and hyperphosphaturia have been previously associated with increased survival in GACI patients, physicians often avoid phosphate repletion as treatment for rickets. As a consequence, GACI patients develop severe rachitic complications such as short stature and skeletal deformities. It appears that the recognition of hypophosphatemia later in life in some GACI patients is a consequence of having survived the first few months of life, and not the cause of their survival per se. Here, we report the long-term follow-up of a GACI patient who was phosphate-repleted for his rickets for more than 7 years without worsening of vascular calcification.

  19. Coronary artery calcification in chronic kidney disease: An update

    PubMed Central

    Stompór, Tomasz

    2014-01-01

    Arterial calcification is a well-recognized complication of advanced atherosclerosis. Chronic kidney disease (CKD) is characterized by significantly more pronounced, disseminated and fast-progressing calcification of the vascular system, including the coronary arteries. New computed tomography-based imaging techniques allow for the noninvasive assessment and monitoring of calcification in different vascular sites. Coronary artery calcification (CAC) develops early in the course of CKD and is tightly associated with mineral and bone disorders, which include but are not limited to secondary hyperparathyroidism. In this review, recent data on the pathogenesis of CAC development and progression are discussed, with a special emphasis on fibroblast growth factor 23 and its co-receptor, klotho. The prevalence, progression and prognostic significance of CAC are reviewed separately for patients with end-stage renal disease treated with dialysis, kidney transplant recipients and patients with earlier stages of CKD. In the last section, therapeutic considerations are discussed, with special attention paid to the importance of treatment that addresses mineral and bone disorders of CKD. PMID:24772252

  20. Metabolic syndrome predicts long-term mortality in subjects without established diabetes mellitus in asymptomatic Korean population: A propensity score matching analysis from the Korea Initiatives on Coronary Artery Calcification (KOICA) registry.

    PubMed

    Won, Ki-Bum; Chang, Hyuk-Jae; Han, Donghee; Sung, Jidong; Choi, Su-Yeon

    2016-12-01

    Despite the different features of diabetes mellitus (DM) in Asian populations compared with Western populations, the impact of metabolic syndrome (MetS) on long-term mortality according to DM status has not yet been elucidated in the Asian population.After performing 1:1 propensity score matching (PSM) using clinical variables including age, gender, smoking, and individual MetS components between DM and non-DM subjects from the data of the Korea Initiatives on Coronary Artery Calcification registry, mortality was evaluated according to DM and MetS in 14,956 asymptomatic Korean subjects.The mean follow-up duration was 53.1 months (interquartile range: 33-80). The overall prevalence of MetS was 60%. DM subjects had higher mortality compared with non-DM subjects (1.2% vs 0.7%, respectively; P = 0.001); the cumulative mortality by Kaplan-Meier analysis was higher in DM subjects than in non-DM subjects (log-rank P = 0.001). DM increased the risk of mortality in PSM participants (hazard ratio [HR] 1.74; P = 0.001). In non-DM subjects, MetS (HR 2.32) and one of its components, central obesity (HR 1.97), were associated with an increased risk of mortality (both P < 0.05). In contrast, there was no significant difference in the risk of mortality according to MetS or its components in DM subjects. After adjusting for confounding risk factors, it was shown that MetS independently increased the risk of mortality in non-DM subjects.Compared with non-DM subjects, DM subjects have an increased risk of long-term mortality among PSM participants. MetS appears to have an independent impact on mortality in subjects without established DM among the asymptomatic Korean population. Our results may not be applicable to the whole subjects with MetS because the PSM using MetS components was performed between subjects with and without DM which was very high risk for adverse clinical events.

  1. [Mechanism of losartan suppressing vascular calcification in rat aortic artery].

    PubMed

    Shao, Juan; Wu, Panfeng; Wu, Jiliang; Li, Mincai

    2016-08-01

    Objective To investigate the effect of the angiotensin II receptor 1 (AT1R) blocker losartan on vascular calcification in rat aortic artery and explore the underlying mechanisms. Methods SD rats were divided randomly into control group, vascular calcification model group and treatment group. Vascular calcification models were made by subcutaneous injection of warfarin plus vitamin K1 for two weeks. Rats in the treatment group were subcutaneously injected with losartan (10 mg/kg) at the end of the first week and consecutively for one week. We observed the morphological changes by HE staining and the calcium deposition by Alizarin red staining in the artery vascular wall. The mRNA expressions of bone morphogenetic protein 2 (BMP2) and Runt-related transcription factor 2 (RUNX2) were analyzed by reverse transcription PCR. The BMP2 and RUNX2 protein expressions were determined by Western blotting. The apoptosis of smooth muscle cells (SMCs) were detected by TUNEL. The AT1R expression was tested by fluorescent immunohistochemistry. Results The aortic vascular calcification was induced by warfarin and vitamin K1. Compared with the vascular calcification model group, the mRNA and protein expressions of BMP2 and RUNX2 were significantly downregulated in the aorta in the losartan treatment group. Furthermore, the apoptosis of SMCs and the AT1R expression obviously decreased. Conclusion AT1R blocker losartan inhibits the apoptosis of SMCs and reduces AT1R expression; it downregulates the BMP2 and RUNX2 expressions in the vascular calcification process.

  2. Coronary artery calcification across ethnic groups in Singapore.

    PubMed

    Chia, Pow Li; Earnest, Arul; Lee, Raymond; Lim, Jamie; Wong, Chun Pong; Chia, Yew Woon; Weng, James Y S; Negi, Anuradha; Khatri, Priyanka; Foo, David

    2013-09-01

    In Singapore, the age-standardised event rates of myocardial infarction (MI) are 2- and 3-fold higher for Malays and Indians respectively compared to the Chinese. The objectives of this study were to determine the prevalence and quantity of coronary artery calcification (CAC) and non-calcified plaques across these 3 ethnic groups. This was a retrospective descriptive study. We identified 1041 patients (810 Chinese, 139 Malays, 92 Indians) without previous history of cardiovascular disease who underwent cardiac computed tomography for atypical chest pain evaluation. A cardiologist, who was blinded to the patients' clinical demographics, reviewed all scans. We retrospectively analysed all their case records. Overall, Malays were most likely to be active smokers (P = 0.02), Indians had the highest prevalence of diabetes mellitus (P = 0.01) and Chinese had the highest mean age (P <0.0001). The overall prevalence of patients with non-calcified plaques as the only manifestation of sub-clinical coronary artery disease was 2.1%. There was no significant difference in the prevalence of CAC, mean CAC score or prevalence of non-calcified plaques among the 3 ethnic groups. Active smoking, age and hypertension were independent predictors of CAC. Non-calcified plaques were positively associated with male gender, age, dyslipidaemia and diabetes mellitus. The higher MI rates in Malays and Indians in Singapore cannot be explained by any difference in CAC or non-calcified plaque. More research with prospective follow-up of larger patient populations is necessary to establish if ethnic-specific calibration of CAC measures is needed to adjust for differences among ethnic groups.

  3. Quantification of breast arterial calcification using full field digital mammography.

    PubMed

    Molloi, Sabee; Xu, Tong; Ducote, Justin; Iribarren, Carlos

    2008-04-01

    Breast arterial calcification is commonly detected on some mammograms. Previous studies indicate that breast arterial calcification is evidence of general atherosclerotic vascular disease and it may be a useful marker of coronary artery disease. It can potentially be a useful tool for assessment of coronary artery disease in women since mammography is widely used as a screening tool for early detection of breast cancer. However, there are currently no available techniques for quantification of calcium mass using mammography. The purpose of this study was to determine whether it is possible to quantify breast arterial calcium mass using standard digital mammography. An anthropomorphic breast phantom along with a vessel calcification phantom was imaged using a full field digital mammography system. Densitometry was used to quantify calcium mass. A calcium calibration measurement was performed at each phantom thickness and beam energy. The known (K) and measured (M) calcium mass on 5 and 9 cm thickness phantoms were related by M=0.964K -0.288 mg (r=0.997 and SEE=0.878 mg) and M=1.004K+0.324 mg (r=0.994 and SEE = 1.32 mg), respectively. The results indicate that accurate calcium mass measurements can be made without correction for scatter glare as long as careful calcium calibration is made for each breast thickness. The results also indicate that composition variations and differences of approximately 1 cm between calibration phantom and breast thickness introduce only minimal error in calcium measurement. The uncertainty in magnification is expected to cause up to 5% and 15% error in calcium mass for 5 and 9 cm breast thicknesses, respectively. In conclusion, a densitometry technique for quantification of breast arterial calcium mass was validated using standard full field digital mammography. The results demonstrated the feasibility and potential utility of the densitometry technique for accurate quantification of breast arterial calcium mass using standard digital

  4. Quantification of breast arterial calcification using full field digital mammography

    PubMed Central

    Molloi, Sabee; Xu, Tong; Ducote, Justin; Iribarren, Carlos

    2008-01-01

    Breast arterial calcification is commonly detected on some mammograms. Previous studies indicate that breast arterial calcification is evidence of general atherosclerotic vascular disease and it may be a useful marker of coronary artery disease. It can potentially be a useful tool for assessment of coronary artery disease in women since mammography is widely used as a screening tool for early detection of breast cancer. However, there are currently no available techniques for quantification of calcium mass using mammography. The purpose of this study was to determine whether it is possible to quantify breast arterial calcium mass using standard digital mammography. An anthropomorphic breast phantom along with a vessel calcification phantom was imaged using a full field digital mammography system. Densitometry was used to quantify calcium mass. A calcium calibration measurement was performed at each phantom thickness and beam energy. The known (K) and measured (M) calcium mass on 5 and 9 cm thickness phantoms were related by M=0.964K−0.288 mg (r=0.997 and SEE=0.878 mg) and M=1.004K+0.324 mg (r=0.994 and SEE=1.32 mg), respectively. The results indicate that accurate calcium mass measurements can be made without correction for scatter glare as long as careful calcium calibration is made for each breast thickness. The results also indicate that composition variations and differences of approximately 1 cm between calibration phantom and breast thickness introduce only minimal error in calcium measurement. The uncertainty in magnification is expected to cause up to 5% and 15% error in calcium mass for 5 and 9 cm breast thicknesses, respectively. In conclusion, a densitometry technique for quantification of breast arterial calcium mass was validated using standard full field digital mammography. The results demonstrated the feasibility and potential utility of the densitometry technique for accurate quantification of breast arterial calcium mass using standard digital

  5. Quantification of breast arterial calcification using full field digital mammography

    SciTech Connect

    Molloi, Sabee; Xu Tong; Ducote, Justin; Iribarren, Carlos

    2008-04-15

    Breast arterial calcification is commonly detected on some mammograms. Previous studies indicate that breast arterial calcification is evidence of general atherosclerotic vascular disease and it may be a useful marker of coronary artery disease. It can potentially be a useful tool for assessment of coronary artery disease in women since mammography is widely used as a screening tool for early detection of breast cancer. However, there are currently no available techniques for quantification of calcium mass using mammography. The purpose of this study was to determine whether it is possible to quantify breast arterial calcium mass using standard digital mammography. An anthropomorphic breast phantom along with a vessel calcification phantom was imaged using a full field digital mammography system. Densitometry was used to quantify calcium mass. A calcium calibration measurement was performed at each phantom thickness and beam energy. The known (K) and measured (M) calcium mass on 5 and 9 cm thickness phantoms were related by M=0.964K-0.288 mg (r=0.997 and SEE=0.878 mg) and M=1.004K+0.324 mg (r=0.994 and SEE=1.32 mg), respectively. The results indicate that accurate calcium mass measurements can be made without correction for scatter glare as long as careful calcium calibration is made for each breast thickness. The results also indicate that composition variations and differences of approximately 1 cm between calibration phantom and breast thickness introduce only minimal error in calcium measurement. The uncertainty in magnification is expected to cause up to 5% and 15% error in calcium mass for 5 and 9 cm breast thicknesses, respectively. In conclusion, a densitometry technique for quantification of breast arterial calcium mass was validated using standard full field digital mammography. The results demonstrated the feasibility and potential utility of the densitometry technique for accurate quantification of breast arterial calcium mass using standard digital

  6. Detection of coronary calcifications from computed tomography scans for automated risk assessment of coronary artery disease

    SciTech Connect

    Isgum, Ivana; Rutten, Annemarieke; Prokop, Mathias; Ginneken, Bram van

    2007-04-15

    A fully automated method for coronary calcification detection from non-contrast-enhanced, ECG-gated multi-slice computed tomography (CT) data is presented. Candidates for coronary calcifications are extracted by thresholding and component labeling. These candidates include coronary calcifications, calcifications in the aorta and in the heart, and other high-density structures such as noise and bone. A dedicated set of 64 features is calculated for each candidate object. They characterize the object's spatial position relative to the heart and the aorta, for which an automatic segmentation scheme was developed, its size and shape, and its appearance, which is described by a set of approximated Gaussian derivatives for which an efficient computational scheme is presented. Three classification strategies were designed. The first one tested direct classification without feature selection. The second approach also utilized direct classification, but with feature selection. Finally, the third scheme employed two-stage classification. In a computationally inexpensive first stage, the most easily recognizable false positives were discarded. The second stage discriminated between more difficult to separate coronary calcium and other candidates. Performance of linear, quadratic, nearest neighbor, and support vector machine classifiers was compared. The method was tested on 76 scans containing 275 calcifications in the coronary arteries and 335 calcifications in the heart and aorta. The best performance was obtained employing a two-stage classification system with a k-nearest neighbor (k-NN) classifier and a feature selection scheme. The method detected 73.8% of coronary calcifications at the expense of on average 0.1 false positives per scan. A calcium score was computed for each scan and subjects were assigned one of four risk categories based on this score. The method assigned the correct risk category to 93.4% of all scans.

  7. High Agatston Calcium Score of Intracranial Carotid Artery

    PubMed Central

    Kao, Hung-Wen; Liou, Michelle; Chung, Hsiao-Wen; Liu, Hua-Shan; Tsai, Ping-Huei; Chiang, Shih-Wei; Chou, Ming-Chung; Peng, Giia-Sheun; Huang, Guo-Shu; Hsu, Hsian-He; Chen, Cheng-Yu

    2015-01-01

    Abstract The effect of intracranial internal carotid artery (ICA) calcification on cognitive impairment is uncertain. Our objective was to investigate whether intracranial ICA calcification is a significant cognitive predictor for cognitive impairment. Global cognition and degrees of intracranial ICA calcification of 579 subjects were assessed with Mini-Mental State Examination (MMSE) and Agatston calcium scoring method, respectively. Other risk factors for cognitive impairment, including age, education level, hypertension, diabetes mellitus, smoking, hyperlipidemia, and body mass index, were documented and analyzed for their associations with cognitive function. In univariate analyses, older age, lower education level, hypertension, diabetes mellitus, and higher intracranial ICA Agatston scores were significantly associated with cognitive impairment. In ordinal logistic regression, only age and total intracranial ICA Agatston score were significant risk factors for cognitive impairment. After adjustment for the other documented risk factors, subjects were 7% (95% CI: 5–10; P < 0.001) and 6% (95% CI: 0–13; P = 0.04) more likely to have lower cognitive category with every year increment of age and every 100-point increment of the total intracranial ICA Agatston score respectively. These results suggest an important role of the intracranial ICA calcification on cognitive impairment. PMID:26426620

  8. Mitral annular calcification and aortic valve calcification may help in predicting significant coronary artery disease.

    PubMed

    Acartürk, Esmeray; Bozkurt, Abdi; Cayli, Murat; Demir, Mesut

    2003-01-01

    Mitral annular calcification (MAC) and aortic valve calcification (AVC) are manifestations of atherosclerosis. To determine whether mitral annular calcification and aortic valve calcification detected by transthoracic echocardiography (TTE) might help in predicting significant coronary artery disease (CAD), 123 patients with significant CAD and 93 patients without CAD detected by coronary angiography were investigated. MAC and AVC identified CAD with a sensitivity and specificity of 60.2%, 55.9% and 74.8%, 52.7%, respectively, and with a negative and a positive predictive values of 51.5%, 64.3% and 61.3% and 67.6%, respectively. The positive predictive value of MAC was greater than gender, hypertension, and hypercholesterolemia. AVC showed a positive predictive value greater than gender, hypertension, family history, and hypercholesterolemia. The negative predictive values of MAC and AVC for CAD were greater than those of all risk factors except diabetes mellitus. In conclusion, presence of MAC and AVC on TTE may help in predicting CAD and should be added to conventional risk factors. Absence of MVC and AVC is a stronger predictor for absence of CAD than all conventional risk factors, except diabetes mellitus. Patients with MAC and AVC should be taken into consideration for the presence of significant CAD and thereby for diagnostic and therapeutic interventions in order to improve the prognosis.

  9. Inflammation, Coronary Artery Calcification and Cardiovascular Events in Incident Renal Transplant Recipients

    PubMed Central

    Roe, Peter; Wolfe, Megan; Joffe, Marshall; Rosas, Sylvia E

    2010-01-01

    Objective Coronary artery calcification (CAC) predicts cardiovascular events in the general population. We conducted a prospective study to determine if inflammatory markers were predictive of CAC and if CAC predicted cardiovascular events and mortality in incident renal transplant recipients. Methods A prospective cohort of 112 asymptomatic incident renal transplant recipients who had no prior history of coronary artery revascularization or myocardial infarction had coronary calcifications measured early post-transplant and at least 18 months later by Agatston score and volume method. Results The mean CAC score was 367.7 (682.3). Inflammatory markers such as WBC and CRP were predictive of CAC severity. Recipients with cardiovascular events (n=11) or death (n=12) during the follow-up period had higher mean [675.1 (669.3) vs. 296.8(669.0), p=0.02] and median [434.8 vs. 28.9, p=0.01] CAC score compared to those without them. Recipients with CAC score less than 100 had a better cumulative survival rate compared to the recipients with CAC score greater than 100 [95.1 vs. 82.3%, p=0.03]. We found a significant unadjusted and adjusted association between CAC score and cardiovascular events and mortality. A quarter (25.9%) of recipients had CAC progression. Coronary calcification progression also predicted cardiovascular events and mortality after adjustment for diabetes, age, dialysis vintage and presence of CAC at time of transplant. Conclusion CAC is prevalent in renal recipients and is predictive of cardiovascular events and mortality. Changes in coronary calcification are common and predict clinical outcomes. Inflammatory markers are predictive of CAC severity at time of transplant, but are not predictive of future cardiovascular event or mortality. PMID:20934074

  10. Factors associated with various arterial calcifications in haemodialysis patients.

    PubMed

    Gelev, S; Spasovski, G; Trajkovski, Z; Damjanovski, G; Amitov, V; Selim, Gj; Dzekova, P; Sikole, Aleksandar

    2008-12-01

    Haemodialysis (HD) patients are at increased risk of the development of arterial intimal (AIC) and medial calcification (AMC). The aim of our study was to analyze the association between the pre-defined potential risk factors and the status of various arterial calcifications in our HD patients. In a cross-sectional study of 150 patients (91 male, mean age 54.55 +/- 12.46 yrs, HD duration 104.77 +/- 68.02 mths) we first determined the presence of AIC and AMC using plain radiography of the pelvis. We then compared the percentages of different radiogram findings in patients stratified according to various cut-off levels or the codes of each clinical and biochemical parameter (mean value of one year laboratory data recorded in the files). We determined arterial calcifications in 77.3% of our patients (AIC in 45.3%, AMC in 32%). The significantly higher frequencies of arterial calcifications of both groups (AIC and/or AMC) and isolated AIC presence were found in patients older than 55 at inclusion and 45 at the start of treatment with HD, with a serum C-reactive protein (CRP) > 4.5 mg/L, predominantly of male gender with diabetes. The patients with a significantly higher occurrence of arterial calcifications had lower percentages of total serum calcium (Ca) levels but within the K/DOQI guideline recommendations. Also, we found a significantly higher proportion of isolated AIC presence in the group of patients with corrected total serum Ca levels > 2.35 mmol/L and serum intact parathyroid hormone (iPTH) levels out of the range proposed by K/DOQI guidelines. In parallel, a significantly higher percentage of absence of arterial calcifications (ACA) was obtained in the patients with corrected total serum Ca levels < 2.35 mmol/L, body mass index (BMI) < 23 kg/m(2), mean pulse pressure < 60 mmHg, blood leucocytes < 6.5 x 10(9)L and serum triglycerides < 1.8 mmol/L. Finally, we found a significantly higher presence of isolated AMC in patients with mean Kt/V < 1.3 (poor

  11. An Integrative Predictive Model of Coronary Artery Calcification in Arteriosclerosis

    PubMed Central

    McGeachie, Michael; Ramoni, Rachel L Badovinac; Mychaleckyj, Josyf C.; Furie, Karen L; Dreyfuss, Jonathan M.; Liu, Yongmei; Herrington, David; Guo, Xiuqing; Lima, João A.; Post, Wendy; Rotter, Jerome I.; Rich, Stephen; Sale, Michèle; Ramoni, Marco F.

    2010-01-01

    Background: Many different genetic and clinical factors have been identified as causes or contributors to atherosclerosis. We present a model of preclinical atherosclerosis based on genetic and clinical data that predicts the presence of coronary artery calcification in healthy Americans of European descent aged 45 to 84 in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results: We assessed 712 individuals for the presence or absence of coronary artery calcification, and their genotypes for 2882 single-nucleotide polymorphisms (SNPs). Using these SNPs and relevant clinical data, a Bayesian network that predicts the presence of coronary calcification was constructed. The model contains 13 SNPs (from genes AGTR1, ALOX15, INSR, PRKAB1, IL1R2, ESR2, KCNK1, FBLN5, PPARA, VEGFA, PON1, TDRD6, PLA2G7, and one ancestry informative marker) and 5 clinical variables (sex, age, weight, smoking, and diabetes) and achieves 85% predictive accuracy, as measured by area under the ROC curve (AUC). This is a significant (p < 0.001) improvement upon models using just the SNP data or using just the clinical variables. Conclusions: We present an investigation of joint genetic and clinical factors associated with atherosclerosis that shows predictive results for both cases, and enhanced performance for the combination. PMID:19948975

  12. Predominance of Nonatherosclerotic Internal Elastic Lamina Calcification in the Intracranial Internal Carotid Artery.

    PubMed

    Vos, Annelotte; Van Hecke, Wim; Spliet, Wim G M; Goldschmeding, Roel; Isgum, Ivana; Kockelkoren, Remko; Bleys, Ronald L A W; Mali, Willem P T M; de Jong, Pim A; Vink, Aryan

    2016-01-01

    Calcification of the intracranial internal carotid artery (iICA) is an independent risk factor for stroke. These calcifications are generally seen as manifestation of atherosclerosis, but histological investigations are limited. The aim of this study is to determine whether calcifications in the iICA are present in atherosclerotic plaques, or in other parts of the arterial wall. Thirty-nine iICAs were histologically assessed, using digital microscopy to quantify the amount of calcification in the different layers of the arterial wall. Calcifications were found in the intima, around the internal elastic lamina and in the medial layer of the arterial wall. In 71% of the arteries, internal elastic lamina calcification contributed most to the total calcified cross-sectional surface area. Internal elastic lamina calcification was unrelated to the occurrence of atherosclerotic intimal lesions. Intimal calcifications were most often associated with atherosclerotic lesions, but also many noncalcified atherosclerotic lesions were found. In the iICA, calcifications are predominantly present around the internal elastic lamina, suggesting that this nonatherosclerotic type of calcification contributes to the previously observed increased risk of stroke in patients with iICA calcifications. © 2015 American Heart Association, Inc.

  13. Pelvic artery calcification detection on CT scans using convolutional neural networks

    NASA Astrophysics Data System (ADS)

    Liu, Jiamin; Lu, Le; Yao, Jianhua; Bagheri, Mohammadhadi; Summers, Ronald M.

    2017-03-01

    Artery calcification is observed commonly in elderly patients, especially in patients with chronic kidney disease, and may affect coronary, carotid and peripheral arteries. Vascular calcification has been associated with many clinical outcomes. Manual identification of calcification in CT scans requires substantial expert interaction, which makes it time-consuming and infeasible for large-scale studies. Many works have been proposed for coronary artery calcification detection in cardiac CT scans. In these works, coronary artery extraction is commonly required for calcification detection. However, there are few works about abdominal or pelvic artery calcification detection. In this work, we present a method for automatic pelvic artery calcification detection on CT scan. This method uses the recent advanced faster region-based convolutional neural network (R-CNN) to directly identify artery calcification without a need for artery extraction since pelvic artery extraction itself is challenging. Our method first generates category-independent region proposals for each slice of the input CT scan using region proposal networks (RPN). Then, each region proposal is jointly classified and refined by softmax classifier and bounding box regressor. We applied the detection method to 500 images from 20 CT scans of patients for evaluation. The detection system achieved a 77.4% average precision and a 85% sensitivity at 1 false positive per image.

  14. Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease: Rationale and Study Protocol (VitaK-CAC Trial).

    PubMed

    Vossen, Liv M; Schurgers, Leon J; van Varik, Bernard J; Kietselaer, Bas L J H; Vermeer, Cees; Meeder, Johannes G; Rahel, Braim M; van Cauteren, Yvonne J M; Hoffland, Ge A; Rennenberg, Roger J M W; Reesink, Koen D; de Leeuw, Peter W; Kroon, Abraham A

    2015-10-28

    Coronary artery calcification (CAC) develops early in the pathogenesis of atherosclerosis and is a strong and independent predictor of cardiovascular disease (CVD). Arterial calcification is caused by an imbalance in calcification regulatory mechanisms. An important inhibitor of calcification is vitamin K-dependent matrix Gla protein (MGP). Both preclinical and clinical studies have shown that inhibition of the vitamin K-cycle by vitamin K antagonists (VKA) results in elevated uncarboxylated MGP (ucMGP) and subsequently in extensive arterial calcification. This led us to hypothesize that vitamin K supplementation may slow down the progression of calcification. To test this, we designed the VitaK-CAC trial which analyses effects of menaquinone-7 (MK-7) supplementation on progression of CAC. The trial is a double-blind, randomized, placebo-controlled trial including patients with coronary artery disease (CAD). Patients with a baseline Agatston CAC-score between 50 and 400 will be randomized to an intervention-group (360 microgram MK-7) or a placebo group. Treatment duration will be 24 months. The primary endpoint is the difference in CAC-score progression between both groups. Secondary endpoints include changes in arterial structure and function, and associations with biomarkers. We hypothesize that treatment with MK-7 will slow down or arrest the progression of CAC and that this trial may lead to a treatment option for vascular calcification and subsequent CVD.

  15. Menaquinone-7 Supplementation to Reduce Vascular Calcification in Patients with Coronary Artery Disease: Rationale and Study Protocol (VitaK-CAC Trial)

    PubMed Central

    Vossen, Liv M.; Schurgers, Leon J.; van Varik, Bernard J.; Kietselaer, Bas L. J. H.; Vermeer, Cees; Meeder, Johannes G.; Rahel, Braim M.; van Cauteren, Yvonne J. M.; Hoffland, Ge A.; Rennenberg, Roger J. M. W.; Reesink, Koen D.; de Leeuw, Peter W.; Kroon, Abraham A.

    2015-01-01

    Coronary artery calcification (CAC) develops early in the pathogenesis of atherosclerosis and is a strong and independent predictor of cardiovascular disease (CVD). Arterial calcification is caused by an imbalance in calcification regulatory mechanisms. An important inhibitor of calcification is vitamin K-dependent matrix Gla protein (MGP). Both preclinical and clinical studies have shown that inhibition of the vitamin K-cycle by vitamin K antagonists (VKA) results in elevated uncarboxylated MGP (ucMGP) and subsequently in extensive arterial calcification. This led us to hypothesize that vitamin K supplementation may slow down the progression of calcification. To test this, we designed the VitaK-CAC trial which analyses effects of menaquinone-7 (MK-7) supplementation on progression of CAC. The trial is a double-blind, randomized, placebo-controlled trial including patients with coronary artery disease (CAD). Patients with a baseline Agatston CAC-score between 50 and 400 will be randomized to an intervention-group (360 microgram MK-7) or a placebo group. Treatment duration will be 24 months. The primary endpoint is the difference in CAC-score progression between both groups. Secondary endpoints include changes in arterial structure and function, and associations with biomarkers. We hypothesize that treatment with MK-7 will slow down or arrest the progression of CAC and that this trial may lead to a treatment option for vascular calcification and subsequent CVD. PMID:26516910

  16. Coronary arterial calcification and thoracic spine mineral density in early menopause.

    PubMed

    Miyabara, Y; Camp, J; Holmes, D; Lahr, B; Bailey, K; Miller, V M; Kearns, A E

    2011-08-01

    Cardiovascular disease and osteoporosis increase in women after menopause. While aortic calcification is associated with bone loss in women, a similar relationship for coronary arterial calcification (CAC), a risk factor for coronary artery disease in women, is less clear. This study was designed to examine the relationship between CAC and volumetric bone mineral density (vBMD) in women (n=137) who were within a median of 18 months past their last menses at screening for the Kronos Early Estrogen Prevention Study (KEEPS). CAC was measured using 64-slice computed tomography; vBMD was measured from these images using the Spine Cancer Assessment program. Concentrations of osteocalcin, bone alkaline phosphatase, tartrate-resident acid phosphatase-5b and osteopontin as bone matrix protein in serum and plasma were evaluated by ELISA. CAC scores ranged from 0 to 327.6 Agatston Units (AU); 113 women had a score of 0 AU, 20 had a CAC score between 0 and 50 AU, and four had a CAC score>50 AU. Although not statistically significant, there was a trend toward decreasing central density of thoracic T9 with increasing CAC. On average, levels of markers of bone turnover were within the normal range but did not correlate with age or with months past menopause. Clinically significant CAC and spine vBMD are quantifiable from the same scans within the first 3 years of menopause. Additional work is needed to determine how these measurements change with increasing age or with estrogenic treatments.

  17. Arterial Calcification in Diabetes Mellitus: Preclinical Models and Translational Implications.

    PubMed

    Stabley, John N; Towler, Dwight A

    2017-02-01

    Diabetes mellitus increasingly afflicts our aging and dysmetabolic population. Type 2 diabetes mellitus and the antecedent metabolic syndrome represent the vast majority of the disease burden-increasingly prevalent in children and older adults. However, type 1 diabetes mellitus is also advancing in preadolescent children. As such, a crushing wave of cardiometabolic disease burden now faces our society. Arteriosclerotic calcification is increased in metabolic syndrome, type 2 diabetes mellitus, and type 1 diabetes mellitus-impairing conduit vessel compliance and function, thereby increasing the risk for dementia, stroke, heart attack, limb ischemia, renal insufficiency, and lower extremity amputation. Preclinical models of these dysmetabolic settings have provided insights into the pathobiology of arterial calcification. Osteochondrogenic morphogens in the BMP-Wnt signaling relay and transcriptional regulatory programs driven by Msx and Runx gene families are entrained to innate immune responses-responses activated by the dysmetabolic state-to direct arterial matrix deposition and mineralization. Recent studies implicate the endothelial-mesenchymal transition in contributing to the phenotypic drift of mineralizing vascular progenitors. In this brief overview, we discuss preclinical disease models that provide mechanistic insights-and point to challenges and opportunities to translate these insights into new therapeutic strategies for our patients afflicted with diabetes mellitus and its arteriosclerotic complications.

  18. Breast Arterial Calcification: a New Marker of Cardiovascular Risk?

    PubMed

    Iribarren, Carlos; Molloi, Sabee

    2013-04-01

    Mammographically-detected breast arterial calcifications (BAC) are considered to be an incidental finding without clinical importance since they are not associated with increased risk of breast cancer. The goal of this article is to review existing evidence that the presence of BAC on mammography correlates with several (but not all) traditional cardiovascular disease (CVD) risk factors and with prevalent and incident CVD. Thus, BAC detected during routine mammography is a noteworthy finding that could be valuable in identifying asymptomatic women at increased future CVD risk that may be candidates for more aggressive management. In addition, there are notable differences in measures of subclinical atherosclerosis burden in women (ie, coronary artery calcification) by race/ethnic background, and the same appears to be true for BAC, although data are very limited. Another noteworthy limitation of prior research on BAC is the reliance on absence vs presence of BAC; no study to date has determined gradation of BAC. Further research is thus required to elucidate the role of BAC gradation in the prediction of CVD outcomes and to determine whether adding BAC gradation to prediction models based on traditional risk factors improves classification of CVD risk.

  19. Bisphosphonates alendronate and ibandronate inhibit artery calcification at doses comparable to those that inhibit bone resorption.

    PubMed

    Price, P A; Faus, S A; Williamson, M K

    2001-05-01

    The present experiments were carried out to test the hypothesis that artery calcification is linked to bone resorption by determining whether the selective inhibition of bone resorption with the bisphosphonates alendronate and ibandronate will inhibit artery calcification. Artery calcification was first induced by treatment of 42-day-old male rats with warfarin, a procedure that inhibits the gamma-carboxylation of matrix Gla protein and has been shown to cause extensive calcification of the artery media within 2 weeks. These experiments revealed that ibandronate (0.05 mg. kg(-1). d(-1)) and alendronate (0.1 mg x kg(-1) x d(-1)) completely inhibited calcification of all arteries and heart valves examined after 2 and 4 weeks of warfarin treatment. A 10-fold lower dose of alendronate reduced artery calcification by 50% (P<0.005). These bisphosphonate doses are comparable to those that inhibit bone resorption in rats of this age. More rapid artery calcification was induced by treatment with warfarin together with high doses of vitamin D, a procedure that causes extensive artery calcification by 84 hours. Alendronate and ibandronate again completely inhibited calcification of all arteries and heart valves examined. The subcutaneous doses of alendronate and ibandronate necessary to inhibit artery calcification are comparable to the daily subcutaneous doses of these drugs that have previously been shown to inhibit bone resorption in rats of the same age, with 50% inhibition of artery calcification at 20 microg alendronate x kg(-1) x d(-1) and at 1 microg ibandronate x kg(-1) x d(-1) x Bisphosphonate treatment did not affect serum calcium and phosphate, and so the inhibition of artery calcification cannot be due to a simple lowering of the serum calcium phosphate ion product. We conclude that bisphosphonates inhibit the calcification of arteries and heart valves at doses comparable to the doses that inhibit bone resorption. These results support the hypothesis that artery

  20. [Association between breast arterial calcifications and degree of control and severity of diabetes].

    PubMed

    Fuster Selva, María Josefa; Orozco Beltrán, Domingo; Sáez Castán, Julio; Merino Sánchez, Jaime

    2004-03-13

    Our goal was to analyze the association between the presence of arterial calcifications detected on mammography and the degree of control and severity of diabetes. We included all menopausal women with diabetes aged between 45 and 68 years from two health districts who participated in the breast cancer screening campaign of the region (n = 230). We reviewed their mammographies to evaluate the presence of arterial calcifications and thus associate these findings with factors determining the control and severity of diabetes (glycemia, glycosylated hemoglobin, micro- and macrovascular chronic complications) as obtained from the patients' medical records. The prevalence of breast arterial calcification was 40%. Patients with breast arterial calcifications had had diabetes for longer time and had more microvascular chronic complications. The presence of arterial calcifications detected on mammography in menopausal women with diabetes over 45 years of age is associated with microvascular chronic complications.

  1. Association of Colony Forming Units with Coronary Artery and Abdominal Aortic Calcification

    PubMed Central

    Cheng, Susan; Cohen, Kenneth S.; Shaw, Stanley Y.; Larson, Martin G.; Hwang, Shih-Jen; McCabe, Elizabeth L.; Martin, Roderick P.; Klein, Rachael J.; Hashmi, Basma; Hoffmann, Udo; Fox, Caroline S.; Vasan, Ramachandran S.; O’Donnell, Christopher J.; Wang, Thomas J.

    2010-01-01

    Background Certain bone marrow-derived cell populations, termed endothelial progenitor cells (EPCs), have been reported to possess angiogenic activity. Experimental data suggest that depletion of these angiogenic cell populations may promote atherogenesis, but limited data are available regarding their relation to subclinical atherosclerotic cardiovascular disease in humans. Methods and Results We studied 889 participants of the Framingham Heart Study who were free of clinically apparent cardiovascular disease (mean age, 65 years; 55% women). Participants underwent EPC phenotyping using an early outgrowth colony forming unit (CFU) assay and cell surface markers. Participants also underwent non-contrast multidetector computed tomography to assess the presence of subclinical atherosclerosis, as reflected by burden of coronary artery calcification (CAC) and abdominal aortic calcification (AAC). In this study sample, we examined the association of EPC-related phenotypes with both CAC and AAC. Across decreasing tertiles of CFU, there was a progressive increase in median CAC and AAC scores. In multivariable analyses adjusting for traditional cardiovascular risk factors, each standard deviation increase in CFU was associated with an approximately 16% decrease in CAC (P=0.02) and 17% decrease in AAC (P=0.03). In contrast, neither CD34+/KDR+ nor CD34+ variation were associated with significant differences in coronary or aortic calcification. Conclusion In this large, community-based sample of men and women, lower CFU number was associated with a higher burden of subclinical atherosclerosis in the coronary arteries and aorta. Decreased angiogenic potential could contribute to the development of atherosclerosis in humans. PMID:20823386

  2. Increased risk for intracranial arterial stenosis in subjects with coronary artery calcification.

    PubMed

    Oh, Hyung-Geun; Chung, Pil-Wook; Rhee, Eun-Jung

    2015-01-01

    Intracranial arterial stenosis (ICAS) is considered an important cause of stroke in Asians. Coronary artery calcification (CAC) is a surrogate marker for subclinical atherosclerosis. We aimed to analyze the association of ICAS assessed by transcranial Doppler ultrasonography and CAC in middle-aged Korean population. This study included 10 550 participants (81.3% men, mean age 43 years) from a health screening program, in whom transcranial Doppler ultrasonography was used to detect >50% intracranial stenosis based on criteria modified from the stroke outcomes and neuroimaging of intracranial atherosclerosis trial. Multidetector computed tomography was used to assess coronary artery calcium score (CACS). CAC grade (0, 1-100, and >100) was defined by CACS. The subjects with CAC showed significantly higher proportion of subjects with ICAS compared with those without CAC (4.4% versus 2.8%; P<0.01). Conversely, the subjects with ICAS showed significantly higher proportion of subjects with CAC (24.8% versus 17.1%; P<0.01). When logistic regression analysis was performed with ICAS as the dependent variable, the presence of CAC showed significantly increased risk for ICAS after adjustment for confounding variables (odds ratio, 1.439; 95% confidence interval, 1.095-1.891). When CACS grade was included in the model, the odds ratio for ICAS was the highest in subjects with CACS >400 compared with those with CACS=0 (odds ratio, 2.754; 95% confidence interval, 1.205-2.936). The risk for ICAS was significantly increased in middle-aged Korean subjects with CAC compared with that in those without CAC. These findings suggest the possibility of a separate undetected atherosclerotic focus in subjects with 1 atherosclerotic event. © 2014 American Heart Association, Inc.

  3. Coronary artery calcification identification and labeling in low-dose chest CT images

    NASA Astrophysics Data System (ADS)

    Xie, Yiting; Liu, Shuang; Miller, Albert; Miller, Jeffrey A.; Markowitz, Steven; Akhund, Ali; Reeves, Anthony P.

    2017-03-01

    A fully automated computer algorithm has been developed to evaluate coronary artery calcification (CAC) from lowdose CT scans. CAC is identified and evaluated in three main coronary artery groups: Left Main and Left Anterior Descending Artery (LM + LAD) CAC, Left Circumflex Artery (LCX) CAC, and Right Coronary Artery (RCA) CAC. The artery labeling is achieved by segmenting all CAC candidates in the heart region and applying geometric constraints on the candidates using locally pre-identified anatomy regions. This algorithm was evaluated on 1,359 low-dose ungated CT scans, in which each artery CAC content was categorically visually scored by a radiologist into none, mild, moderate and extensive. The Spearman correlation coefficient R was used to assess the agreement between three automated CAC scores (Agatston-weighted, volume, and mass) and categorical visual scores. For Agatston-weighted automated scores, R was 0.87 for total CAC, 0.82 for LM + LAD CAC, 0.66 for LCX CAC and 0.72 for RCA CAC; results using volume and mass scores were similar. CAC detection sensitivities were: 0.87 for total, 0.82 for LM + LAD, 0.65 for LCX and 0.74 for RCA. To assess the impact of image noise, the dataset was further partitioned into three subsets based on heart region noise level (low<=80HU, medium=(80HU, 110HU], high>110HU). The low and medium noise subsets had higher sensitivities and correlations than the high noise subset. These results indicate that location specific heart risk assessment is possible from low-dose chest CT images.

  4. The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer.

    PubMed

    Russo, D; Miranda, I; Ruocco, C; Battaglia, Y; Buonanno, E; Manzi, S; Russo, L; Scafarto, A; Andreucci, V E

    2007-11-01

    Coronary artery calcification is more prevalent in dialysis patients than in patients without kidney disease and this is associated with high serum phosphorus. In this study, we evaluate the effect of calcium carbonate or sevelamer treatments on the progression of calcification in 90 predialysis patients. Inclusion criteria were stable serum calcium, phosphorus, parathyroid hormone, and a similar baseline total calcium score (TCS). These patients were not treated by phosphate binder, vitamin D, or statin. They were given low-phosphorus diets without or with daily calcium carbonate or sevelamer throughout the study that averaged 2 years. Baseline demographic or clinical characteristics along with biochemical parameters were not different among the three groups. The TCS significantly increased in patients on the low-phosphorus diet alone, to a lesser extent in calcium carbonate-treated patients, and not at all in sevelamer-treated patients. The progression of coronary calcification paralleled that of the calcium score. Our study shows that sevelamer treatment should not be restricted to dialysis patients; however, a larger study should be undertaken to confirm these results.

  5. Association Between Sonographically Diagnosed Nephrolithiasis and Subclinical Coronary Artery Calcification in Adults.

    PubMed

    Kim, Seolhye; Chang, Yoosoo; Sung, Eunju; Kang, Jeong Gyu; Yun, Kyung Eun; Jung, Hyun-Suk; Hyun, Young Youl; Lee, Kyu-Beck; Joo, Kwan Joong; Shin, Hocheol; Ryu, Seungho

    2017-08-17

    Although recent studies suggest an association between nephrolithiasis and clinical cardiovascular events, this association has been underexplored. Cross-sectional study. 62,091 asymptomatic adults without known coronary heart disease who underwent a screening health examination that included cardiac tomography. Nephrolithiasis. Coronary artery calcification (CAC). Nephrolithiasis assessed using ultrasonography of the abdomen. CAC scoring assessed using cardiac computed tomography. The prevalence of CAC scores > 0 was 13.1% overall. Participants with nephrolithiasis had a higher prevalence of coronary calcification than those without (19.1% vs 12.8%). In Tobit models adjusted for age and sex, the CAC score ratio comparing participants with nephrolithiasis with those without nephrolithiasis was 1.56 (95% CI, 1.19-2.05). After further adjustment for screening center, year of screening examination, physical activity, alcohol intake, smoking status, education level, body mass index, family history of cardiovascular disease, total energy intake, glucose concentration, systolic blood pressure, triglyceride concentration, high-density lipoprotein cholesterol concentration, uric acid concentration, and estimated glomerular filtration rate, the CAC score ratio was attenuated, but remained significant (CAC score ratio, 1.31; 95% CI, 1.00-1.71). Computed tomographic diagnosis of nephrolithiasis was unavailable. Nephrolithiasis was associated with the presence of CAC in adults without known coronary heart disease, supporting the hypothesis that these 2 health conditions share a common pathophysiology. Copyright © 2017. Published by Elsevier Inc.

  6. [Computed tomographic measurement of coronary artery calcification in the assessment of cardiovascular risk: a descriptive study].

    PubMed

    Morcillo, César; Valderas, José M; Roca, Joan M; Oliveró, Ruperto; Núñez, Cristina; Sánchez, Mónica; Bechich, Siraj

    2007-03-01

    Measurement of coronary artery calcification (CAC) is used in the evaluation of cardiovascular risk. We investigated its usefulness by comparing CAC assessment with that of various risk charts. We determined cardiovascular risk in patients without known atherosclerosis using the 1998 European Task Force (ETF), REGICOR (Registre Gironí del Corazón) and SCORE (Systematic Coronary Risk Evaluation) charts. CAC was assessed by computerized tomography and measurements were classified as low risk (i.e., score <1), intermediate risk (i.e., score 1-100), or high risk (i.e., score >100). The study included 331 patients (mean age 54 [8.5] years, 89% male). In 44.1%, CAC was detected (mean score 96 [278]). The degree of agreement between the cardiovascular risk derived from the CAC score and that derived from the SCORE and ETF charts was acceptable: kappa=.33 (P<.05) and kappa=.28 (P<.05), respectively, but agreement was poor with the REGICOR chart: kappa=.02 (P=.32). The SCORE and ETF charts, respectively, classified 45.0% and 38.3% of patients with a CAC score >100 as high risk, whereas the REGICOR chart did not classify any of these patients as high risk. Male sex, older age, smoking history, and a family history of coronary heart disease were all associated with the detection of CAC. Measurement of CAC demonstrated calcification in 44.1% of patients without known atherosclerosis. By regarding those with a CAC score > 100 as high-risk, 10.4% of patients evaluated using the SCORE chart would be reclassified as high risk, as would 11.6% of those evaluated using the ETF chart, and 18.9% of those evaluated using the REGICOR chart. Consequently, more patients would be eligible for preventative treatment.

  7. Quantification of lower leg arterial calcifications by high-resolution peripheral quantitative computed tomography.

    PubMed

    Patsch, Janina M; Zulliger, Martin A; Vilayphou, Nicolas; Samelson, Elizabeth J; Cejka, Daniel; Diarra, Danielle; Berzaczy, Gundula; Burghardt, Andrew J; Link, Thomas M; Weber, Michael; Loewe, Christian

    2014-01-01

    Vascular calcifications and bone health seem to be etiologically linked via common risk factors such as aging and subclinical chronic inflammation. Epidemiologic studies have shown significant associations between low bone mineral density (BMD), fragility fractures and calcifications of the coronary arteries and the abdominal aorta. In the last decade, high-resolution peripheral quantitative computed tomography (HR-pQCT) has emerged as in-vivo research tool for the assessment of peripheral bone geometry, density, and microarchitecture. Although vascular calcifications are frequently observed as incidental findings in HR-pQCT scans, they have not yet been incorporated into quantitative HR-pQCT analyses. We developed a semi-automated algorithm to quantify lower leg arterial calcifications (LLACs), captured by HR-pQCT. The objective of our study was to determine validity and reliability of the LLAC measure. HR-pQCT scans were downscaled to a voxel size of 250μm. After subtraction of bone volumes from the scans, LLACs were detected and contoured by a semi-automated, dual-threshold seed-point segmentation. LLAC mass (in mg hydroxyapatite; HA) was calculated as the product of voxel-based calcification volume (mm(3)) and mean calcification density (mgHA/cm(3))/1000. To determine validity, we compared LLACs to coronary artery calcifications (CACs), as quantified by multi-detector computed tomography (MDCT) and Agatston scoring in forty-six patients on chronic hemodialysis. Moreover, we investigated associations of LLACs with age, time on dialysis, type-2 diabetes mellitus, history of stroke, and myocardial infarction. In a second step, we determined intra- and inter-reader reliability of the LLAC measure. In the validity study, LLACs were present (>0mgHA) in 76% of patients, 78% of patients had CACs (>0mgHA). Median LLAC was 6.65 (0.08-24.40)mgHA and median CAC as expressed by Agatston score was 266.3 (15.88-1877.28). We found a significant positive correlation between

  8. Angiotensin II type 1 receptor blocker inhibits arterial calcification in a pre-clinical model.

    PubMed

    Armstrong, Zachary B; Boughner, Derek R; Drangova, Maria; Rogers, Kem A

    2011-04-01

    Arterial calcification is a common complication of several disorders and is a strong predictor of mortality. The mechanism underlying arterial calcification is not fully understood and as such, no pharmaceutical therapies are currently available which impede its progression. The aim of this study was to investigate the effects of an angiotensin II (AngII) type 1 receptor blocker (ARB) on arterial calcification. Male New Zealand White rabbits were fed an atherogenic diet to induce atherosclerosis and arterial calcification over a period of 12 weeks, with an ARB administered in the final 4 weeks. Using clinically relevant micro-computed tomography, we found that animals fed the atherogenic diet displayed extensive arterial calcification when compared with control. In contrast, administration of the ARB completely inhibited calcification (2.80 ± 1.17 vs. 0.01 ± 0.01% calcified tissue in cholesterol and ARB-treated, respectively; n = 6 and 5; P < 0.05). Calcified regions were characterized by up-regulation of bone morphogenetic protein 2, osteocalcin, and the AngII type 1 receptor and concomitant down-regulation of α-smooth muscle actin, consistent with a phenotypic switch from vascular to osteoblast-like cells. These data provide the first evidence that angiotensin receptor blockade can inhibit arterial calcification by disrupting vascular osteogenesis and suggest that ARBs may be a novel treatment option for patients suffering from vascular calcification.

  9. Coronary artery calcification (CAC) classification with deep convolutional neural networks

    NASA Astrophysics Data System (ADS)

    Liu, Xiuming; Wang, Shice; Deng, Yufeng; Chen, Kuan

    2017-03-01

    Coronary artery calcification (CAC) is a typical marker of the coronary artery disease, which is one of the biggest causes of mortality in the U.S. This study evaluates the feasibility of using a deep convolutional neural network (DCNN) to automatically detect CAC in X-ray images. 1768 posteroanterior (PA) view chest X-Ray images from Sichuan Province Peoples Hospital, China were collected retrospectively. Each image is associated with a corresponding diagnostic report written by a trained radiologist (907 normal, 861 diagnosed with CAC). Onequarter of the images were randomly selected as test samples; the rest were used as training samples. DCNN models consisting of 2,4,6 and 8 convolutional layers were designed using blocks of pre-designed CNN layers. Each block was implemented in Theano with Graphics Processing Units (GPU). Human-in-the-loop learning was also performed on a subset of 165 images with framed arteries by trained physicians. The results from the DCNN models were compared to the diagnostic reports. The average diagnostic accuracies for models with 2,4,6,8 layers were 0.85, 0.87, 0.88, and 0.89 respectively. The areas under the curve (AUC) were 0.92, 0.95, 0.95, and 0.96. As the model grows deeper, the AUC or diagnostic accuracies did not have statistically significant changes. The results of this study indicate that DCNN models have promising potential in the field of intelligent medical image diagnosis practice.

  10. Coronary artery calcium score: current status

    PubMed Central

    Neves, Priscilla Ornellas; Andrade, Joalbo; Monção, Henry

    2017-01-01

    The coronary artery calcium score plays an Important role In cardiovascular risk stratification, showing a significant association with the medium- or long-term occurrence of major cardiovascular events. Here, we discuss the following: protocols for the acquisition and quantification of the coronary artery calcium score by multidetector computed tomography; the role of the coronary artery calcium score in coronary risk stratification and its comparison with other clinical scores; its indications, interpretation, and prognosis in asymptomatic patients; and its use in patients who are symptomatic or have diabetes. PMID:28670030

  11. High Parathyroid Hormone Level and Osteoporosis Predict Progression of Coronary Artery Calcification in Patients on Dialysis

    PubMed Central

    Blomquist, Gustav; Monier-Faugere, Marie-Claude; Cantor, Thomas L.; Davenport, Daniel L.

    2015-01-01

    Coronary artery calcifications (CACs) are observed in most patients with CKD on dialysis (CKD-5D). CACs frequently progress and are associated with increased risk for cardiovascular events, the major cause of death in these patients. A link between bone and vascular calcification has been shown. This prospective study was designed to identify noninvasive tests for predicting CAC progression, including measurements of bone mineral density (BMD) and novel bone markers in adult patients with CKD-5D. At baseline and after 1 year, patients underwent routine blood tests and measurement of CAC, BMD, and novel serum bone markers. A total of 213 patients received baseline measurements, of whom about 80% had measurable CAC and almost 50% had CAC Agatston scores>400, conferring high risk for cardiovascular events. Independent positive predictors of baseline CAC included coronary artery disease, diabetes, dialysis vintage, fibroblast growth factor-23 concentration, and age, whereas BMD of the spine measured by quantitative computed tomography was an inverse predictor. Hypertension, HDL level, and smoking were not baseline predictors in these patients. Three quarters of 122 patients completing the study had CAC increases at 1 year. Independent risk factors for CAC progression were age, baseline total or whole parathyroid hormone level greater than nine times the normal value, and osteoporosis by t scores. Our results confirm a role for bone in CKD–associated CAC prevalence and progression. PMID:25838468

  12. Automated coronary artery calcification detection on low-dose chest CT images

    NASA Astrophysics Data System (ADS)

    Xie, Yiting; Cham, Matthew D.; Henschke, Claudia; Yankelevitz, David; Reeves, Anthony P.

    2014-03-01

    Coronary artery calcification (CAC) measurement from low-dose CT images can be used to assess the risk of coronary artery disease. A fully automatic algorithm to detect and measure CAC from low-dose non-contrast, non-ECG-gated chest CT scans is presented. Based on the automatically detected CAC, the Agatston score (AS), mass score and volume score were computed. These were compared with scores obtained manually from standard-dose ECG-gated scans and low-dose un-gated scans of the same patient. The automatic algorithm segments the heart region based on other pre-segmented organs to provide a coronary region mask. The mitral valve and aortic valve calcification is identified and excluded. All remaining voxels greater than 180HU within the mask region are considered as CAC candidates. The heart segmentation algorithm was evaluated on 400 non-contrast cases with both low-dose and regular dose CT scans. By visual inspection, 371 (92.8%) of the segmentations were acceptable. The automated CAC detection algorithm was evaluated on 41 low-dose non-contrast CT scans. Manual markings were performed on both low-dose and standard-dose scans for these cases. Using linear regression, the correlation of the automatic AS with the standard-dose manual scores was 0.86; with the low-dose manual scores the correlation was 0.91. Standard risk categories were also computed. The automated method risk category agreed with manual markings of gated scans for 24 cases while 15 cases were 1 category off. For low-dose scans, the automatic method agreed with 33 cases while 7 cases were 1 category off.

  13. Can nontriggered thoracic CT be used for coronary artery calcium scoring? A phantom study

    SciTech Connect

    Xie, Xueqian; Greuter, Marcel J. W.; Groen, Jaap M.; Bock, Geertruida H. de; Oudkerk, Matthijs; Jong, Pim A. de; Vliegenthart, Rozemarijn

    2013-08-15

    Purpose: Coronary artery calcium score, traditionally based on electrocardiography (ECG)-triggered computed tomography (CT), predicts cardiovascular risk. However, nontriggered CT is extensively utilized. The study-purpose is to evaluate the in vitro agreement in coronary calcium score between nontriggered thoracic CT and ECG-triggered cardiac CT.Methods: Three artificial coronary arteries containing calcifications of different densities (high, medium, and low), and sizes (large, medium, and small), were studied in a moving cardiac phantom. Two 64-detector CT systems were used. The phantom moved at 0–90 mm/s in nontriggered low-dose CT as index test, and at 0–30 mm/s in ECG-triggered CT as reference. Differences in calcium scores between nontriggered and ECG-triggered CT were analyzed by t-test and 95% confidence interval. The sensitivity to detect calcification was calculated as the percentage of positive calcium scores.Results: Overall, calcium scores in nontriggered CT were not significantly different to those in ECG-triggered CT (p > 0.05). Calcium scores in nontriggered CT were within the 95% confidence interval of calcium scores in ECG-triggered CT, except predominantly at higher velocities (≥50 mm/s) for the high-density and large-size calcifications. The sensitivity for a nonzero calcium score was 100% for large calcifications, but 46%± 11% for small calcifications in nontriggered CT.Conclusions: When performing multiple measurements, good agreement in positive calcium scores is found between nontriggered thoracic and ECG-triggered cardiac CT. Agreement decreases with increasing coronary velocity. From this phantom study, it can be concluded that a high calcium score can be detected by nontriggered CT, and thus, that nontriggered CT likely can identify individuals at high risk of cardiovascular disease. On the other hand, a zero calcium score in nontriggered CT does not reliably exclude coronary calcification.

  14. Toward the automatic detection of coronary artery calcification in non-contrast computed tomography data.

    PubMed

    Brunner, Gerd; Chittajallu, Deepak R; Kurkure, Uday; Kakadiaris, Ioannis A

    2010-10-01

    Measurements related to coronary artery calcification (CAC) offer significant predictive value for coronary artery disease (CAD). In current medical practice CAC scoring is a labor-intensive task. The objective of this paper is the development and evaluation of a family of coronary artery region (CAR) models applied to the detection of CACs in coronary artery zones and sections. Thirty patients underwent non-contrast electron-beam computed tomography scanning. Coronary artery trajectory points as presented in the University of Houston heart-centered coordinate system were utilized to construct the CAR models which automatically detect coronary artery zones and sections. On a per-patient and per-zone basis the proposed CAR models detected CACs with a sensitivity, specificity and accuracy of 85.56 (± 15.80)%, 93.54 (± 1.98)%, and 85.27 (± 14.67)%, respectively while the corresponding values in the zones and segments based case were 77.94 (± 7.78)%, 96.57 (± 4.90)%, and 73.58 (± 8.96)%, respectively. The results of this study suggest that the family of CAR models provide an effective method to detect different regions of the coronaries. Further, the CAR classifiers are able to detect CACs with a mean sensitivity and specificity of 86.33 and 93.78%, respectively.

  15. CT screened arterial calcification as a risk factor for mortality after trauma.

    PubMed

    De'Ath, Henry D; Oakland, Kathryn; Brohi, Karim

    2016-10-10

    Arterial calcification on Computerised Tomography (CT) is a marker of cardiovascular disease. It is predictive of future adverse cardiac events and mortality in many disease states. The incidence of arterial disease and its impact on outcomes of the injured is not known. The objectives of this study were to describe the incidence of arterial calcification in trauma patients, and establish its impact on mortality. A retrospective cohort study of all injured patients aged over 45 years presenting to a major trauma centre over a 34-month period. The presence and quantity of coronary, aortic and abdominal arterial calcification on admission CT scans of the chest, abdomen and pelvis was established, and the association between cardiovascular disease and in-hospital mortality following trauma was determined. Five hundred ninety-one patients were included in the study. Cardiac calcium was visible on 432 (73 %) scans, and abdominal arterial calcification on 472 (79.9 %). Fifty (8.5 %) patients died. Patients with Superior Mesenteric (SMA) and Common Iliac Artery calcification had a significantly higher mortality than those without (p < 0.01). In multivariarate analysis, only SMA calcification was independently associated with mortality (OR 2.462, 95 % CI 1.08-5.60, p = 0.032). Coronary calcium demonstrated no independent statistical relationship with death (Left Anterior Descending Artery OR 1.189, 95 % CI 0.51-2.78, Circumflex OR 1.290, 95 % CI 0.56-2.98, Right Coronary Artery OR 0.483, 95 % CI 0.21-1.10). This study has demonstrated that the identification of arterial calcification on admission CT scans of trauma patients is possible. Calcification was common, and present in around three-quarters of injured individuals over the age of 45 years. SMA calcium was an independent predictor of mortality. However, whilst the presence of arterial calcium demonstrated a tendency towards lower survival, this association was not significant in other territories

  16. Visceral fat and coronary artery calcification in patients with chronic kidney disease.

    PubMed

    Cordeiro, Antonio Carlos; Qureshi, Abdul Rashid; Lindholm, Bengt; Amparo, Fernanda Cassullo; Tito-Paladino-Filho, Antonio; Perini, Marcela; Lourenço, Fernanda Silvestre; Pinto, Ibraim Masciarelli Francisco; Amodeo, Celso; Carrero, Juan Jesús

    2013-11-01

    Abdominal fat is a metabolically active tissue which has been associated with cardiovascular events and death in chronic kidney disease (CKD) patients. We explore here the association between surrogates of abdominal fat and coronary artery calcium score (CACs). Cross-sectional analysis of 232 non-dialysis-dependent CKD patients Stages 3-5 (median age 60 [25th-75th percentile 52-67] years; 60% men). Visceral adipose tissue (VAT) and CACs were assessed by computed tomography. Surrogates of abdominal fat included VAT and waist circumference (WC). VAT was positively associated with CACs in univariate analysis (ρ = 0.23). Across increasing VAT quartiles, patients were older, more often men and smokers. Although increasing VAT quartiles associated with higher glomerular filtration rate and leptin, better nutritional status (subjective global assessment) as well as larger muscle stores and strength, they were also more insulin resistant (HOMA-IR), dyslipidemic and inflamed (C-reactive protein and white blood cells). In addition, CACs were incrementally higher. Clinically evident coronary artery calcification (CACs ≥ 10 Agatston) was present in 63% of the patients. Both increased visceral fat (odd ratio 1.60 [95% CI 1.23-2.09] per standard deviation increase) and increased WC (1.05 [1.01-1.12] per cm increase), augmented the odds to present calcification. Such associations remained statistically significant after extensive multivariate adjustment for confounders. Abdominal fat is associated with coronary artery calcification in non-dialysis dependent CKD patients, supporting its potential role as a cardiovascular risk factor in uremia.

  17. Stationary digital chest tomosynthesis for coronary artery calcium scoring

    NASA Astrophysics Data System (ADS)

    Wu, Gongting; Wang, Jiong; Potuzko, Marci; Harman, Allison; Pearce, Caleb; Shan, Jing; Lee, Yueh Z.; Zhou, Otto; Lu, Jianping

    2016-03-01

    The coronary artery calcium score (CACS) measures the buildup of calcium on the coronary artery wall and has been shown to be an important predictor of the risk of coronary artery diseases (CAD). Currently CACS is measured using CT, though the relatively high cost and high radiation dose has limited its adoption as a routine screening procedure. Digital Chest Tomosynthesis (DCT), a low dose and low cost alternative to CT, and has been shown to achieve 90% of sensitivity of CT in lung disease screening. However commercial DCT requires long scanning time and cannot be adapted for high resolution gated cardiac imaging, necessary for CACS. The stationary DCT system (s- DCT), developed in our lab, has the potential to significantly shorten the scanning time and enables high resolution cardiac gated imaging. Here we report the preliminary results of using s-DCT to estimate the CACS. A phantom heart model was developed and scanned by the s-DCT system and a clinical CT in a phantom model with realistic coronary calcifications. The adapted fan-beam volume reconstruction (AFVR) method, developed specifically for stationary tomosynthesis systems, is used to obtain high resolution tomosynthesis images. A trained cardiologist segmented out the calcifications and the CACS was obtained. We observed a strong correlation between the tomosynthesis derived CACS and CT CACS (r2 = 0.88). Our results shows s-DCT imaging has the potential to estimate CACS, thus providing a possible low cost and low dose imaging protocol for screening and monitoring CAD.

  18. [Arterial calcification and risk of cardiovascular events in diabetes mellitus].

    PubMed

    Iwai, Kunimitu; Morimoto, Shigeto

    2010-11-01

    The cohort studies reported the subclinical vascular calcification including atheroslerosis starts during prediabetic state characterized by impaired fasting glucose. In the cardiovascular systems of diabetes mellitus there is an original mechanism to induce the medial calcification other than intimal calcification observed in the classical atherosclerosis. This is characterized as the ectipic osteogenesis induced by paracrine signals from inflammatory lesions in the adventitia. On the other hand, many internal systems have been discovered to inhibit vascular calcification.

  19. Arterial Calcification Is Driven by RAGE in Enpp1–/– Mice

    PubMed Central

    Cecil, Denise L.; Terkeltaub, Robert A.

    2011-01-01

    Background/Aims Ectopic osteochondral differentiation, driven by ENPP1-catalyzed generation of the chondrogenesis and calcification inhibitor inorganic pyrophosphate (PPi), promotes generalized arterial calcification of infancy. The multiligand receptor for advanced glycation end-products (RAGE), which promotes atherosclerosis and diabetic cardiovascular and renal complications, also mediates chondrocyte differentiation in response to RAGE ligand calgranulins such as S100A11. Here, we tested RAGE involvement in ENPP1 deficiency-associated arterial calcification. Methods Because ectopic artery calcification in Enpp1–/– mice is Pi-dependent and mediated by PPi deficiency, in vitro studies on effects of S100A11 and RAGE on mouse aortic explants were conducted using exogenous Pi, as well as alkaline phosphatase to hydrolyze ambient PPi. Results S100A11 induced cartilage-specific collagen IX/XI expression and calcification dependent on RAGE in mouse aortic explants that was inhibited by the endogenous RAGE signaling inhibitor soluble RAGE (sRAGE). Enpp1–/– aortic explants demonstrated decreased Pi-stimulated release of sRAGE, and increased calcification and type IX/XI collagen expression that were suppressed by exogenous sRAGE and by Rage knockout. Last, Rage knockout suppressed spontaneous aortic calcification in situ in Enpp1–/– mice. Conclusion Cultured Enpp1–/– aortic explants have decreased Pi-stimulated release of sRAGE, and RAGE promotes ectopic chondrogenic differentiation and arterial calcification in Enpp1–/– mice. PMID:21099228

  20. Coronary artery calcifications predict long term cardiovascular events in non diabetic Caucasian hemodialysis patients

    PubMed Central

    Noce, Annalisa; Canale, Maria Paola; Capria, Ambrogio; Rovella, Valentina; Tesauro, Manfredi; Splendiani, Giorgio; Annicchiarico-Petruzzelli, Margherita; Manzuoli, Micol; Simonetti, Giovanni; Di Daniele, Nicola

    2015-01-01

    Vascular calcifications are frequent in chronic renal disease and are associated to significant cardiovascular morbidity and mortality. The long term predictive value of coronary artery calcifications detected by multi-layer spiral computed tomography for major cardiovascular events was evaluated in non-diabetic Caucasian patients on maintenance hemodialysis free of clinical cardiovascular disease. Two-hundred and five patients on maintenance hemodialysis were enrolled into this observational, prospective cohort study. Patients underwent a single cardiac multi-layer spiral computed tomography. Calcium load was quantified and patients grouped according to the Agatston score: group 1 (Agatston score: 0), group 2 (Agatston score 1-400), group 3 (Agatston score 401-1000) and group 4 (Agatston score >1000). Follow-up was longer than seven years. Primary endpoint was death from a major cardiovascular event. Actuarial survival was calculated separately in the four groups with Kaplan-Meier method. Patients who died from causes other than cardiovascular disease and transplanted patients were censored. The “log rank” test was employed to compare survival curves. One-hundred two patients (49.7%) died for a major cardiovascular event during the follow-up period. Seven-year actuarial survival was more than 90% for groups 1 and 2, but failed to about 50% for group 3 and to <10% for group 4. Hence, Agatston score >400 predicts a significantly higher cardiovascular mortality compared with Agatston score <400 (p<0.0001); furthermore, serum Parathyroid hormone levels > 300 pg/l were associated to a lower survival (p < 0.05). Extended coronary artery calcifications detected by cardiac multi-layer spiral computed tomography, strongly predicted long term cardiovascular mortality in non-diabetic Caucasian patients on maintenance hemodialysis. Moreover, it was not related to conventional indices of atherosclerosis, but to other non-traditional risk factors, as serum Parathyroid

  1. Is Mitral Annular Calcification Associated With Atherosclerotic Risk Factors and Severity and Complexity of Coronary Artery Disease?

    PubMed

    Bhatt, Hemal; Sanghani, Dharmesh; Julliard, Kell; Fernaine, George

    2015-08-01

    We assessed the association of mitral annular calcification (MAC) with atherosclerotic risk factors and severity and complexity of coronary artery disease (CAD). Cardiac catheterization reports and electronic medical records from 2010 to 2011 were retrospectively reviewed. A total of 481 patients were divided into 2 groups: MAC present (209) and MAC absent (272). All major cardiovascular risk factors, comorbidities, and coronary lesion characteristics were included. On linear regression analysis, age (P = .001, β 1.12) and female gender (P = .031, β 0.50) were the independent predictors of MAC. Mitral annular calcification was not independently associated with the presence of lesions with >70% stenosis (P = .283), number of obstructive vessels (P = .469), lesions with 50% to 70% stenosis (P = .458), and Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score (P = .479). Mitral annular calcification is probably a benign marker of age-related degenerative changes in the heart independent of the severity and complexity of CAD.

  2. Comparison of coronary artery calcification scores and National Cholesterol Education program guidelines for coronary heart disease risk assessment and treatment paradigms in individuals with chronic traumatic spinal cord injury.

    PubMed

    Lieberman, Jesse A; Hammond, Flora M; Barringer, Thomas A; Norton, H J; Goff, David C; Bockenek, William L; Scelza, William M

    2011-01-01

    To investigate the risk of coronary heart disease (CHD) in individuals with spinal cord injury (SCI) according to the National Cholesterol Educational Program (NCEP) guidelines and CT coronary artery calcium scores (CCS). Cross-sectional study of consecutive sample of males with SCI presenting to a single site for CHD risk assessment. Males age 45-70 with traumatic SCI (American Spinal Injury Association (ASIA) A, B, and C) injured for at least 10 years with no prior history of clinical CHD. Medical history, blood-pressure, and fasting lipid panel were used to calculate risk for CHD with the use of the Framingham risk score (FRS). Risk and treatment eligibility status was assessed based on NCEP/FRS recommendations and by presence and amount of CCS. Percent agreement (PA) and kappa were calculated between the two algorithms. Spearman correlations were calculated between CCS and FRS and individual risk factors. A total of 38 men were assessed; 18 (47.4%) had CCS > 0. The PA between NCEP/FRS assessment and CCS was 18% with a kappa of -0.03. 11 (28.9%) had CCS > 100 or >75th percentile for their age, sex, and race, which might qualify them for lipid-lowering treatment. Only 26 were placed into the same treatment category by NCEP/FRS and CCS, for a PA of 68% with a kappa of 0.35. In all, 20 (52.6%) were eligible for lipid-lowering treatment by either NCEP/FRS (n=9) or CCS (n = 11). Seven subjects were above the treatment threshold based on CCS, but not NCEP/FRS and five subjects were above the NCEP/FRS threshold, but not CCS. Just four subjects were eligible by both algorithms. CCS only correlated with FRS (r = 0.508, P = 0.001) and age (r = 0.679, P < 0.001).

  3. Low serum bilirubin concentration is associated with coronary artery calcification (CAC).

    PubMed

    Tanaka, Muhei; Fukui, Michiaki; Tomiyasu, Ki-ichiro; Akabame, Satoshi; Nakano, Koji; Hasegawa, Goji; Oda, Yohei; Nakamura, Naoto

    2009-09-01

    Bilirubin is a potent antioxidant and previous studies have reported the relationship between low serum bilirubin concentration and atherosclerosis. The purpose of this study was to assess the correlation between serum bilirubin concentration and coronary artery calcification (CAC). This study consisted of 637 participants and we evaluated the relationship between CAC score determined by multislice computed tomography and serum bilirubin concentration. An inverse correlation was found between serum bilirubin concentration and log(CAC+1) (r=-0.361, P<0.0001). Multiple regression analysis also demonstrated that age (beta=0.261, P=0.0125), systolic blood pressure (beta=0.153, P=0.0237), uric acid (beta=0.126, P=0.0441), estimated glomerular filtration rate (beta=-0.139, P=0.0416) and serum bilirubin concentration (beta=-0.281, P<0.0001) were independent determinants of log(CAC+1). An increment of 1 micromol/L in serum bilirubin concentration was associated with 14% decrease in the odds for CAC score > or =400 after adjustment for several risk factors. Both age and SBP were also positively associated with CAC score > or =400, but the odds ratio for CAC score > or =400 was greater for every 1 micromol/L increment in serum bilirubin concentration than for every 1-year increment in age and 1-mmHg increment in SBP. Low serum bilirubin concentration is associated with coronary artery calcification. Serum bilirubin concentration can be measured easily in the clinical laboratory and applied in medical practice, and low serum bilirubin concentration would be useful as a provisional new risk factor of CAC.

  4. Calcium/Vitamin D Supplementation and Coronary Artery Calcification

    PubMed Central

    Manson, JoAnn E.; Allison, Matthew A.; Carr, J. Jeffrey; Langer, Robert D.; Cochrane, Barbara B.; Hendrix, Susan L.; Hsia, Judith; Hunt, Julie R.; Lewis, Cora E.; Margolis, Karen L.; Robinson, Jennifer G.; Rodabough, Rebecca J.; Thomas, Asha M.

    2010-01-01

    Objectives Coronary artery calcified plaque is a marker for atheromatous plaque burden and predicts future risk of cardiovascular events. The relationship between calcium plus vitamin D supplementation and coronary artery calcium (CAC) has not been previously assessed in a randomized trial setting. We compared coronary artery calcium scores among women randomized to calcium/vitamin D supplementation versus placebo following trial completion. Methods In an ancillary substudy of women randomized to calcium carbonate (1000 mg of elemental calcium daily) plus vitamin D3 (400 IU daily) versus placebo, nested within the Women’s Health Initiative trial of estrogen among women with hysterectomy, we measured CAC with cardiac computed tomography in 754 women aged 50–59 years at randomization. Imaging for CAC was performed at 28 of 40 centers following a mean of 7 years of treatment and scans were read centrally. Coronary artery calcium scores were measured by a central reading center with masking to randomization assignments. Results Post-trial CAC measurements were similar in women randomized to calcium/vitamin D supplementation (calcium/D) and those receiving placebo. The mean CAC score was 91.6 for calcium/D and 100.5 for placebo (rank test p-value=0.74). After adjustment for coronary risk factors, multivariate odds ratios for increasing CAC score cutpoints (CAC >0, ≥10, and ≥100) for calcium/D vs placebo were 0.92 (95% confidence interval, 0.64–1.34), 1.29 (0.88–1.87), and 0.90 (0.56–1.44), respectively. Corresponding odds ratios among women with >50% adherence to study pills and for higher levels of CAC (>300), were similar. Conclusions Treatment with moderate doses of calcium plus vitamin D3 did not appear to alter coronary artery calcified plaque burden among postmenopausal women. PMID:20551849

  5. Adipocyte induced arterial calcification is prevented with sodium thiosulfate

    SciTech Connect

    Chen, Neal X.; O’Neill, Kalisha; Akl, Nader Kassis; Moe, Sharon M.

    2014-06-20

    Highlights: • High phosphorus can induce calcification of adipocytes, even when fully differentiated. • Adipocytes can induce vascular calcification in an autocrine manner. • Sodium thiosulfate inhibits adipocyte calcification. - Abstract: Background: Calcification can occur in fat in multiple clinical conditions including in the dermis, breasts and in the abdomen in calciphylaxis. All of these are more common in patients with advanced kidney disease. Clinically, hyperphosphatemia and obesity are risk factors. Thus we tested the hypothesis that adipocytes can calcify in the presence of elevated phosphorus and/or that adipocytes exposed to phosphorus can induce vascular smooth muscle cell (VSMC) calcification. Methods: 3T3-L1 preadipocytes were induced into mature adipocytes and then treated with media containing high phosphorus. Calcification was assessed biochemically and PCR performed to determine the expression of genes for osteoblast and adipocyte differentiation. Adipocytes were also co-cultured with bovine VSMC to determine paracrine effects, and the efficacy of sodium thiosulfate was determined. Results: The results demonstrated that high phosphorus induced the calcification of differentiated adipocytes with increased expression of osteopontin, the osteoblast transcription factor Runx2 and decreased expression of adipocyte transcription factors peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT-enhancer-binding protein α (CEBPα), indicating that high phosphorus led to a phenotypic switch of adipocytes to an osteoblast like phenotype. Sodium thiosulfate, dose dependently decreased adipocyte calcification and inhibited adipocyte induced increase of VSMC calcification. Co-culture studies demonstrated that adipocytes facilitated VSMC calcification partially mediated by changes of secretion of leptin and vascular endothelial growth factor (VEGF) from adipocytes. Conclusion: High phosphorus induced calcification of mature adipocytes, and

  6. Intracranial arterial calcification is highly prevalent in hemodialysis patients but does not associate with acute ischemic stroke.

    PubMed

    Power, Albert; Chan, Kakit; Haydar, Ali; Hamady, Mohamed; Cairns, Tom; Taube, David; Duncan, Neill

    2011-04-01

    Intracranial arterial calcification (IAC) is associated with ischemic stroke in the general population but this relationship has not been examined in hemodialysis patients. We examined the factors associated with IAC and its relationship with acute ischemic stroke in this population. We retrospectively studied 490 head computed tomographic scans from 2225 hemodialysis patients presenting with neurological symptoms at our center (October 2005-May 2009). Intracranial arterial calcification was graded using a validated scoring system. Multivariate regression was used to examine the factors associated with the presence of IAC, its severity, and its ability to predict acute ischemic stroke. Weibull's survival models analyzed the relationship between IAC severity and survival. Ninety-five percent of patients with ischemic stroke had IAC vs. 83% in the nonstroke group (P=0.02). Intracranial arterial calcification severity increased with age (P<0.001), hemodialysis vintage (P<0.001), serum phosphate (P<0.05), and major comorbidities. In patients with multiple computed tomographic scans during the study period, increased IAC severity at baseline was predictive of acute ischemic stroke (P=0.05) on logistic regression analysis. High-grade and not low-grade IAC was associated with worse survival (P=0.008). Intracranial arterial calcification is highly prevalent in hemodialysis patients, especially in those with acute ischemic stroke. Its severity is prognostically significant and associated with risk factors for vascular calcification and may confer a greater risk of acute ischemic stroke. The mechanisms underlying the high incidence of ischemic stroke in this patient group require further comprehensive study. © 2011 The Authors. Hemodialysis International © 2011 International Society for Hemodialysis.

  7. Relation of heart rate recovery after exercise testing to coronary artery calcification.

    PubMed

    Jae, Sae Young; Kurl, Sudhir; Laukkanen, Jari A; Yoon, Eun Sun; Choi, Yoon-Ho; Fernhall, Bo; Franklin, Barry A

    2017-08-01

    We examined whether slow heart rate recovery (HRR) after exercise testing as an estimate of impaired autonomic function is related to coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. We evaluated 2088 men who participated in a health-screening program that included measures of CAC and peak or symptom-limited cardiopulmonary exercise testing. HRR was calculated as the difference between peak heart rate (HR) during exercise testing and the HR at 2 min of recovery after peak exercise. We measured CAC using multidetector computed tomography to calculate the Agatston coronary artery calcium score. Advanced CAC was defined as a mean CAC >75th percentile for each age group. HRR was negatively correlated with CAC (r = -.14, p < .01). After adjusting for conventional risk factors, participants in the lowest quartile of HRR (<38 bpm) were 1.59 times (95% CI: 1.17-2.18; p < .05) more likely to have advanced CAC than their counterparts in the highest quartile of HRR (>52 bpm). Each 1 bpm decrease in HRR was associated with 1% increase in advanced CAC after adjusting for potential confounders. An attenuated HRR after exercise testing is associated with advanced CAC, independent of coronary risk factors and other related hemodynamic response. KEY MESSAGES Slow heart rate recovery (HRR) after maximal exercise testing, indicating decreased autonomic function, is associated with an increased risk of cardiovascular event and mortality. Slow HRR has been linked with the occurrence of malignant ventricular arrhythmias, but it remains unclear whether slow HRR is associated with an increased risk of coronary artery calcification (CAC), an emerging marker of coronary atherosclerosis. An attenuated HRR after exercise testing was associated with advanced CAC, independent of coronary risk factors and other potential hemodynamic confounder, supporting the hypothesis that slow HRR is related to the burden of atherosclerotic coronary artery

  8. Predicting ischemic stroke after carotid artery stenting based on proximal calcification and the jellyfish sign.

    PubMed

    Ichinose, Nobuhiko; Hama, Seiji; Tsuji, Toshio; Soh, Zu; Hayashi, Hideaki; Kiura, Yoshihiro; Sakamoto, Shigeyuki; Okazaki, Takahito; Ishii, Daizo; Shinagawa, Katsuhiro; Kurisu, Kaoru

    2017-07-07

    OBJECTIVE Carotid artery stenting (CAS) has been considered to prevent ischemic strokes caused by stenosis of the cervical carotid artery. The most common complication of CAS is new cerebral infarction. The authors have previously reported that the jellyfish sign-the rise and fall of the mobile component of the carotid plaque surface detected by carotid ultrasonography-suggests thinning and rupture of the fibrous cap over the unstable plaque content, such as the lipid-rich necrotic core or internal plaque hemorrhage. The authors' aim in the present study was to evaluate the risk of a new ischemic lesion after CAS by using many risk factors including calcification (size and location) and the jellyfish sign. METHODS Eighty-six lesions (77 patients) were treated with CAS. The presence of ischemic stroke was determined using diffusion-weighted imaging (DWI). Risk factors included calcification of the plaque (classified into 5 groups for size and 3 groups for location) and the jellyfish sign, among others. Multiple linear regression analysis (stepwise analysis and partial least squares [PLS] analysis) was conducted, followed by a machine learning analysis using an artificial neural network (ANN) based on the log-linearized gaussian mixture network (LLGMN). The additive effects of the jellyfish sign and calcification on ischemic stroke after CAS were examined using the Kruskal-Wallis test, followed by the Steel-Dwass test. RESULTS The stepwise analysis selected the jellyfish sign, proximal calcification (proximal Ca), low-density lipoprotein (LDL) cholesterol, and patient age for the prediction model to predict new DWI lesions. The PLS analysis revealed the same top 3 variables (jellyfish sign, proximal Ca, and LDL cholesterol) according to the variable importance in projection scores. The ANN was then used, showing that these 3 variables remained. The accuracy of the ANN improved; areas under the receiver operating characteristic curves of the stepwise analysis, the PLS

  9. Spousal relationship quality and cardiovascular risk: dyadic perceptions of relationship ambivalence are associated with coronary-artery calcification.

    PubMed

    Uchino, Bert N; Smith, Timothy W; Berg, Cynthia A

    2014-04-01

    The quality of spousal relationships has been related to physical-health outcomes. However, most studies have focused on relationship positivity or negativity in isolation, despite the fact that many close relationships are characterized by both positive and negative aspects (i.e., ambivalence). In addition, most work has not accounted for the reciprocal nature of close-relationship processes that can have an impact on health. Using a sample of 136 older married couples, we tested whether actor-partner models of relationships that were either primarily positive or ambivalent (i.e., perceived as having both helpful and upsetting aspects) predicted measures of coronary-artery calcification. Results revealed an Actor × Partner interaction whereby coronary-artery calcification scores were highest for individuals who both viewed and were viewed by their spouse as ambivalent. These data are discussed in light of the importance of considering both positive and negative aspects of relationship quality and modeling the interdependence of close relationships.

  10. Aortic and pulmonary artery calcification: An unusual manifestation of twin-to-twin transfusion syndrome

    PubMed Central

    Venkatesh, Sumitra; Sanyukta, J; Jain, S; Prabhu, SS; Kulkarni, S

    2017-01-01

    Twin-to-twin transfusion syndrome (TTTS) at times complicates monochorionic twin gestations, resulting in conditions ranging from discordant sizes to fetal demise of one baby. Various types of cardiac defects have been described in the recipient twin of this syndrome. Isolated great artery calcification, i.e. aortic and pulmonary artery calcification is one such uncommon condition associated with TTTS. Calcification of the walls of great vessels may be due to chronic vascular injury sustained as a result of circulatory volume overload in the recipient twin. It may also cause severe systemic hypertension and cardiomyopathy. An accurate diagnosis is important for an optimal follow-up and appropriate genetic counseling. We report a case of aortic and pulmonary artery calcification in association with TTTS. PMID:28163434

  11. Aortic and pulmonary artery calcification: An unusual manifestation of twin-to-twin transfusion syndrome.

    PubMed

    Venkatesh, Sumitra; Sanyukta, J; Jain, S; Prabhu, S S; Kulkarni, S

    2017-01-01

    Twin-to-twin transfusion syndrome (TTTS) at times complicates monochorionic twin gestations, resulting in conditions ranging from discordant sizes to fetal demise of one baby. Various types of cardiac defects have been described in the recipient twin of this syndrome. Isolated great artery calcification, i.e. aortic and pulmonary artery calcification is one such uncommon condition associated with TTTS. Calcification of the walls of great vessels may be due to chronic vascular injury sustained as a result of circulatory volume overload in the recipient twin. It may also cause severe systemic hypertension and cardiomyopathy. An accurate diagnosis is important for an optimal follow-up and appropriate genetic counseling. We report a case of aortic and pulmonary artery calcification in association with TTTS.

  12. Exposure to Cigarette Smoke and the Carotid Arteries Calcification Index in Patients with Essential Hypertension.

    PubMed

    Gać, Paweł; Jaźwiec, Przemysław; Mazur, Grzegorz; Poręba, Rafał

    2017-07-01

    The arteries calcification index is a quantitative, mathematically estimated parameter characterizing the total amount of calcium within atherosclerotic plaques in the walls of arteries. The objective is to determine a relationship between exposure to cigarette smoke and the carotid arteries calcification index in patients with essential hypertension. The tested group included 66 patients with essential hypertension: 19 active smokers (subgroup A), 20 non-smokers, environmentally exposed to cigarette smoke (subgroup B) and 27 persons without exposure to cigarette smoke (subgroup C). The tested group was subjected to computed tomography angiography of carotid arteries. Evaluation of the carotid arteries calcification indexes was conducted. The average value of the total calcification index of the carotid arteries (CAci) amounted to 368.28 ± 384.21. In subgroup A and B in relation to subgroup C, CAci was significantly higher. In summary, active and passive smoking in patients with essential hypertension may be associated with a higher calcification index of carotid arteries.

  13. The functional significance of calcification of coronary arteries as detected on CT.

    PubMed

    Timins, M E; Pinsk, R; Sider, L; Bear, G

    1991-12-01

    We evaluated the coronary arteries on computed tomography (CT) scans of the chest and on coronary angiograms of 27 patients who underwent both studies. We related the presence or absence of coronary artery calcification on CT to percentage stenosis on angiogram. For the left anterior descending artery (LAD), the likelihood of calcification rose proportionately with degree of stenosis; this was less true for the circumflex, and not true for the right coronary artery (RCA). The sensitivity of CT in detecting coronary artery calcification in patients with angiographic criteria of significant coronary artery disease (CAD) was 78% for the LAD, 63% for the circumflex, and 16% for the RCA. Specificities were 78%, 80%, and 100%, and positive predictive values were 88%, 83%, and 100%. The high positive predictive values suggest that coronary artery calcification diagnosed by chest CT has a high correlation with clinically significant CAD. Therefore, when we detect such calcification in a patient without documented heart disease, we suggest that a cardiac workup is indicated.

  14. Adipocyte induced arterial calcification is prevented with sodium thiosulfate.

    PubMed

    Chen, Neal X; O'Neill, Kalisha; Akl, Nader Kassis; Moe, Sharon M

    2014-06-20

    Calcification can occur in fat in multiple clinical conditions including in the dermis, breasts and in the abdomen in calciphylaxis. All of these are more common in patients with advanced kidney disease. Clinically, hyperphosphatemia and obesity are risk factors. Thus we tested the hypothesis that adipocytes can calcify in the presence of elevated phosphorus and/or that adipocytes exposed to phosphorus can induce vascular smooth muscle cell (VSMC) calcification. 3T3-L1 preadipocytes were induced into mature adipocytes and then treated with media containing high phosphorus. Calcification was assessed biochemically and PCR performed to determine the expression of genes for osteoblast and adipocyte differentiation. Adipocytes were also co-cultured with bovine VSMC to determine paracrine effects, and the efficacy of sodium thiosulfate was determined. The results demonstrated that high phosphorus induced the calcification of differentiated adipocytes with increased expression of osteopontin, the osteoblast transcription factor Runx2 and decreased expression of adipocyte transcription factors peroxisome proliferator-activated receptor γ (PPARγ) and CCAAT-enhancer-binding protein α (CEBPα), indicating that high phosphorus led to a phenotypic switch of adipocytes to an osteoblast like phenotype. Sodium thiosulfate, dose dependently decreased adipocyte calcification and inhibited adipocyte induced increase of VSMC calcification. Co-culture studies demonstrated that adipocytes facilitated VSMC calcification partially mediated by changes of secretion of leptin and vascular endothelial growth factor (VEGF) from adipocytes. High phosphorus induced calcification of mature adipocytes, and adipocytes exposed to elevated phosphorus can induce calcification of VSMC in a paracrine manner. Sodium thiosulfate inhibited this calcification and decreased the secretin of leptin and VEGF from adipocytes. These results suggest that adipocyte exposure to elevated phosphorus may be a

  15. Coronary artery disease associated gene Phactr1 modulates severity of vascular calcification in vitro.

    PubMed

    Aherrahrou, Redouane; Aherrahrou, Zouhair; Schunkert, Heribert; Erdmann, Jeanette

    2017-09-16

    Calcification of vessels is strongly associated with atherosclerosis and leads to coronary artery disease (CAD) and myocardial infarction (MI). Genome-wide association studies (GWAS) revealed several genes that are associated with and contribute to CAD/MI as well as coronary artery calcification (CAC); however, the underlying mechanisms are unknown. PHACTR1, which encodes phosphatase and actin regulator 1, is among these risk genes. The aim of this study was to functionally test whether Phactr1 regulates calcification in vitro using murine embryonic stem cell (mESC)-derived smooth muscle cells (SMCs). Phactr1 was stably up- or down-regulated in mESCs. These mESCs were differentiated into SMCs, and calcification was enhanced using osteogenic medium. Calcium phosphate deposits were detected and quantified. RT-PCR analysis demonstrated that gene expression of Phactr1 correlated with increased calcification in mESC-derived SMCs as well as primary human aortic SMCs. Down-regulation of Phactr1 decreased calcification. Decreased expression of the osteogenic marker osteopontin confirmed this finding at the molecular level. By contrast, overexpression of Phactr1 in calcifying mESC-derived SMCs enhanced mineralization. Taken together, we demonstrated that PHACTR1 gene expression increases with the progression of calcification and that regulation of PHACTR1 in SMCs modulates the severity of vascular calcification. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. [Effect of sodium thiosulfate on coronary artery calcification in maintenance hemodialysis patients].

    PubMed

    Yu, Y; Bi, Z M; Wang, Y; Chen, Z Q; Xu, S W

    2016-12-13

    Objective: To investigate the factors correlated to coronary artery calcification (CAC)in maintenance hemodialysis (MHD) patients and observe the effect of sodium thiosulfate (STS) on the progression of vascular calcification and its safety. Methods: Thirty-eight subjects from Fuzhou Genernal Hospital who underwent coronary artery CT scan using Philip's spiral CT were enrolled and the calcification degree was evaluated by CAC scores from December 2013 to December 2014. The hemodialysis patients were divided into CAC group (CAC scores>10, 27 cases) and non-CAC group (CAC scores≤10, 11 cases)according to the CT scan results.The differences of age, duration of dialysis, blood pressure and other hematological indices between the two groups were analyzed to investigate the factors correlated to CAC. Next, those with CAC (CAC scores≥50) received intravenous 0.18 g/kg STS (dissolved in 100 ml saline) in 30 minutes after each dialysis for 3 months (n=17, only 15 patients completed STS treatment) or received conventional treatment (n=10). Baseline data between the two groups before treatment had no significant statistical difference. All examination indices were evaluated before and after the treatment course. The changes of vascular calcification imaging, CAC scores, biochemical indices and bone mineral density were compared between two groups before and after the treatment. Besides, adverse reactions were observed during the treatment of STS. This study was approved by the Ethics Committee of Fuzhou General Hospital(2013No1). Results: Twenty-seven out of 38 patients (71.05%) had CAC, and the patients with CAC had significantly higher age, phosphate, the product of calcium and phosphate, intact parathyroid hormone (hPTH), hypersensitive C-reactive protein (hsCRP), and longer duration of dialysis (P=0.017, 0.038, 0.037, 0.012, 0.002, 0.037) and lower serum albumin (P=0.026) than patients without CAC.There was no significant statistical difference in the baseline

  17. Coronary Artery Calcification; report from the Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Osawa, Kazuhiro; Nakanishi, Rine; Budoff, Matthew

    2016-01-01

    Coronary artery calcification (CAC) is an established marker of subclinical atherosclerosis and an independent predictor of future coronary heart disease in the asymptomatic primary prevention population, particularly in the intermediate risk cohort. CAC also helps in reclassifying those patients and their risk of cardiovascular events into higher or lower risk categories. MESA (Multi-Ethnic Study of Atherosclerosis) is a NHLBI-sponsored population-based medical research study involving 6,814 men and women from six US communities without a medical history of clinical cardiovascular disease. The evidence from this population cohort revealed that CAC scoring was independently predictive and highly effective at risk stratification of major adverse cardiac events. This article provides available data based on MESA. We focus on the utility of CAC for stratification of individuals and we describe its diagnostic value in identifying patients at risk. PMID:27741976

  18. MicroRNA-32 promotes calcification in vascular smooth muscle cells: Implications as a novel marker for coronary artery calcification

    PubMed Central

    Shen, Yingying; Chen, Ling; Xu, Canxin; Zhao, Heng; Wu, Ying; Zhang, Qinghai; Zhong, Jing; Tang, Zhenwang; Liu, Changhui; Zhao, Qiang; Zheng, Yi; Cao, Renxian; Zu, Xuyu

    2017-01-01

    Cardiovascular calcification is one of the most severe outcomes associated with cardiovascular disease and often results in significant morbidity and mortality. Previous reports indicated that epigenomic regulation of microRNAs (miRNAs) might play important roles in vascular smooth muscle cell (VSMC) calcification. Here, we identified potential key miRNAs involved in vascular calcification in vivo and investigated the role of miR-32-5p (miR-32). According to microarray analysis, we observed increased expression of miR-125b, miR-30a, and miR-32 and decreased expression of miR-29a, miR-210, and miR-320 during the progression of vascularcalcification. Additionally, gain- and loss-of-function studies of miR-32 confirmed promotion of VSMC calcification in mice through the enhanced expression of bonemorphogenetic protein-2, runt-related transcription factor-2(RUNX2), osteopontin, and the bone-specific phosphoprotein matrix GLA protein in vitro. Moreover, miR-32 modulated vascularcalcification progression by activating phosphoinositide 3-kinase (PI3K)signaling and increasing RUNX2 expression and phosphorylation by targeting the 3′-untranslated region of phosphatase and tensin homolog Mrna (PTEN) in mouse VSMCs. Furthermore, we detected higher miR-32 levels in plasmafrom patients with coronary artery disease with coronary artery calcification (CAC) as compared with levels observed in non-CAC patients (P = 0.016), further confirming miR-32 as a critical modulator and potential diagnostic marker for CAC. PMID:28319142

  19. Association of lower extremity arterial calcification with amputation and mortality in patients with symptomatic peripheral artery disease.

    PubMed

    Huang, Chi-Lun; Wu, I-Hui; Wu, Yen-Wen; Hwang, Juey-Jen; Wang, Shoei-Shen; Chen, Wen-Jone; Lee, Wen-Jeng; Yang, Wei-Shiung

    2014-01-01

    The clinical implication of the coronary artery calcium score (CS) is well demonstrated. However, little is known about the association between lower extremity arterial calcification and clinical outcomes. Eighty-two patients with symptomatic peripheral artery disease (age 61.0±12.4 years) were followed for 21±11 months. CSs, ranging from the common iliac artery bifurcation to the ankle area, were analyzed through noncontrast multidetector computed tomography images retrospectively. The primary endpoints of this study were amputation and mortality. Old age, diabetes, hyperlipidemia, and end-stage renal disease were associated with higher CSs. Patients with more advanced Fontaine stages also tended to have significantly higher CSs (p = 0.03). During the follow-up period (21±11 months), 29 (35%) patients underwent amputation, and 24 (29%) patients died. Among the patients who underwent amputation, there were no significant differences in CSs between the amputated legs and the non-amputated legs. In the Cox proportional hazard model with CS divided into quartiles, patients with CS in the highest quartile had a 2.88-fold (95% confidence interval [CI] 1.18-12.72, p = 0.03) and a 5.16-fold (95% CI 1.13-21.61, p = 0.04) higher risk for amputation and all-cause mortality, respectively, than those with CS in the lowest quartile. These predictive effects remained after conventional risk factor adjustment. Lower extremity arterial CSs are associated with disease severity and outcomes, including amputation and all-cause mortality, in patients with symptomatic peripheral artery disease. However, the independent predictive value needs further investigation in large scale, prospective studies.

  20. The function and meaning of receptor activator of NF-κB ligand in arterial calcification.

    PubMed

    Nie, Bin; Zhou, Shao-qiong; Fang, Xin; Zhang, Shao-ying; Guan, Si-ming

    2015-10-01

    Osteoclast-like cells are known to inhibit arterial calcification. Receptor activator of NF-κB ligand (RANKL) is likely to act as an inducer of osteoclast-like cell differentiation. However, several studies have shown that RANKL promotes arterial calcification rather than inhibiting arterial calcification. The present study was conducted in order to investigate and elucidate this paradox. Firstly, RANKL was added into the media, and the monocyte precursor cells were cultured. Morphological observation and Tartrate resistant acid phosphatase (TRAP) staining were used to assess whether RANKL could induce the monocyte precursor cells to differentiate into osteoclast-like cells. During arterial calcification, in vivo and in vitro expression of RANKL and its inhibitor, osteoprotegerin (OPG), was detected by real-time PCR. The extent of osteoclast-like cell differentiation was also assessed. It was found RANKL could induce osteoclast-like cell differentiation. There was no in vivo or in vitro expression of osteoclast-like cells in the early stage of calcification. At that time, the ratio of RANKL to OPG was very low. In the late stage of calcification, a small amount of osteoclast-like cell expression coincided with a relatively high ratio of RANKL to OPG. According to the results, the ratio of RANKL to OPG was very low during most of the arterial calcification period. This made it possible for OPG to completely inhibit RANKL-induced osteoclast-like cell differentiation. This likely explains why RANKL had the ability to induce osteoclast-like cell differentiation but acted as a promoter of calcification instead.

  1. Pathology of Human Coronary and Carotid Artery Atherosclerosis and Vascular Calcification in Diabetes Mellitus.

    PubMed

    Yahagi, Kazuyuki; Kolodgie, Frank D; Lutter, Christoph; Mori, Hiroyoshi; Romero, Maria E; Finn, Aloke V; Virmani, Renu

    2017-02-01

    The continuing increase in the prevalence of diabetes mellitus in the general population is predicted to result in a higher incidence of cardiovascular disease. Although the mechanisms of diabetes mellitus-associated progression of atherosclerosis are not fully understood, at clinical and pathological levels, there is an appreciation of increased disease burden and higher levels of arterial calcification in these subjects. Plaques within the coronary arteries of patients with diabetes mellitus generally exhibit larger necrotic cores and significantly greater inflammation consisting mainly of macrophages and T lymphocytes relative to patients without diabetes mellitus. Moreover, there is a higher incidence of healed plaque ruptures and positive remodeling in hearts from subjects with type 1 diabetes mellitus and type 2 diabetes mellitus, suggesting a more active atherogenic process. Lesion calcification in the coronary, carotid, and other arterial beds is also more extensive. Although the role of coronary artery calcification in identifying cardiovascular disease and predicting its outcome is undeniable, our understanding of how key hormonal and physiological alterations associated with diabetes mellitus such as insulin resistance and hyperglycemia influence the process of vascular calcification continues to grow. Important drivers of atherosclerotic calcification in diabetes mellitus include oxidative stress, endothelial dysfunction, alterations in mineral metabolism, increased inflammatory cytokine production, and release of osteoprogenitor cells from the marrow into the circulation. Our review will focus on the pathophysiology of type 1 diabetes mellitus- and type 2 diabetes mellitus-associated vascular disease with particular focus on coronary and carotid atherosclerotic calcification.

  2. Deoxycholic Acid, a Metabolite of Circulating Bile Acids, and Coronary Artery Vascular Calcification in CKD.

    PubMed

    Jovanovich, Anna; Isakova, Tamara; Block, Geoffrey; Stubbs, Jason; Smits, Gerard; Chonchol, Michel; Miyazaki, Makoto

    2017-08-09

    Vascular calcification is common among patients with chronic kidney disease (CKD), and it is associated with all-cause and cardiovascular disease mortality. Deoxycholic acid, a metabolite of circulating bile acids, is elevated in CKD and induces vascular mineralization and osteogenic differentiation in animal models. Cohort analysis of clinical trial participants. 112 patients with moderate to severe CKD (estimated glomerular filtration rate, 20-45mL/min/1.73m(2)) who participated in a randomized controlled study to examine the effects of phosphate binders on vascular calcification. Serum deoxycholic acid concentration. Baseline coronary artery calcification (CAC) volume score and bone mineral density (BMD) and change in CAC volume score and BMD after 9 months. Deoxycholic acid was assayed in stored baseline serum samples using liquid chromatography-tandem mass spectrometry, CAC was measured using a GE-Imitron C150 scanner, and BMD was determined using computed tomographic scans of the abdomen with calibrated phantom of known density. Higher serum deoxycholic acid concentrations were significantly correlated with greater baseline CAC volume and lower baseline BMD. After adjusting for demographics, coexisting illness, body mass index, estimated glomerular filtration rate, and concentrations of circulating markers of mineral metabolism, including serum calcium, phosphorus, vitamin D, parathyroid hormone, and fibroblast growth factor 23, a serum deoxycholic acid concentration > 58ng/mL (the median) was positively associated with baseline CAC volume (β=0.71; 95% CI, 0.26-1.16; P=0.003) and negatively associated with baseline BMD (β = -20.3; 95% CI, -1.5 to -39.1; P=0.04). Serum deoxycholic acid concentration > 58ng/mL was not significantly associated with change in CAC volume score after 9 months (β=0.06; 95% CI, -0.09 to 0.21; P=0.4). The analysis for the relationship between baseline deoxycholic acid concentrations and change in BMD after 9 months was not

  3. Warfarin exposure and calcification of the arterial system in the rat

    PubMed Central

    Howe, A M; Webster, W S

    2000-01-01

    There is evidence from knock-out mice that the extrahepatic vitamin K-dependent protein, matrix gla protein, is necessary to prevent arterial calcification. The aim of this study was to determine if a warfarin treatment regimen in rats, designed to cause extra-hepatic vitamin K deficiency, would also cause arterial calcification. Sprague-Dawley rats were treated from birth for 5–12 weeks with daily doses of warfarin and concurrent vitamin K1. This treatment causes an extrahepatic vitamin K deficiency without affecting the vitamin K-dependent blood clotting factors. At the end of treatment the rats were killed and the vascular system was examined for evidence of calcification. All treated animals showed extensive arterial calcification. The cerebral arteries and the veins and capillaries did not appear to be affected. It is likely that humans on long-term warfarin treatment have extrahepatic vitamin K deficiency and hence they are potentially at increased risk of developing arterial calcification. PMID:10718864

  4. Atypical moyamoya syndrome with brain calcification and stenosis of abdominal aorta and renal arteries.

    PubMed

    Uchikawa, Hideki; Fujii, Katsunori; Fujita, Mayuko; Okunushi, Tomoko; Shimojo, Naoki

    2017-09-01

    Moyamoya syndrome is a progressive cerebrovascular disease that is characterized by stenosis of the terminal portion of the internal carotid artery and its main branches, in combination with an accompanying disease. We herein describe an 8-year-old boy exhibiting transient loss of consciousness, who had recurrent seizures in infancy with progressive brain calcification. On admission, he was alert but magnetic resonance angiography showed bilateral stenosis of the whole internal carotid artery and proliferation of vascular collaterals, and brain CT revealed calcification on bilateral putamen. Given that this fulfilled diagnostic criteria, we finally diagnosed him as having moyamoya syndrome, though the etiology was unclear. Interestingly, a whole vessel survey revealed vascular stenosis of abdominal aorta and renal arteries, in which the former has not been reported in moyamoya syndrome. We considered that brain calcification was gradually formed by decreased cerebral vascular flow from infancy, and stenosis of abdominal aorta was possibly extended from renal arteries. This is, moyamoya syndrome with brain calcification and stenosis of abdominal aorta, suggesting that morphological screening of whole vessels containing cerebral and abdominal arteries should be considered in cases of slowly progressive brain calcification. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  5. Fibroblast growth factor 23 is not associated with and does not induce arterial calcification

    PubMed Central

    Scialla, Julia J.; Lau, Wei Ling; Reilly, Muredach P.; Isakova, Tamara; Yang, Hsueh-Ying; Crouthamel, Matthew H.; Chavkin, Nicholas W.; Rahman, Mahboob; Wahl, Patricia; Amaral, Ansel P.; Hamano, Takayuki; Master, Stephen R.; Nessel, Lisa; Chai, Boyang; Xie, Dawei; Kallem, Radhakrishna R.; Chen, Jing; Lash, James P.; Kusek, John W.; Budoff, Matthew J.; Giachelli, Cecilia M.; Wolf, Myles

    2013-01-01

    Elevated fibroblast growth factor 23 (FGF23) is associated with cardiovascular disease in patients with chronic kidney disease. As a potential mediating mechanism, FGF23 induces left ventricular hypertrophy; however, its role in arterial calcification is less clear. In order to study this we quantified coronary artery and thoracic aorta calcium by computed tomography in 1501 patients from the Chronic Renal Insufficiency Cohort (CRIC) study within a median of 376 days (interquartile range 331 to 420 days) of baseline. Baseline plasma FGF23 was not associated with prevalence or severity of coronary artery calcium after multivariable adjustment. In contrast, higher serum phosphate levels were associated with prevalence and severity of coronary artery calcium, even after adjustment for FGF23. Neither FGF23 nor serum phosphate were consistently associated with thoracic aorta calcium. We could not detect mRNA expression of FGF23 or its co-receptor, klotho, in human or mouse vascular smooth muscle cells, or normal or calcified mouse aorta. Whereas elevated phosphate concentrations induced calcification in vitro, FGF23 had no effect on phosphate uptake or phosphate-induced calcification regardless of phosphate concentration or even in the presence of soluble klotho. Thus, in contrast to serum phosphate, FGF23 is not associated with arterial calcification and does not promote calcification experimentally. Hence, phosphate and FGF23 promote cardiovascular disease through distinct mechanisms. PMID:23389416

  6. Are there ways to attenuate arterial calcification and improve cardiovascular outcomes in chronic kidney disease?

    PubMed Central

    Vo, Thanh-Mai; Disthabanchong, Sinee

    2014-01-01

    The risk of cardiovascular mortality among patients with end-stage renal disease is several times higher than general population. Arterial calcification, a marker of atherosclerosis and a predictor of cardiovascular mortality, is common in chronic kidney disease (CKD). The presence of traditional cardiovascular risk factors such as diabetes, hypertension, hyperlipidemia, and advanced age cannot fully explain the high prevalence of atherosclerosis and arterial calcification. Other factors specific to CKD such as hyperphosphatemia, excess of calcium, high dose active vitamin D and prolonged dialysis vintage play important roles in the development of arterial calcification. Due to the significant health risk, it is prudent to attempt to lower arterial calcification burden in CKD. Treatment of hyperlipidemia with statin has failed to lower atherosclerotic and arterial calcification burden. Data on diabetes and blood pressure controls as well as smoking cessation on cardiovascular outcomes in CKD population are limited. Currently available treatment options include non-calcium containing phosphate binders, low dose active vitamin D, calcimimetic agent and perhaps bisphosphonates, vitamin K and sodium thiosulfate. Preliminary data on bisphosphonates, vitamin K and sodium thiosulfate are encouraging but larger studies on efficacy and outcomes are needed. PMID:24944752

  7. Association Between Hematological Indices and Coronary Calcification in Symptomatic Patients without History of Coronary Artery Disease

    PubMed Central

    Chaikriangkrai, Kongkiat; Kassi, Mahwash; Alchalabi, Sama; Bala, Sayf Khaleel; Adigun, Rosalyn; Botero, Sharleen; Chang, Su Min

    2014-01-01

    Background: Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied. Materials and Methods: Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups. Results: The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25). Conclusion: Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD. PMID:25317386

  8. Coronary artery calcification and outcomes in diabetic patients with and without chronic kidney disease.

    PubMed

    Russo, D; Morrone, L F P; Imbriaco, M; Pota, A; Russo, L; Scognamiglio, B; Sorrentino, R

    2013-01-01

    Presence and progression of coronary artery calcification (CAC) indicate severe atherosclerosis and predict cardiovascular events (CVE) in dialysis (ESRD patients) and nondialysis patients (CKD patients). This study aimed at evaluating the prevalence and progression of CAC and CVE in CKD patients with diabetes in whom atherosclerosis of coronary arteries is the leading cause of CVE. This was a retrospective study conducted in both out- and in-patients with chronic kidney disease, stage 2-5. CAC were assessed by the total calcium (TC) score. CT scans were performed at the entry and at the end of the study. Patients (n = 341) were divided into nondiabetic (n = 281) and diabetic patients (n = 60). CAC prevalence and TC score were higher in diabetics and associated with age, diabetes mellitus and pulse pressure. Diabetics with CKD presented a higher percentage of CAC progression and CVE. Prevalence, extent, progression of CAC and CVE are higher in diabetics with concomitant CKD. These findings may promote a more aggressive protocol of screening and care in type 2 diabetics with concomitant CKD. Copyright © 2013 S. Karger AG, Basel.

  9. Is Coronary Artery Calcification Associated with Vertebral Bone Density in Nondialyzed Chronic Kidney Disease Patients?

    PubMed Central

    Filgueira, Agostinho; Carvalho, Aluizio Barbosa; Tomiyama, Cristiane; Higa, Andrea; Rochitte, Carlos E.; Santos, Raul D.

    2011-01-01

    Summary Background and objectives Low bone mineral density and coronary artery calcification (CAC) are highly prevalent among chronic kidney disease (CKD) patients, and both conditions are strongly associated with higher mortality. The study presented here aimed to investigate whether reduced vertebral bone density (VBD) was associated with the presence of CAC in the earlier stages of CKD. Design, setting, participants, & measurements Seventy-two nondialyzed CKD patients (age 52 ± 11.7 years, 70% male, 42% diabetics, creatinine clearance 40.4 ± 18.2 ml/min per 1.73 m2) were studied. VBD and CAC were quantified by computed tomography. Results CAC > 10 Agatston units (AU) was observed in 50% of the patients (median 120 AU [interquartile range 32 to 584 AU]), and a calcification score ≥ 400 AU was found in 19% (736 [527 to 1012] AU). VBD (190 ± 52 Hounsfield units) correlated inversely with age (r = −0.41, P < 0.001) and calcium score (r = −0.31, P = 0.01), and no correlation was found with gender, creatinine clearance, proteinuria, lipid profile, mineral parameters, body mass index, and diabetes. Patients in the lowest tertile of VBD had expressively increased calcium score in comparison to the middle and highest tertile groups. In the multiple logistic regression analysis adjusting for confounding variables, low VBD was independently associated with the presence of CAC. Conclusions Low VBD was associated with CAC in nondialyzed CKD patients. The authors suggest that low VBD might constitute another nontraditional risk factor for cardiovascular disease in CKD. PMID:21617086

  10. Association between vascular calcification scores on plain radiographs and fatty acid contents of erythrocyte membrane in hemodialysis patients.

    PubMed

    Son, Young K; Lee, Su M; Kim, Seong E; Kim, Ki H; Lee, Seon Y; Bae, Hae R; Han, Jin Y; Park, Yongsoon; An, Won S

    2012-01-01

    Vascular calcification (VC) scores determined by using simple plain radiographic films are known to be associated with coronary artery disease and mortality in patients undergoing hemodialysis (HD). Omega-3 fatty acid (FA) has been shown to reduce ectopic calcifications in an animal model, and it has also been shown that erythrocyte membrane omega-3 FA content is an independent discriminator of coronary artery disease. The present study was designed to demonstrate relations between VC scores and erythrocyte membrane FA contents in patients undergoing HD. A cross-sectional study was carried out. The study was carried out at an outpatient hemodialysis unit at Dong-A University Hospital, Busan, Republic of Korea. A total of 31 patients undergoing HD were recruited. Patients with significant malnutrition, a short duration of dialysis (<12 months), a history of recent infection, malignancy, or liver disease were excluded. Plain radiographic films of the feet, hands, pelvis, and lateral lumbar spine were examined and VC scores were determined using previously reported methods. Erythrocyte membrane FA contents were analyzed by gas chromatography. The erythrocyte membrane contents of eicosapentaenoic acid and docosahexaenoic acid were not found to be related with VC on simple plain radiographic films. However, erythrocyte membrane contents of oleic acid and total monounsaturated FA (MUFA) were significantly higher in patients with significant VC scores. Furthermore, erythrocyte membrane contents of MUFA and oleic acid were found to be negatively associated with high-density lipoprotein cholesterol level and positively associated with triglyceride level. Erythrocyte membrane contents of MUFA and oleic acid were found to be associated with VC scores determined using plain radiographs and with dyslipidemia in patients undergoing HD. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

  11. The Neutrophil-Lymphocyte Ratio Is Associated with Coronary Artery Calcification in Asymptomatic Korean Males: A Cross-Sectional Study

    PubMed Central

    Nam, Su-Hyun

    2017-01-01

    Introduction. The neutrophil-lymphocyte ratio (NLR) is a significant systemic predictor of cardiovascular disease (CVD). The coronary artery calcium score (CACS) reflects coronary artery calcification and is an independent risk factor for coronary artery stenosis. In the present study, we explored the relationship between the NLR and CACS in terms of subclinical inflammation and coronary artery calcification. Materials and Methods. We evaluated males and females who did not have CVD, diabetes, high blood pressure, or high fasting blood sugar levels. We measured white blood cell, neutrophil, lymphocyte counts, fasting blood sugar, total cholesterol, high-density lipoprotein cholesterol, triglycerides (TG), and high-sensitivity C-reactive protein levels in blood samples. We also obtained CACSs using coronary multidetector computed tomography. Results. Multivariate logistic regression showed that older age was significantly associated with a higher CACS (P < 0.001); males had higher CACSs than females (P < 0.001); and the higher the TG level, the higher the CACS (P = 0.019). The NLR of males, but not females, was significantly associated with the CACS. Conclusion. An independent association between the NLR and CACS was thus evident in healthy adult males after adjusting for other CVD risk factors. Therefore, the NLR is a significant predictor of potential CVD in male subjects with subclinical atherosclerosis. PMID:28280728

  12. Effect of type 1 diabetes on the gender difference in coronary artery calcification: a role for insulin resistance? The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study.

    PubMed

    Dabelea, Dana; Kinney, Gregory; Snell-Bergeon, Janet K; Hokanson, John E; Eckel, Robert H; Ehrlich, James; Garg, Satish; Hamman, Richard F; Rewers, Marian

    2003-11-01

    The objective of this is study was to examine whether estimated insulin resistance and insulin resistance-related factors are associated with coronary artery calcification (CAC) in 1,420 asymptomatic participants in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study. A total of 656 patients with type 1 diabetes and 764 control subjects aged 20-55 years were examined. CAC was assessed by electron-beam computed tomography. Insulin resistance was computed with linear regression based on an equation previously validated in clamp studies on type 1 diabetic adults. Insulin resistance was associated with CAC (OR 1.6 in type 1 diabetes and 1.4 in control subjects, P < 0.001), independent of coronary artery disease risk factors. There was a male excess of CAC in control subjects (OR 2.7, adjusted for age, smoking, and LDL and HDL cholesterol levels) and in type 1 diabetic patients (OR 2.2, adjusted for the same factors and diabetes duration). After adjusting for insulin resistance, the CAC male excess in diabetic patients decreased from OR 2.2 (P < 0.001) to 1.8 (P = 0.04). After adjustment for waist-to-hip ratio, waist circumference, or visceral fat, the gender difference in CAC was not significant in diabetic subjects. In conclusion, gender differences in insulin resistance-associated fat distribution may explain why type 1 diabetes increases coronary calcification in women relatively more than in men.

  13. Association between Pulse Wave Velocity and Coronary Artery Calcification in Japanese men.

    PubMed

    Torii, Sayuki; Arima, Hisatomi; Ohkubo, Takayoshi; Fujiyoshi, Akira; Kadota, Aya; Takashima, Naoyuki; Kadowaki, Sayaka; Hisamatsu, Takashi; Saito, Yoshino; Miyagawa, Naoko; Zaid, Maryam; Murakami, Yoshitaka; Abbott, Robert D; Horie, Minoru; Miura, Katsuyuki; Ueshima, Hirotsugu

    2015-01-01

    Pulse wave velocity (PWV) is a simple and valid clinical method for assessing arterial stiffness. Coronary artery calcification (CAC) is an intermediate stage in the process leading to overt cardiovascular disease (CVD) and an established determinant of coronary artery disease. This study aimed to examine the association between PWV and CAC in a population-based sample of Japanese men. This is a cross-sectional study of 986 randomly selected men aged 40-79 years from Shiga, Japan. CVD-free participants were examined from 2006 to 2008. Brachial-ankle PWV (baPWV) was measured using an automatic waveform analyzer. CAC was assessed using computed tomography. Agatston scores ≥ 10 were defined as the presence of CAC. Prevalence of CAC progressively increased with rising levels of baPWV: 20.6%, 41.7%, 56.3%, and 66.7% across baPWV quartiles < 1378, 1378-1563, 1564-1849, and > 1849 cm/s (P < 0.001 for trend). Associations remained significant after adjusting for age and other factors, including body mass index, systolic blood pressure, pulse rate, total and high-density lipoprotein cholesterol, hemoglobin A1c, drinking, smoking and exercise status, and the use of medication to treat hypertension, dyslipidemia and diabetes (P=0.042 for trend). The optimal cutoff level of baPWV to detect CAC was 1612 cm/s using receiver operating characteristic curve analysis. Arterial stiffness as defined by an elevated baPWV is associated with an increased prevalence of CAC in a general population-based setting among Japanese men.

  14. Circulating microRNAs correlated with the level of coronary artery calcification in symptomatic patients

    PubMed Central

    Liu, Wei; Ling, Shukuan; Sun, Weijia; Liu, Tong; Li, Yuheng; Zhong, Guohui; Zhao, Dingsheng; Zhang, Pengfei; Song, Jinping; Jin, Xiaoyan; Xu, Zi; Song, Hailin; Li, Qi; Liu, Shujuan; Chai, Meng; Dai, Qinyi; He, Yi; Fan, Zhanming; Zhou, Yu Jie; Li, Yingxian

    2015-01-01

    The purpose of this study was to find the circulating microRNAs (miRNAs) co-related with the severity of coronary artery calcification (CAC), and testify whether the selected miRNAs could reflect the obstructive coronary artery disease in symptomatic patients. Patients with chest pain and moderated risk for coronary artery disease (CAD) were characterized with coronary artery calcium score (CACS) from cardiac computed tomography (CT). We analyzed plasma miRNA levels of clinical matched 11 CAC (CACS > 100) and 6 non-CAC (CACS = 0) subjects by microarray profile. Microarray analysis identified 34 differentially expressed miRNAs between CAC and non CAC groups. Eight miRNAs (miR-223, miR-3135b, miR-133a-3p, miR-2861, miR-134, miR-191-3p, miR-3679-5p, miR-1229 in CAC patients) were significantly increased in CAC plasma in an independent clinical matched cohort. Four miRNAs (miR-2861, 134, 1229 and 3135b) were correlated with the degree of CAC. Validation test in angiographic cohort showed that miR-134, miR-3135b and miR-2861 were significantly changed in patients with obstructive CAD . We identified three significantly upregulated circulating miRNAs (miR-134, miR-3135b and 2861) correlated with CAC while detected obstructive coronary disease in symptomatic patients. PMID:26537670

  15. Elevated IL-37 levels in the plasma of patients with severe coronary artery calcification.

    PubMed

    Chai, Meng; Zhang, Hai-Tao; Zhou, Yu-Jie; Ji, Qing-Wei; Yang, Qing; Liu, Yu-Yang; Zhao, Ying-Xin; Shi, Dong-Mei; Liu, Wei; Yang, Li-Xia; Zhang, Lin-Lin; Liang, Jing

    2017-05-01

    Coronary artery calcification (CAC) is a predictor of cardiovascular events and plaque burden and is closely associated with chronic inflammation. Interleukin (IL)-37 is a newly discovered member of the IL-1 family and is considered an anti-inflammatory cytokine. Our recent study on mice indicated that IL-37 could attenuate atherosclerosis and vascular calcification, which suggests that IL-37 could be associated with the development of atherosclerosis and related diseases. The aim of this study was to investigate if IL-37 plays a role in the progression of CAC in patients. Two hundred participants with suspected cardiovascular disease were recruited. The levels of plasma IL-37, osteoprotegerin (OPG), hypersensitive C-reactive protein (hsCRP) together with other biochemical parameters were measured, and a coronary calcium assessment was carried out by multi-detector row CT. A score of < 10 AU (Agatston units) denotes an absence of CAC, a score of 11-100 AU denotes mild CAC, 101-400 denotes moderate CAC, and > 400 AU denotes severe CAC. Our initial data showed that there were no apparent differences in plasma IL-37 levels among patients with or without mild or moderate CAC. However, IL-37 levels were significantly increased in patients with severe CAC (P < 0.001). Similar results were observed for plasma OPG and hsCRP levels. When IL-37 levels in patients with severe calcification were compared with that in all of the other non-severe CAC groups, it became apparent that there was a significant positive correlation between IL-37 level and severe CAC (r = 0.360, P < 0.001; OR = 1.033) using Spearman's correlation and binary logistic regression analysis. This study demonstrates that the anti-inflammatory cytokine IL-37 is associated with high coronary calcium levels, suggesting that IL-37 expression may be caused by the activation of inflammation and that IL-37 might become a predictor of severe CAC in the future, which requires further investigation.

  16. Elevated IL-37 levels in the plasma of patients with severe coronary artery calcification

    PubMed Central

    Chai, Meng; Zhang, Hai-Tao; Zhou, Yu-Jie; Ji, Qing-Wei; Yang, Qing; Liu, Yu-Yang; Zhao, Ying-Xin; Shi, Dong-Mei; Liu, Wei; Yang, Li-Xia; Zhang, Lin-Lin; Liang, Jing

    2017-01-01

    Background Coronary artery calcification (CAC) is a predictor of cardiovascular events and plaque burden and is closely associated with chronic inflammation. Interleukin (IL)-37 is a newly discovered member of the IL-1 family and is considered an anti-inflammatory cytokine. Our recent study on mice indicated that IL-37 could attenuate atherosclerosis and vascular calcification, which suggests that IL-37 could be associated with the development of atherosclerosis and related diseases. The aim of this study was to investigate if IL-37 plays a role in the progression of CAC in patients. Methods Two hundred participants with suspected cardiovascular disease were recruited. The levels of plasma IL-37, osteoprotegerin (OPG), hypersensitive C-reactive protein (hsCRP) together with other biochemical parameters were measured, and a coronary calcium assessment was carried out by multi-detector row CT. A score of < 10 AU (Agatston units) denotes an absence of CAC, a score of 11–100 AU denotes mild CAC, 101–400 denotes moderate CAC, and > 400 AU denotes severe CAC. Results Our initial data showed that there were no apparent differences in plasma IL-37 levels among patients with or without mild or moderate CAC. However, IL-37 levels were significantly increased in patients with severe CAC (P < 0.001). Similar results were observed for plasma OPG and hsCRP levels. When IL-37 levels in patients with severe calcification were compared with that in all of the other non-severe CAC groups, it became apparent that there was a significant positive correlation between IL-37 level and severe CAC (r = 0.360, P < 0.001; OR = 1.033) using Spearman's correlation and binary logistic regression analysis. Conclusions This study demonstrates that the anti-inflammatory cytokine IL-37 is associated with high coronary calcium levels, suggesting that IL-37 expression may be caused by the activation of inflammation and that IL-37 might become a predictor of severe CAC in the future, which

  17. Large Artery Calcification on Dialysis Patients Is Located in the Intima and Related to Atherosclerosis

    PubMed Central

    Coll, Blai; Betriu, Angels; Martínez-Alonso, Montserrat; Amoedo, Maria Luisa; Arcidiacono, Maria Vittoria; Borras, Merce; Valdivielso, Jose Manuel

    2011-01-01

    Summary Background and objectives Vascular calcification (VC) has a significant effect in cardiovascular diseases on dialysis patients. However, VC is assessed with x-ray-based techniques, which do not inform about calcium localization (intima, media, atherosclerosis-related). The aim of this work is to study VC and its related factors using arterial ultrasound to report the exact location of calcium. Design, setting, participants, & measurements This was an observational, cross-sectional, case-control study that included 232 patients in dialysis and 208 age- and sex-matched controls with normal kidney function. Demographic data and laboratory values were collated. Carotid, femoral, and brachial ultrasounds were performed to assess VC and atherosclerosis burden using a standardized protocol. Results Cardiovascular risk factors were predominantly found in controls, although the burden of atherosclerosis was higher in the dialysis group. VC was significantly more prevalent in the group of patients on dialysis than control subjects, and in both groups the most prevalent pattern of VC was linear calcification located in the intima of the artery wall. Age and undergoing dialysis (with or without previous cardiovascular diseases) were positively and significantly associated with linear calcification. Conversely, the absence of atherosclerosis and low levels of C-reactive protein and phosphorus significantly impeded the development of linear calcification. Conclusions VC in large, conduit arteries is more prevalent in patients on dialysis than controls and is predominantly located in a linear fashion in the intima of the arteries. PMID:20930091

  18. Calcium intake is not associated with increased coronary artery calcification: The Framingham Study

    USDA-ARS?s Scientific Manuscript database

    Adequate calcium intake is known to protect the skeleton. However, studies that have reported adverse effects of calcium supplementation on vascular events have raised widespread concern. We assessed the association between calcium intake (from diet and supplements) and coronary artery calcification...

  19. Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure.

    PubMed

    Wu, Gang-Yong; Xu, Bai-Da; Wu, Ting; Wang, Xiao-Ying; Wang, Tian-Xiao; Zhang, Xiao; Wang, Xiao; Xia, Yang; Zong, Gang-Jun

    2016-11-01

    The aim of the present study was to investigate the correlation between serum parathyroid hormone (PTH) levels and coronary artery calcification (CAC) in patients without renal failure, as well as to determine independent risk factors of CAC score (CACS). A total of 157 patients who underwent coronary computed tomography angiographic examination at the 101th Hospital of the People's Liberation Army between December 2013 and February 2015 were retrospectively evaluated. The correlation between PTH levels and CACS was determined using a Pearson correlation analysis. A receiver operating characteristic (ROC) curve was drawn to determine the best cutoff PTH level for prediction of CAC. The independent association between serum PTH levels and CAC was analyzed by using a logistic regression analysis model with the response variable Be binary class. The results revealed that PTH levels in patients in the CAC group were significantly higher than those of patients in the non-calcification group. PTH levels were positively correlated with CACS (r=0.288, P<0.001). The ROC curve suggested that a PTH level of ≥31.05 pg/ml was the best cut-off point for the prediction of CAC, with a sensitivity of 80.88%, specificity of 60.67% and an area under the curve of 0.761. After including predictive factors for CAC (gender, age, smoking status, diabetes, hypertension, hyperlipidemia, body mass index, glomerular filtration rate and calcium, phosphorus, calcium-phosphorus product, magnesium, PTH, total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol and C-reactive protein levels), the odds ratio of the serum PTH levels regarding the prediction of CAC was 1.050 (95% confidence interval, 1.027-1.074; P<0.001). In conclusion, the present study suggested that serum PTH levels are correlated with CAC in patients without renal failure and may thus be used as a reliable predictor of CAC.

  20. Correlation between serum parathyroid hormone levels and coronary artery calcification in patients without renal failure

    PubMed Central

    Wu, Gang-Yong; Xu, Bai-Da; Wu, Ting; Wang, Xiao-Ying; Wang, Tian-Xiao; Zhang, Xiao; Wang, Xiao; Xia, Yang; Zong, Gang-Jun

    2016-01-01

    The aim of the present study was to investigate the correlation between serum parathyroid hormone (PTH) levels and coronary artery calcification (CAC) in patients without renal failure, as well as to determine independent risk factors of CAC score (CACS). A total of 157 patients who underwent coronary computed tomography angiographic examination at the 101th Hospital of the People's Liberation Army between December 2013 and February 2015 were retrospectively evaluated. The correlation between PTH levels and CACS was determined using a Pearson correlation analysis. A receiver operating characteristic (ROC) curve was drawn to determine the best cutoff PTH level for prediction of CAC. The independent association between serum PTH levels and CAC was analyzed by using a logistic regression analysis model with the response variable Be binary class. The results revealed that PTH levels in patients in the CAC group were significantly higher than those of patients in the non-calcification group. PTH levels were positively correlated with CACS (r=0.288, P<0.001). The ROC curve suggested that a PTH level of ≥31.05 pg/ml was the best cut-off point for the prediction of CAC, with a sensitivity of 80.88%, specificity of 60.67% and an area under the curve of 0.761. After including predictive factors for CAC (gender, age, smoking status, diabetes, hypertension, hyperlipidemia, body mass index, glomerular filtration rate and calcium, phosphorus, calcium-phosphorus product, magnesium, PTH, total cholesterol, low-density lipoprotein cholesterol, triglyceride, high-density lipoprotein cholesterol and C-reactive protein levels), the odds ratio of the serum PTH levels regarding the prediction of CAC was 1.050 (95% confidence interval, 1.027–1.074; P<0.001). In conclusion, the present study suggested that serum PTH levels are correlated with CAC in patients without renal failure and may thus be used as a reliable predictor of CAC. PMID:27882224

  1. Alcohol and coronary artery calcification: an investigation using alcohol flushing as an instrumental variable.

    PubMed

    Yun, Kyung Eun; Chang, Yoosoo; Yun, Sung-Cheol; Davey Smith, George; Ryu, Seungho; Cho, Sung-Il; Chung, Eun Chul; Shin, Hocheol; Khang, Young-Ho

    2017-01-10

    We examined whether alcohol flushing could be used as an instrumental variable (IV) and investigated the effect of alcohol consumption on coronary calcification using alcohol flushing status as an IV. We analysed cross-sectional data from 24 681 Korean adults (20 696 men and 3985 women) who had been administered a questionnaire assessing alcohol consumption and alcohol flushing, as well as a coronary artery calcium (CAC) measurement. The associations of alcohol flushing status with potential confounders and alcohol consumption were examined. We employed two-stage predictor substitution methodology for the IV analysis. The prevalence of alcohol flushing did not differ depending on gender, education, household income, cigarette smoking or physical activity. Balanced levels of confounders were observed between alcohol flushers and non-flushers. Alcohol flushing was closely related to alcohol consumption and levels of liver enzymes. In men, a doubling in alcohol consumption was associated with increased odds of coronary calcification in both the IV analysis [odds ratio (OR) of CAC scores of 1 or over = 1.11; 95% confidence interval (CI) = 1.03-1.20) and the multivariable regression analysis (OR = 1.04; 95% CI = 1.01-1.07). For cardiovascular risk factors, the IV analysis showed a positive association between alcohol consumption and blood pressure and high-density lipoprotein-cholesterol. Alcohol flushing can be used as an IV in studies evaluating the health impact of alcohol consumption, especially in East Asian countries. Through such an analysis, we found that increased alcohol consumption was associated with an increased risk of subclinical coronary atherosclerosis. © The Author 2017; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

  2. Coronary Artery Calcification, Epicardial Fat Burden, and Cardiovascular Events in Chronic Obstructive Pulmonary Disease

    PubMed Central

    Schwarz, Esther I.; Possner, Mathias; Stehli, Julia; Sievi, Noriane A.; Clarenbach, Christian F.; Dey, Damini; Slomka, Piotr J.; Kaufmann, Philipp A.; Kohler, Malcolm

    2015-01-01

    Rationale Patients with chronic obstructive pulmonary disease (COPD) suffer from significantly more cardiovascular comorbidity and mortality than would be anticipated from conventional risk factors. The aim of this study was to determine whether COPD patients have a higher coronary artery calcium score (CACS) and epicardial fat burden, compared to control subjects, and their association with cardiovascular events. Methods From a registry of 1906 patients 81 patients with clinically diagnosed COPD were one-to-one matched to 81 non-COPD control subjects with a smoking history, according to their age, sex, and the number of classic cardiovascular risk factors (arterial hypertension, diabetes mellitus, dyslipidemia, family history of premature coronary artery disease). CACS, epicardial fat, and subsequent major adverse cardiovascular events (MACE) during follow-up were compared between groups. Results Patients with COPD (Global Initiative for Chronic Obstructive Lung Disease-classification I: 5%, II: 23%, III: 16% and IV: 56%) showed no difference in CACS (median difference 68 Agatston Units [95% confidence interval -176.5 to 192.5], p=0.899) or epicardial fat volume (mean difference -0.5 cm3 [95% confidence interval -20.9 to 21.9], p=0.961) compared with controls. After a median follow-up of 42.6 months a higher incidence of MACE was observed in COPD patients (RR=2.80, p=0.016) compared with controls. Cox proportional hazard regression identified cardiac ischemias and CACS as independent predictors for MACE. Conclusion COPD patients experienced a higher MACE incidence compared to controls despite no baseline differences in coronary calcification and epicardial fat burden. Other mechanisms such as undersupply of medication seem to account for an excess cardiovascular comorbidity in COPD patients. PMID:26011039

  3. Serum cystatin C levels are associated with coronary artery calcification in women without chronic kidney disease.

    PubMed

    Sugiyama, Hiroyasu; Miyoshi, Toru; Osawa, Kazuhiro; Miki, Takashi; Koide, Yuji; Nakamura, Kazufumi; Morita, Hiroshi; Ito, Hiroshi

    2017-06-01

    Chronic renal disease (CKD) is a determinant of coronary artery calcification (CAC), which is a predictor of cardiovascular events. However, in a population without CKD, the association between CAC and renal function is unclear. CAC is affected by sex. This study aimed to determine whether serum cystatin C, a sensitive marker of kidney function, or sex differences are associated with CAC in patients without CKD. We evaluated 456 consecutive patients (61±13 years, 42% women) without CKD and evidence of coronary artery disease. The CAC (Agatston) score was examined by multidetector computed tomography. When patients were categorized into three CAC groups based on the Agatston score, mild (<10), moderate (11-399), and severe (≥400) in each sex, serum cystatin C levels gradually increased by severity of CAC in women, but not men. Receiver operating characteristic curve analysis showed that, in women, a cut-off value of 0.97mg/l for cystatin C discriminated patients with severe CAC with a sensitivity of 71% and specificity of 77% (area under the curve, 0.74; 95% CI: 0.62-0.86; p<0.01). Multivariate logistic analysis showed that serum cystatin C was not associated with severe CAC in all patients and men, but this association was observed in women (OR: 7.80 for cystatin C≥0.97mg/l, 95% CI: 1.76-34.6, p<0.01). Higher serum cystatin C levels are associated with greater CAC in women without CKD. Measurement of cystatin C may be useful for identifying women who are at high risk for cardiovascular disease. Copyright © 2017 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

  4. Egg consumption and coronary artery calcification in asymptomatic men and women.

    PubMed

    Choi, Yuni; Chang, Yoosoo; Lee, Jung Eun; Chun, Sohyun; Cho, Juhee; Sung, Eunju; Suh, Byung-Seong; Rampal, Sanjay; Zhao, Di; Zhang, Yiyi; Pastor-Barriuso, Roberto; Lima, Joao A C; Shin, Hocheol; Ryu, Seungho; Guallar, Eliseo

    2015-08-01

    The association of egg consumption with subclinical coronary atherosclerosis remains unknown. Our aim was to examine the association between egg consumption and prevalence of coronary artery calcium (CAC). Cross-sectional study of 23,417 asymptomatic adult men and women without a history of cardiovascular disease (CVD) or hypercholesterolemia, who underwent a health screening examination including cardiac computed tomography for CAC scoring and completed a validated food frequency questionnaire at the Kangbuk Samsung Hospital Total Healthcare Centers, South Korea (March 2011-April 2013). The prevalence of detectable CAC (CAC score > 0) was 11.2%. In multivariable-adjusted models, CAC score ratio (95% confidence interval [CI]) comparing participants eating ≥ 7 eggs/wk to those eating < 1 egg/wk was 1.80 (1.14-2.83; P for trend = 0.003). The multivariable CAC score ratio (95% CI) associated with an increase in consumption of 1 egg/day was 1.54 (1.11-2.14). The positive association seemed to be more pronounced among participants with low vegetable intake (P for interaction = 0.02) and those with high BMI (P for interaction = 0.05). The association was attenuated and no longer significant after further adjustment for dietary cholesterol. Egg consumption was associated with an increased prevalence of subclinical coronary atherosclerosis and with a greater degree of coronary calcification in asymptomatic Korean adults, which may be mediated by dietary cholesterol. The association was particularly pronounced among individuals with low vegetable intake and those with high BMI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  5. Association of Coronary Artery Calcification and Mortality in the National Lung Screening Trial

    PubMed Central

    Chiles, Caroline; Duan, Fenghai; Gladish, Gregory W.; Ravenel, James G.; Baginski, Scott G.; Snyder, Bradley S.; DeMello, Sarah; Desjardins, Stephanie S.; Munden, Reginald F.

    2016-01-01

    Purpose To evaluate three coronary artery calcification (CAC) scoring methods to assess risk of coronary heart disease (CHD) death and all-cause mortality in National Lung Screening Trial (NLST) participants across levels of CAC scores. Materials and Methods The NLST was approved by the institutional review board at each participating institution, and informed consent was obtained from all participants. Image review was HIPAA compliant. Five cardiothoracic radiologists evaluated 1575 low-dose computed tomographic (CT) scans from three groups: 210 CHD deaths, 315 deaths not from CHD, and 1050 participants who were alive at conclusion of the trial. Radiologists used three scoring methods: overall visual assessment, segmented vessel-specific scoring, and Agatston scoring. Weighted Cox proportional hazards models were fit to evaluate the association between scoring methods and outcomes. Results In multivariate analysis of time to CHD death, Agatston scores of 1–100, 101–1000, and greater than 1000 (reference category 0) were associated with hazard ratios of 1.27 (95% confidence interval: 0.69, 2.53), 3.57 (95% confidence interval: 2.14, 7.48), and 6.63 (95% confidence interval: 3.57, 14.97), respectively; hazard ratios for summed segmented vessel-specific scores of 1–5, 6–11, and 12–30 (reference category 0) were 1.72 (95% confidence interval: 1.05, 3.34), 5.11 (95% confidence interval: 2.92, 10.94), and 6.10 (95% confidence interval: 3.19, 14.05), respectively; and hazard ratios for overall visual assessment of mild, moderate, or heavy (reference category none) were 2.09 (95% confidence interval: 1.30, 4.16), 3.86 (95% confidence interval: 2.02, 8.20), and 6.95 (95% confidence interval: 3.73, 15.67), respectively. Conclusion By using low-dose CT performed for lung cancer screening in older, heavy smokers, a simple visual assessment of CAC can be generated for risk assessment of CHD death and all-cause mortality, which is comparable to Agatston scoring and

  6. Arterial calcification: Finger-pointing at resident and circulating stem cells

    PubMed Central

    Vasuri, Francesco; Fittipaldi, Silvia; Pasquinelli, Gianandrea

    2014-01-01

    The term ‘‘Stammzelle’’ (stem cells) originally appeared in 1868 in the works of Ernst Haeckel who used it to describe the ancestor unicellular organism from which he presumed all multicellular organisms evolved. Since then stem cells have been studied in a wide spectrum of normal and pathological conditions; it is remarkable to note that ectopic arterial calcification was considered a passive deposit of calcium since its original discovering in 1877; in the last decades, resident and circulating stem cells were imaged to drive arterial calcification through chondro-osteogenic differentiation thus opening the idea that an active mechanism could be at the basis of the process that clinically shows a Janus effect: calcifications either lead to the stabilization or rupture of the atherosclerotic plaques. A review of the literature underlines that 130 years after stem cell discovery, antigenic markers of stem cells are still debated and the identification of the osteoprogenitor phenotype is even more elusive due to tissue degradation occurring at processing and manipulation. It is necessary to find a consensus to perform comparable studies that implies phenotypic recognition of stem cells antigens. A hypothesis is based on the singular morphology and amitotic mechanism of division of osteoclasts: it constitutes the opening to a new approach on osteoprogenitors markers and recognition. Our aim was to highlight all the present evidences of the active calcification process, summarize the different cellular types involved, and discuss a novel approach to discover osteoprogenitor phenotypes in arterial wall. PMID:25426251

  7. Arterial calcification: Finger-pointing at resident and circulating stem cells.

    PubMed

    Vasuri, Francesco; Fittipaldi, Silvia; Pasquinelli, Gianandrea

    2014-11-26

    The term ''Stammzelle'' (stem cells) originally appeared in 1868 in the works of Ernst Haeckel who used it to describe the ancestor unicellular organism from which he presumed all multicellular organisms evolved. Since then stem cells have been studied in a wide spectrum of normal and pathological conditions; it is remarkable to note that ectopic arterial calcification was considered a passive deposit of calcium since its original discovering in 1877; in the last decades, resident and circulating stem cells were imaged to drive arterial calcification through chondro-osteogenic differentiation thus opening the idea that an active mechanism could be at the basis of the process that clinically shows a Janus effect: calcifications either lead to the stabilization or rupture of the atherosclerotic plaques. A review of the literature underlines that 130 years after stem cell discovery, antigenic markers of stem cells are still debated and the identification of the osteoprogenitor phenotype is even more elusive due to tissue degradation occurring at processing and manipulation. It is necessary to find a consensus to perform comparable studies that implies phenotypic recognition of stem cells antigens. A hypothesis is based on the singular morphology and amitotic mechanism of division of osteoclasts: it constitutes the opening to a new approach on osteoprogenitors markers and recognition. Our aim was to highlight all the present evidences of the active calcification process, summarize the different cellular types involved, and discuss a novel approach to discover osteoprogenitor phenotypes in arterial wall.

  8. Improvement of determination technique for extracting centerline in coronary artery with calcification on CTA.

    PubMed

    Ikai, Akihiro; Lee, Yongbum; Tsai, Du-Yih; Yamamoto, Isao; Matsumoto, Kazunori; Kimura, Motomasa

    2009-09-20

    The present study proposes a method for improving an existing technique used for extracting the centerlines of coronary arteries with calcifications on CTA. Through the use of the improved centerline extraction method, CPR images could be depicted accurately. In the proposed method, two dynamic range compression algorithms using two ITC for blood vessel regions and calcification regions were employed. Two dynamic range compressed CTA images obtained from the two ITC were then subtracted. After that, automatic tracing to determine the centerline for creating CPR images was performed using 3D image processing equipment. The usefulness of our proposed method was confirmed by using simulated CTA of the coronary artery with calcification. We also applied the proposed method to CTA images of 39 branches in 18 cases, and to 48 segments. Our experimental results showed that automatic tracing software pre-installed in the workstation could accurately determine the centerline of the coronary artery without being affected by the existence of calcification. Furthermore, an experienced radiological technologist evaluated the CPR images obtained by the proposed method. The results showed that most created CPR images could be used as diagnostic images after a minor revision performed manually.

  9. Calcification of coronary arteries and abdominal aorta in relation to traditional and novel risk factors of atherosclerosis in hemodialysis patients

    PubMed Central

    2013-01-01

    Background Process of accelerated atherosclerosis specific for uremia increases cardiovascular risk in patients with chronic kidney disease (CKD) and may be influenced by the different structure of arteries. The study assesses the influence of traditional and novel risk factors on calcification of coronary arteries (CAC) and abdominal aorta (AAC) in hemodialysis patients (HD). Methods CAC and AAC were assessed by CT in 104 prevalent adult HD and 14 apparently healthy subjects with normal kidney function (control group). Mineral metabolism parameters, plasma levels of FGF-23, MGP, osteoprotegerin, osteopontin, fetuin-A, CRP, IL-6 and TNF-α were measured. Results CAC and AAC (calcification score ≥ 1) were found in 76 (73.1%) and 83 (79.8%) HD respectively, more frequent than in the control group. In 7 HD with AAC no CAC were detected. The frequency and severity of calcifications increased with age. Both CAC and AAC were more frequently detected in diabetics (OR = 17.37 and 13.00, respectively). CAC score was significantly greater in males. CAC and AAC scores were correlated significantly with pack-years of smoking and plasma osteoprotegrin levels. However the independent contribution of plasma osteoprotegerin levels was not confirmed in multiple regression analysis. Age (OR = 1.13) and hemodialysis vintage (OR = 1.14) were the independent risk factor favoring the occurrence of CAC; while age (OR = 1.20) was the only predictor of AAC occurrence in HD. Conclusions 1. AAC precedes the occurrence of CAC in HD patients. 2. The exposition to uremic milieu and systemic chronic microinflammation has more deteriorative effect on the CAC than the AAC. PMID:23317172

  10. Automated coronary artery calcium scoring from non-contrast CT using a patient-specific algorithm

    NASA Astrophysics Data System (ADS)

    Ding, Xiaowei; Slomka, Piotr J.; Diaz-Zamudio, Mariana; Germano, Guido; Berman, Daniel S.; Terzopoulos, Demetri; Dey, Damini

    2015-03-01

    Non-contrast cardiac CT is used worldwide to assess coronary artery calcium (CAC), a subclinical marker of coronary atherosclerosis. Manual quantification of regional CAC scores includes identifying candidate regions, followed by thresholding and connected component labeling. We aimed to develop and validate a fully-automated, algorithm for both overall and regional measurement of CAC scores from non-contrast CT using a hybrid multi-atlas registration, active contours and knowledge-based region separation algorithm. A co-registered segmented CT atlas was created from manually segmented non-contrast CT data from 10 patients (5 men, 5 women) and stored offline. For each patient scan, the heart region, left ventricle, right ventricle, ascending aorta and aortic root are located by multi-atlas registration followed by active contours refinement. Regional coronary artery territories (left anterior descending artery, left circumflex artery and right coronary artery) are separated using a knowledge-based region separation algorithm. Calcifications from these coronary artery territories are detected by region growing at each lesion. Global and regional Agatston scores and volume scores were calculated in 50 patients. Agatston scores and volume scores calculated by the algorithm and the expert showed excellent correlation (Agatston score: r = 0.97, p < 0.0001, volume score: r = 0.97, p < 0.0001) with no significant differences by comparison of individual data points (Agatston score: p = 0.30, volume score: p = 0.33). The total time was <60 sec on a standard computer. Our results show that fast accurate and automated quantification of CAC scores from non-contrast CT is feasible.

  11. Prevention of arterial calcification corrects the low bone mass phenotype in MGP-deficient mice.

    PubMed

    Marulanda, Juliana; Gao, Chan; Roman, Hassem; Henderson, Janet E; Murshed, Monzur

    2013-12-01

    Matrix gla protein (MGP), a potent inhibitor of extracellular matrix (ECM) mineralization, is primarily produced by vascular smooth muscle cells (VSMCs) and chondrocytes. Consistent with its expression profile, MGP deficiency in mice (Mgp-/- mice) results in extensive mineralization of all arteries and cartilaginous ECMs. Interestingly, we observed a progressive loss of body weight in Mgp-/- mice, which becomes apparent by the third week of age. Taking into account the new paradigm linking the metabolic regulators of energy metabolism and body mass to that of bone remodeling, we compared the bone volume in Mgp-/- mice to that of their wild type littermates by micro-CT and bone histomorphometry. We found a decrease of bone volume over tissue volume in Mgp-/- mice caused by an impaired osteoblast function. In culture, early differentiation of Mgp-/- primary osteoblasts was not affected; however there was a significant upregulation of the late osteogenic marker Bglap (osteocalcin). We examined whether the prevention of arterial calcification in Mgp-/- mice could correct the low bone mass phenotype. The bones of two different genetic models: Mgp-/-;SM22-Mgp and Mgp-/-;Eln+/- mice were analyzed. In the former strain, vascular calcification was fully rescued by transgenic overexpression of Mgp in the VSMCs, while in the latter, elastin haploinsufficiency significantly impeded the deposition of minerals in the arterial walls. In both models, the low mass phenotype seen in Mgp-/- mice was rescued. Our data support the hypothesis that the arterial calcification, not MGP deficiency itself, causes the low bone mass phenotype in Mgp-/- mice. Taken together, we provide evidence that arterial calcification affects bone remodeling and pave the way for further mechanistic studies to identify the pathway(s) regulating this process. © 2013.

  12. Coronary Artery Calcification in Obese Youth: What Are the Phenotypic and Metabolic Determinants?

    PubMed Central

    Edmundowicz, Daniel; Sutton-Tyrell, Kim; Lee, SoJung; Tfayli, Hala; Arslanian, Silva A.

    2014-01-01

    OBJECTIVE Obesity in adolescence has been associated with increased risk for coronary heart disease in adulthood. This study evaluated subclinical atherosclerosis in obese youth and the underlying risk factors. RESEARCH DESIGN AND METHODS Ninety obese adolescents (37 normal glucose tolerant, 27 prediabetes, and 26 type 2 diabetes) underwent evaluation of coronary artery calcifications (CACs) by electron beam computed tomography, aortic pulse wave velocity (PWV), carotid intima-media thickness (IMT), lipids, leptin, inflammatory markers, and body composition (DEXA). A total of 68 underwent evaluation of insulin sensitivity (IS) (hyperinsulinemic-euglycemic clamp) and abdominal adiposity (computed tomography). RESULTS A total of 50% had CACs (CAC+: Agatston CAC score ≥1). CAC+ youth had higher BMI, fat mass, and abdominal fat, with no difference in sex, race, IS per fat-free mass (ISFFM), glucose tolerance, PWV, or IMT compared with the CAC− group. PWV was inversely related to IS. In multiple regression analyses with age, race, sex, HbA1c, BMI (or waist circumference), ISFFM, diastolic blood pressure, non–HDL cholesterol, and leptin as independent variables, BMI (or waist) (R2 = 0.41; P = 0.001) was the significant determinant of CAC; leptin (R2 = 0.37; P = 0.034) for PWV; and HbA1c, race, and age (R2 = 0.34; P = 0.02) for IMT. CONCLUSIONS Early in the course of obesity, there is evidence of CAC independent of glycemia. The different biomarkers of subclinical atherosclerosis appear to be differentially modulated, adiposity being the major determinant of CAC, hyperglycemia, age, and race for IMT, and leptin and IS for arterial stiffness. These findings highlight the increased cardiovascular disease risk in obese youth and the need for early interventions to reverse obesity and atherosclerosis. PMID:25147256

  13. Association between mitral and aortic valve calcification and preferential left or right coronary artery disease.

    PubMed

    Yosefy, Chaim; Malushitsky, Ariela; Jamal, Jafary; Sahar, Gideon; Katz, Amos

    2009-11-01

    Mitral annular calcification (MAC) and aortic valve calcification (AVC) are predictive of coronary artery disease (CAD). However, no data exist concerning the association between preferential CAD side localization to the left or right coronary arteries and MAC or AVC. A cohort analysis was performed of 1,000 consecutive coronary angiographies recorded in patients with CAD. The angiographies were divided according to the distribution of CAD to the isolated right coronary tree disease, left coronary tree disease, or both. The echocardiograms were reviewed for MAC, AVC or combined valvular calcification (CVC). Significant CAD (lumenal stenosis > 70%) was observed in 688 patients, among whom 167 had isolated (right or left) CAD and 521 double-sided coronary tree disease. Valvular calcification (VC) was observed in 70 (42%) of the isolated CAD patients; of these, 41 had isolated left CAD and 29 isolated right CAD. Among the isolated left CAD patients with VC, 13 (32%) had AVC, 22 (53%) had CVC, and only six (15%) had MAC (p < 0.01). Among the isolated right CAD patients with VC, 18 (62%) had MAC, nine (31%) had CVC, and only two (7%) had AVC (p < 0.01). VC was observed in 266 patients (51%) with mixed CAD; of these, 152 (57%) had CVC, 103 (39%) had AVC, and 11 (4%) had MAC (p < 0.01). Isolated left CAD is associated with AVC or CVC more frequently than with MAC. In contrast, isolated right CAD is associated with MAC or CVC, but rarely with AVC.

  14. Association between extra- and intracranial calcifications of the internal carotid artery: a CBCT imaging study

    PubMed Central

    Aartman, I H A; Tsiklakis, K; van der Stelt, P; Berkhout, W E R

    2015-01-01

    Objectives: This study aimed to evaluate the association between the extracranial and intracranial calcification depiction of the internal carotid artery (ICA), incidentally found in CBCT examinations in adults, and to discuss the conspicuous clinical implications. Methods: Out of a series of 1085 CBCT examinations, 705 CBCT scans were selected according to pre-defined criteria. The extra- and intracranial calcifications depicted along the course of the ICA were documented according to a comprehensive set of descriptive criteria. Results: In total, 799 findings were detected, 60.1% (n = 480) were intracranially and 39.9% (n = 319) were extracranially allocated. The χ2 test showed associations between all variables (p < 0.001). Also, most of the combinations of variables showed statistically significant results in the McNemar's test (p < 0.001). Conclusions: We found that a significant correlation exists between extra- and intracranial calcifications of the ICA. It is clear that in cases of the presence of a calcification in the ICA extracranially, the artery's intracranial portion has an increased risk of showing the same findings. CBCT imaging is widely used as a diagnostic tool, thus, our results contribute to the identification of a subgroup of patients who should undergo further medical evaluation of the atherosclerosis of the ICAs. PMID:25690425

  15. The relationship between serum hypoxia-inducible factor 1α and coronary artery calcification in asymptomatic type 2 diabetic patients

    PubMed Central

    2014-01-01

    Background Hypoxia-inducible factor 1 (HIF-1), a master regulator of oxygen homeostasis, is a heterodimer consisting of HIF-1α and HIF-1β subunits, and is implicated in calcification of cartilage and vasculature. The goal of this study was to determine the relationship between serum HIF-1α with coronary artery calcification (CAC) in patients with type 2 diabetes. Methods The subjects were 405 (262 males, 143 females, age 51.3 ± 6.4 years) asymptomatic patients with type 2 diabetes mellitus. Serum HIF-1α and interleukin-6 (IL-6) levels were measured by ELISA. CAC scores were assessed by a 320-slice CT scanner. The subjects were divided into 4 quartiles depending on serum HIF-1α levels. Results Average serum HIF-1α was 184.4 ± 66.7 pg/ml. Among patients with higher CAC scores, HIF-1α levels were also significantly increased (p <0.001). HIF-1α levels positively correlated with CRP, IL-6, UKPDS risk score, HbA1c, FBG, and CACS, but did not correlate with diabetes duration, age, and LDL. According to the multivariate analysis, HIF-1α levels significantly and independently predict the presence of CAC. ROC curve analysis showed that the serum HIF-1α level can predict the extent of CAC, but the specificity was lower than the traditional risk factors UKPDS and HbA1c. Conclusion As a marker of hypoxia, serum HIF-1α level may be an independent risk factor for the presence of CAC. These findings indicate that elevated serum HIF-1α may be involved in vascular calcification in patients with type 2 diabetes mellitus. PMID:24564828

  16. High Calcium-Magnesium Ratio in Hair Is Associated with Coronary Artery Calcification in Middle-Aged and Elderly Individuals.

    PubMed

    Park, Byoungjin; Kim, Mi-Hyun; Cha, Choong Keun; Lee, Yong-Jae; Kim, Kyong-Chol

    2017-02-06

    The interaction between calcium and magnesium as a risk modifier for cardiovascular disease (CVD) has been largely overlooked in previous studies, for the strict regulatory system in blood has been thought to keep such homeostatic interactions under tight control. This study aimed to investigate the association between calcium-magnesium ratio in hair and subclinical coronary artery calcification. Using multiple linear regression analysis, we examined the associations between calcium-magnesium ratio in hair and the coronary calcium score (CCS) in 216 Koreans aged 40 years and above (122 men and 94 women). We found that the calcium-to-magnesium ratio in hair was independently and positively associated with CCS after adjusting for age and sex (regression coefficient 6.051 ± 2.329, P = 0.010). When we assessed the association between the calcium-magnesium ratio and CCS after adjusting for potential cardiovascular risk factors and vascular function modifying drugs, we found that the strength of association with CCS was comparable to before (regression coefficient 5.434 ± 2.523, P = 0.032). Our findings suggest that among middle-aged and elderly Koreans without clinical CVD, the association between coronary artery calcification and hair calcium-magnesium ratio is stronger in those with a higher calcium-magnesium ratio in hair than in those with a lower ratio.

  17. Calcification of Cryopreserved Arterial Graft Causing Delayed Obstruction of Portal Vein Flow After Liver Transplant.

    PubMed

    Cimsit, Bayindir; Yankol, Yucel; Mecit, Nesimi; Kanmaz, Turan; Acarli, Koray; Kalayoglu, Munci

    2015-10-01

    In patients with biliary atresia, portal vein problems may cause challenges for liver transplant. Interposition grafts have been used for vascular anastomoses in transplant recipients with varied success. A cryopreserved iliac artery graft was used for the reconstruction of the portal vein in a 29-month-old infant with biliary atresia. At 17 months after transplant, she developed upper gastrointestinal bleeding that was caused by portal vein occlusion because of vascular calcifications in the graft. Upper gastrointestinal endoscopy showed esophageal varices with fresh bleeding, and the varices were band ligated. At 3 months after the bleeding episode, the patient was asymptomatic and biochemical tests were normal. In summary, liver transplant with cryopreserved iliac artery graft may be complicated by calcifications and portal vein occlusion, and caution is advised in using this graft material for portal vein anastomoses.

  18. Prevalence and severity of coronary artery disease in diabetic patients with aortic valve calcification.

    PubMed

    Chen, Zhang-wei; Qian, Ju-ying; Jian, Ying; Ge, Lei; Liu, Xue-bo; Shu, Xian-hong; Ge, Junbo

    2011-02-01

    Aortic valve calcification (AVC) is common in the elderly and associated with increased cardiovascular mortality, while diabetes is one of the confirmed risk factors for coronary artery disease (CAD). In this study, we aimed to evaluate the prevalence and severity of CAD in type-2 diabetic patients with AVC. From June to December in 2007, a total of 325 consecutive patients with chest pain or chest distress were admitted for coronary angiography. The severity of CAD was evaluated by the Gensini score and the number of stenosed vessels. All patients underwent transthoracic echocardiography for detecting AVC. Compared with the patients without diabetes (n = 221), the type-2 diabetic patients (n = 104) had a similar prevalence of CAD (66.5% vs. 72.1%, P = 0.312). Further classified by the presence of AVC, patients with AVC had a higher prevalence of CAD, average Gensini score and the number of stenosed vessels, both in the group with and without diabetes. It was also demonstrated that the odds ratio (OR) of AVC for CAD in the diabetic patients was higher than in the non-diabetic ones (3.405 vs 2.515) after chi-square analysis (single-variable). However, at multivariable logistic regression analysis for CAD, the OR of AVC was 3.757 (P = 0.03) in diabetic group, while it did not achieve statistical significance in the non-diabetic group (OR = 2.130, P= 0.074). Type-2 diabetic patients with AVC had a higher prevalence of and more severe CAD.

  19. Combined intravascular photoacoustic and ultrasound imaging imaging of atherosclerotic calcification in human artery

    NASA Astrophysics Data System (ADS)

    Wei, Wei; Li, Xiang; Zhou, Qifa; Shung, K. Kirk; Chen, Zhongping

    2012-03-01

    Intravascular ultrasound (IVUS) is mature imaging modality to diagnose blood vessel disease, especially for calcification characterization. Based on the intrinsic optical absorption, intravascular photoacoustic (IVPA) works as a complementary method to IVUS. In this paper, we develop a miniature intravascular probe combined photoacoustic and ultrasound imaging. The optical components and ultrasound transducer were integrated to achieve internal illumination. Atherosclerotic human artery was imaged ex vivo, which demonstrates the imaging ability of the multi-functional probe and illustrate its clinical potential.

  20. Integrative DNA, RNA, and protein evidence connects TREML4 to coronary artery calcification.

    PubMed

    Sen, Shurjo K; Boelte, Kimberly C; Barb, Jennifer J; Joehanes, Roby; Zhao, XiaoQing; Cheng, Qi; Adams, Lila; Teer, Jamie K; Accame, David S; Chowdhury, Soma; Singh, Larry N; Kavousi, Maryam; Peyser, Patricia A; Quigley, Laura; Priel, Debra Long; Lau, Karen; Kuhns, Douglas B; Yoshimura, Teizo; Johnson, Andrew D; Hwang, Shih-Jen; Chen, Marcus Y; Arai, Andrew E; Green, Eric D; Mullikin, James C; Kolodgie, Frank D; O'Donnell, Christopher J; Virmani, Renu; Munson, Peter J; McVicar, Daniel W; Biesecker, Leslie G

    2014-07-03

    Coronary artery calcification (CAC) is a heritable and definitive morphologic marker of atherosclerosis that strongly predicts risk for future cardiovascular events. To search for genes involved in CAC, we used an integrative transcriptomic, genomic, and protein expression strategy by using next-generation DNA sequencing in the discovery phase with follow-up studies using traditional molecular biology and histopathology techniques. RNA sequencing of peripheral blood from a discovery set of CAC cases and controls was used to identify dysregulated genes, which were validated by ClinSeq and Framingham Heart Study data. Only a single gene, TREML4, was upregulated in CAC cases in both studies. Further examination showed that rs2803496 was a TREML4 cis-eQTL and that the minor allele at this locus conferred up to a 6.5-fold increased relative risk of CAC. We characterized human TREML4 and demonstrated by immunohistochemical techniques that it is localized in macrophages surrounding the necrotic core of coronary plaques complicated by calcification (but not in arteries with less advanced disease). Finally, we determined by von Kossa staining that TREML4 colocalizes with areas of microcalcification within coronary plaques. Overall, we present integrative RNA, DNA, and protein evidence implicating TREML4 in coronary artery calcification. Our findings connect multimodal genomics data with a commonly used clinical marker of cardiovascular disease.

  1. Integrative DNA, RNA, and Protein Evidence Connects TREML4 to Coronary Artery Calcification

    PubMed Central

    Sen, Shurjo K.; Boelte, Kimberly C.; Barb, Jennifer J.; Joehanes, Roby; Zhao, XiaoQing; Cheng, Qi; Adams, Lila; Teer, Jamie K.; Accame, David S.; Chowdhury, Soma; Singh, Larry N.; Kavousi, Maryam; Peyser, Patricia A.; Quigley, Laura; Priel, Debra Long; Lau, Karen; Kuhns, Douglas B.; Yoshimura, Teizo; Johnson, Andrew D.; Hwang, Shih-Jen; Chen, Marcus Y.; Arai, Andrew E.; Green, Eric D.; Mullikin, James C.; Kolodgie, Frank D.; O’Donnell, Christopher J.; Virmani, Renu; Munson, Peter J.; McVicar, Daniel W.; Biesecker, Leslie G.

    2014-01-01

    Coronary artery calcification (CAC) is a heritable and definitive morphologic marker of atherosclerosis that strongly predicts risk for future cardiovascular events. To search for genes involved in CAC, we used an integrative transcriptomic, genomic, and protein expression strategy by using next-generation DNA sequencing in the discovery phase with follow-up studies using traditional molecular biology and histopathology techniques. RNA sequencing of peripheral blood from a discovery set of CAC cases and controls was used to identify dysregulated genes, which were validated by ClinSeq and Framingham Heart Study data. Only a single gene, TREML4, was upregulated in CAC cases in both studies. Further examination showed that rs2803496 was a TREML4 cis-eQTL and that the minor allele at this locus conferred up to a 6.5-fold increased relative risk of CAC. We characterized human TREML4 and demonstrated by immunohistochemical techniques that it is localized in macrophages surrounding the necrotic core of coronary plaques complicated by calcification (but not in arteries with less advanced disease). Finally, we determined by von Kossa staining that TREML4 colocalizes with areas of microcalcification within coronary plaques. Overall, we present integrative RNA, DNA, and protein evidence implicating TREML4 in coronary artery calcification. Our findings connect multimodal genomics data with a commonly used clinical marker of cardiovascular disease. PMID:24975946

  2. Calcium score of small coronary calcifications on multidetector computed tomography: results from a static phantom study.

    PubMed

    Groen, J M; Kofoed, K F; Zacho, M; Vliegenthart, R; Willems, T P; Greuter, M J W

    2013-02-01

    Multi detector computed tomography (MDCT) underestimates the coronary calcium score as compared to electron beam tomography (EBT). Therefore clinical risk stratification based on MDCT calcium scoring may be inaccurate. The aim of this study was to assess the feasibility of a new phantom which enables establishment of a calcium scoring protocol for MDCT that yields a calcium score comparable to the EBT values and to the physical mass. A phantom containing 100 small calcifications ranging from 0.5 to 2.0mm was scanned on EBT using a standard coronary calcium protocol. In addition, the phantom was scanned on a 320-row MDCT scanner using different scanning, reconstruction and scoring parameters (tube voltage 80-135 kV, slice thickness 0.5-3.0mm, reconstruction kernel FC11-FC15 and threshold 110-150 HU). The Agatston and mass score of both modalities was compared and the influence of the parameters was assessed. On EBT the Agatston and mass scores were between 0 and 20, and 0 and 3mg, respectively. On MDCT the Agatston and mass scores were between 0 and 20, and 0 and 4 mg, respectively. All parameters showed an influence on the calcium score. The Agatston score on MDCT differed 52% between the 80 and 135kV, 65% between 0.5 and 3.0mm and 48% between FC11 and FC15. More calcifications were detected with a lower tube voltage, a smaller slice thickness, a sharper kernel and a lower threshold. Based on these observations an acquisition protocol with a tube voltage of 100 kV and two reconstructions protocols were defined with a FC12 reconstruction kernel; one with a slice thickness of 3.0mm and a one with a slice thickness of 0.5mm. This protocol yielded an Agatston score as close to the EBT as possible, but also a mass score as close to the physical phantom value as possible, respectively. With the new phantom one acquisition protocol and two reconstruction protocols can be defined which produces Agatston scores comparable to EBT values and to the physical mass. Copyright

  3. Relationship between cardio-ankle vascular index (CAVI) and coronary artery calcification (CAC) in patients with type 2 diabetes mellitus.

    PubMed

    Mineoka, Yusuke; Fukui, Michiaki; Tanaka, Muhei; Tomiyasu, Ki-ichiro; Akabame, Satoshi; Nakano, Koji; Yamazaki, Masahiro; Hasegawa, Goji; Oda, Yohei; Nakamura, Naoto

    2012-03-01

    Early detection of atherosclerosis is important for patients with type 2 diabetes mellitus because cardiovascular disease (CVD) is a main cause of death in these people. In this study, we investigated the relationship between an arterial stiffness parameter called cardio-ankle vascular index (CAVI) and coronary artery calcification (CAC). We performed a cross-sectional study in 371 type 2 diabetic patients with clinical suspicion of coronary heart disease (CHD). We evaluated the relationships between CAVI and CAC score determined by multislice computed tomography as well as major cardiovascular risk factors, including age, body mass index, hemoglobinA1c and the Framingham CHD risk score. CAVI was correlated with age (r = 0.301, p < 0.0001), uric acid (r = 0.236, p < 0.0001), estimated glomerular filtration rate (r = -0.145, p = 0.0166), CHD risk score (r = 0.327, p < 0.0001) and log (CAC + 1) (r = 0.303, p < 0.0001). The area under the receiver operating characteristic curve for CAVI was higher than that of CHD risk score in predicting CAC >0, CAC >100, CAC >400, or CAC >1000. CAVI is positively correlated with CAC, and is considered to be a useful method to detect CAC.

  4. Relationship between abdominal aortic and coronary artery calcification as detected by computed tomography in chronic kidney disease patients.

    PubMed

    Takayama, Yohei; Yasuda, Yoshinari; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Shibata, Kanako; Niwa, Misao; Sawai, Akihiro; Morimoto, Ryota; Kato, Sawako; Ishii, Hideki; Maruyama, Shoichi; Murohara, Toyoaki

    2016-07-01

    The purpose of this study was to investigate the relationship between abdominal aortic calcification (AAC) and coronary artery calcification (CAC) in chronic kidney disease (CKD) patients. We evaluated 126 asymptomatic CKD patients (mean estimated glomerular filtration rate: 36.1 ± 14.1 mL/min/1.73 m(2), mean age 70.3 ± 10.1 years). A non-contrast computed tomography scan was used to determine the abdominal aortic calcification index (ACI) and CAC score, and this relationship was investigated. Among the subjects, AAC was present in 109 patients (86.5 %) as defined by ACI >0 and median ACI was 11.7 %. ACI increased in accordance with advances in CAC score grades (3.0, 5.2, 17.2, and 32.8 % for CAC score 0, 1-100, 101-400, and 401 or more, respectively, p < 0.001). Even after multivariate adjustment, ACI was independently associated with severe CAC score as defined by CAC score >400 [odds ratio 1.08, 95 % confidence interval (CI) 1.04-1.12, p < 0.001]. Receiver-operating curve analysis showed that the ACI optimal cut-off value predicting severe CAC score was 16.5 % (area under the curve = 0.79, 95 % CI 0.69-0.90, p < 0.001). The C statics for predicting CAC score was significantly increased by adding ACI values to the model including other risk factors (0.853 versus 0.737, p = 0.023). In conclusion, the ACI value of 16.5 % allows us to predict the presence of severe CAC in CKD patients, and that the addition of ACI to the model with traditional risk factors significantly improves the predictive ability of severe CAC score. These data reinforce the utility of ACI as a screening tool in clinical practice.

  5. Using panoramic radiographs to detect carotid artery calcifications: are they a helpful diagnostic tool?

    PubMed

    Gouvea, Adriele Ferreira; Vargas, Pablo Agustin; Jorge, Jacks; Lopes, Marcio Ajudarte

    2009-01-01

    More than 50% of cerebrovascular accidents are caused by atherosclerotic disease at the carotid artery.1 Carotid artery stenosis may be detected by the standard method of duplex ultrasound (DUS), while calcifications can be detected by panoramic radiographs.2-4 Panoramic radiographs may be used as a selective tool, reducing health costs by identifying individuals at risk of stroke or myocardial infarction.5-7 The present study sought a correlation between laboratory findings/behaviors and panoramic radiographs and DUS images, thus determining the value of the panoramic radiographs' findings.

  6. Coronary artery calcifications in children with end-stage renal disease.

    PubMed

    Civilibal, Mahmut; Caliskan, Salim; Adaletli, Ibrahim; Oflaz, Huseyin; Sever, Lale; Candan, Cengiz; Canpolat, Nur; Kasapcopur, Ozgur; Kuruoglu, Sebuh; Arisoy, Nil

    2006-10-01

    Coronary artery calcification (CAC) is common in adults with end-stage renal disease (ESRD), but little is known about the prevalence and the extent of it in children. We used multidetector spiral computed tomography (MDCT), echocardiography, and carotid and brachial high-resolution ultrasonography to screen for the presence and predisposing factors of CAC in 53 children with ESRD [15 hemodialysis (HD) patients, 24 peritoneal dialysis (PD) patients, and 14 renal transplant (rTx) recipients]. CAC was present in 15% of patients (three HD patients, three PD patients, and two rTx). The mean age of the patients with CAC was 16.4 years (range: 11.0-21.2 years), and their median CAC score was 101.3, ranging from 8.5 to 4,322 according to the Agatston method. The patients with CAC had longer duration of total dialysis (P=0.005), had higher time-integrated serum phosphorus (P<0.001), calcium-phosphate (CaxP) product (P=0.012), intact parathyroid hormone (P=0.010), vitamin B(12) levels (P=0.010), the amount of cumulative calcium-containing oral phosphate binders (OBPs) (P<0.001), and calcitriol intake (P<0.001), and had lower serum hemoglobin level (P=0.014). Interventricular septum systolic thickness (P=0.033) was significantly higher, relative wall thickness (P=0.062) tended to be higher, and flow-mediated endothelium-dependent dilatations (P=0.071) were lower without reaching statistically significant levels in those with CAC. A stepwise logistic regression analysis revealed that serum phosphorus (P=0.018) and the cumulative exposure to calcium-containing OPBs (P=0.016) were the most significant independent predictors in the development of CAC. These results indicate that even adolescents and children with ESRD may have coronary calcifications. We concluded that impaired divalent ion metabolism is the main factor in the formation of CAC in this age group.

  7. Association of Serum Phosphorus Variability with Coronary Artery Calcification among Hemodialysis Patients

    PubMed Central

    You, Li; Yu, Xiaoling; Zhang, Min; Zhu, Ruijiang; Hao, Chuanming; Zhang, Zhijie; Chen, Jing

    2014-01-01

    Coronary artery calcification (CAC) is associated with increased mortality in patients on maintenance hemodialysis (MHD), but the pathogenesis of this condition is not well understood. We evaluated the relationship of CAC score (CACs) and variability in serum phosphorus in MHD patients. Seventy-seven adults on MHD at Huashan Hospital (Shanghai) were enrolled in July, 2010. CAC of all the patients were measured by computed tomography and CACs was calculated by the Agatston method at the entry of enrollment. Patients were divided into three categories according to their CACs (0∼10, 11∼400, and >400). Blood chemistry was recorded every 3 months from January 2008 to July 2010. Phosphorus variation was defined by the standard deviation (SD) or coefficient of variation (CV) and it was calculated from the past records. The ordinal multivariate logistic regression analysis was used to analyze the predictors of CAC. The mean patient age (± SD) was 61.7 years (±11.3) and 51% of patients were men. The mean CACs was 609.6 (±1062.9), the median CACs was 168.5, and 78% of patients had CACs more than 0. Multivariate analysis indicated that female gender (OR = 0.20, 95% CI = 0.07–0.55), age (OR = 2.31, 95% CI = 1.32–4.04), serum fibroblast growth factor 23 (OR = 2.25, 95% CI = 1.31–3.85), SD-phosphorus calculated from the most recent 6 measurements (OR = 2.12; 95% CI = 1.23–3.63), and CV-phosphorus calculated from the most recent 6 measurements (OR = 1.90, 95% CI = 1.16–3.11) were significantly and independently associated with CACs. These associations persisted for phosphorus variation calculated from past 7, 8, 9, 10, and 11 follow-up values. Variability of serum phosphorus may contribute significantly to CAC and keeping serum phosphorus stable may decrease coronary calcification and associated morbidity and mortality in MHD patients. PMID:24747427

  8. Plasma phylloquinone, menaquinone-4 and menaquinone-7 levels and coronary artery calcification.

    PubMed

    Torii, S; Ikari, Y; Tanabe, K; Kakuta, T; Hatori, M; Shioi, A; Okano, T

    2016-01-01

    Vitamin K is considered to be involved in the pathological mechanisms of coronary artery calcification (CAC). Correlation between CAC and plasma vitamin K levels was studied. A total of 103 patients, with at least one coronary risk factor, were studied. CAC was measured using 64-slice multislice computed tomography (MSCT) and divided into three groups: none (CAC score = 0; n 25), mild to moderate (0 < CAC score < 400; n 52) and severe (CAC score > 400; n 26). Phylloquinone (PK) and menaquinone (MK)-4 and MK-7 were measured by HPLC-tandem MS. Mean age of patients was 64 (sd 13) years, of which 57 % were male. Median CAC score was 57·2. Median levels of PK, MK-4 and MK-7 were 1·33, 0 and 6·99 ng/ml, showing that MK-7 was the dominant vitamin K in this population. MK-7 showed a significant inverse correlation with uncarboxylated osteocalcin (ucOC, P = 0·014), protein induced by vitamin K absence of antagonist-2 (PIVKA-2, P = 0·013), intact parathyroid hormone (P = 0·007) and bone-specific alkaline phosphatase (P = 0·018). CAC showed an inverse correlation with total circulating uncarboxylated matrix Gla protein (t-ucMGP, P = 0·018) and Hb (P = 0·05), and a positive correlation with age (P < 0·001), creatinine, collagen type 1 cross-linked N-terminal telopeptide (NTX, P = 0·03), pulse wave velocity (P < 0·001) and osteoprotegerin (P < 0·001). However, CAC did not have a significant correlation with plasma levels of PK, MK-4 or MK-7. In conclusion, plasma MK-7, MK-4 or PK level did not show significant correlation with CAC despite the association between plasma vitamin K levels and vitamin K-dependent proteins such as ucOC or PIVKA-2.

  9. Prevalence and predictors of coronary artery disease in patients with a calcium score of zero.

    PubMed

    de Carvalho, Maria Salomé Leal; de Araújo Gonçalves, Pedro; Garcia-Garcia, Hector M; de Sousa, Pedro Jerónimo; Dores, Helder; Ferreira, António; Cardim, Nuno; Carmo, Miguel Mota; Aleixo, Ana; Mendes, Miguel; Machado, Francisco Pereira; Roquette, José; Marques, Hugo

    2013-12-01

    The absence of coronary calcification is associated with an excellent prognosis. However, a calcium score of zero does not exclude the presence of coronary artery disease (CAD) or the possibility of future cardiovascular events. Our aim was to study the prevalence and predictors of coronary artery disease in patients with a calcium score of zero. Prospective registry consisted of 3,012 consecutive patients that underwent cardiac CT (dual source CT). Stable patients referred for evaluation of possible CAD that had a calcium score of zero (n = 864) were selected for this analysis. The variables that were statistically significant were included in a multivariable logistic regression model. From 864 patients with a calcium score of zero, 107 (12.4%) had coronary plaques on the contrast CT (10.8%, n = 93 with nonobstructive CAD and 1.6%, n = 14 with obstructive CAD). By logistic regression analysis, the independent predictors of CAD in this population were age >55 years [odds ratio (OR) 1.63 (1.05-2.52)], hypertension [OR 1.64 (1.05-2.56)] and dyslipidemia [OR 1.54 (1.00-2.36)]. In the presence of these 3 variables, the probability of having coronary plaques was 21%. The absence of coronary artery calcification does not exclude the presence of coronary artery disease, but the prevalence of obstructive disease is very low. In this population, the independent predictors of CAD in the setting of a calcium score of zero were hypertension, dyslipidemia, and age above 55 years. In the presence of these 3 predictors, the probability of having CAD was almost 2 times higher than in the general population.

  10. Higher mineralized bone volume is associated with a lower plain X-Ray vascular calcification score in hemodialysis patients.

    PubMed

    Adragao, Teresa; Ferreira, Anibal; Frazao, Joao M; Papoila, Ana Luisa; Pinto, Iola; Monier-Faugere, Marie-Claude; Malluche, Hartmut H

    2017-01-01

    In dialysis patients, there is an increasing evidence that altered bone metabolism is associated with cardiovascular calcifications. The main objective of this study was to analyse, in hemodialysis patients, the relationships between bone turnover, mineralization and volume, evaluated in bone biopsies, with a plain X-ray vascular calcification score. In a cross-sectional study, bone biopsies and evaluation of vascular calcifications were performed in fifty hemodialysis patients. Cancellous bone volume, mineralized bone volume, osteoid volume, activation frequency, bone formation rate/bone surface, osteoid thickness and mineralization lag time were determined by histomorphometry. Vascular calcifications were assessed by the simple vascular calcification score (SVCS) in plain X-Ray of pelvis and hands and, for comparison, by the Agatston score in Multi-Slice Computed Tomography (MSCT). SVCS≥3 was present in 20 patients (40%). Low and high bone turnover were present in 54% and 38% of patients, respectively. Low bone volume was present in 20% of patients. In multivariable analysis, higher age (p = 0.015) and longer hemodialysis duration (p = 0.017) were associated with SVCS≥3. Contrary to cancellous bone volume, the addition to this model of mineralized bone volume (OR = 0.863; 95%CI: 0.766, 0.971; p = 0.015), improved the performance of the model. For each increase of 1% in mineralized bone volume there was a 13.7% decrease in the odds of having SVCS≥3 (p = 0.015). An Agatston score>400 was observed in 80% of the patients with a SVCS≥3 versus 4% of patients with a SVCS<3, (p<0.001). Higher mineralized bone volume was associated with a lower plain X-ray vascular calcification. This study corroborates the hypothesis of the existence of a link between bone and vessel and reinforces the clinical utility of this simple and inexpensive vascular calcification score in dialysis patients.

  11. Autosomal genome-wide scan for coronary artery calcification loci in sibships at high risk for hypertension.

    PubMed

    Lange, Leslie A; Lange, Ethan M; Bielak, Lawrence F; Langefeld, Carl D; Kardia, Sharon L; Royston, Patrick; Turner, Stephen T; Sheedy, Patrick F; Boerwinkle, Eric; Peyser, Patricia A

    2002-03-01

    Coronary artery disease (CAD) is the leading cause of mortality in the developed world. Although several CAD risk factors, including measures of lipid metabolism, obesity, and blood pressure, have a genetic basis, many genes for CAD susceptibility have yet to be identified. Coronary atherosclerosis is the major cause of CAD, but many with coronary atherosclerosis lack symptoms. Thus, a major limitation of using symptomatic CAD endpoints (eg, sudden coronary death, myocardial infarction) as a study outcome is substantial disease misclassification. Coronary artery calcification (CAC) is part of the atherosclerotic process and is an independent predictor of CAD endpoints. In the present study, CAC was noninvasively quantified by electron beam computed tomography. We performed genome-wide multipoint mode-of-inheritance-free linkage analysis on affected sib pairs, defined as being > or = the 70th sex- and age-specific percentile for CAC quantity, in a sample of 29 families enriched for hypertension. Almost 95% of participants were asymptomatic for CAD. Our LOD score (log10 odds in favor of linkage) results provide evidence that chromosomal regions 6p21.3 (maximum LOD score=2.22, P=0.00070) and 10q21.3 (maximum LOD score=3.24, P=0.000057) may harbor genes associated with subclinical coronary atherosclerosis.

  12. U-shaped relationship between insulin level and coronary artery calcification (CAC).

    PubMed

    Tanaka, Muhei; Fukui, Michiaki; Tomiyasu, Ki-ichiro; Akabame, Satoshi; Nakano, Koji; Hasegawa, Goji; Oda, Yohei; Nakamura, Naoto

    2010-10-27

    Recent studies have suggested that hyperinsulinemia is associated with high cardiovascular risk. The purpose of this study was to assess the relationship between the serum insulin level and coronary artery calcification (CAC). We performed a cross-sectional study of 582 consecutive and nondiabetic participants with clinical suspicion of coronary heart disease, and assessed the CAC score determined by multislice computed tomography. A standard 75-g oral glucose tolerance test was performed and venous blood was collected at 0, 30, 60 and 120 min for the measurement of plasma glucose and serum insulin. Statistical analyses were conducted for 4 subgroups according to fasting insulin and insulin area under the concentration time curve (InsAUC). Mean log (CAC+1) and InsAUC were 1.6 and 109.1 µIU/mL, respectively. Unadjusted analysis demonstrated that the fasting insulin quartiles (p=0.0256) and InsAUC quartiles (p<0.0001) were significantly associated with log (CAC+1), and the lowest fasting insulin quartiles (p<0.0001) and the lowest InsAUC quartile (p=0.0006) had lower glucose AUC. Analysis of covariance demonstrated that the lowest InsAUC quartile had the highest log (CAC+1), and the highest InsAUC quartile had a higher log (CAC+1) than the second and third InsAUC quartiles, adjusted for several coronary risk factors (p<0.0001). The lowest InsAUC quartile was related to CAC, although the lowest InsAUC quartile maintained glucose homeostasis, in this study population. Not only hyperinsulinemia but also a low insulin level are independently associated with CAC.

  13. Genetics of coronary artery calcification among African Americans, a meta-analysis

    PubMed Central

    2013-01-01

    Background Coronary heart disease (CHD) is the major cause of death in the United States. Coronary artery calcification (CAC) scores are independent predictors of CHD. African Americans (AA) have higher rates of CHD but are less well-studied in genomic studies. We assembled the largest AA data resource currently available with measured CAC to identify associated genetic variants. Methods We analyzed log transformed CAC quantity (ln(CAC + 1)), for association with ~2.5 million single nucleotide polymorphisms (SNPs) and performed an inverse-variance weighted meta-analysis on results for 5,823 AA from 8 studies. Heritability was calculated using family studies. The most significant SNPs among AAs were evaluated in European Ancestry (EA) CAC data; conversely, the significance of published SNPs for CAC/CHD in EA was queried within our AA meta-analysis. Results Heritability of CAC was lower in AA (~30%) than previously reported for EA (~50%). No SNP reached genome wide significance (p < 5E-08). Of 67 SNPs with p < 1E-05 in AA there was no evidence of association in EA CAC data. Four SNPs in regions previously implicated in CAC/CHD (at 9p21 and PHACTR1) in EA reached nominal significance for CAC in AA, with concordant direction. Among AA, rs16905644 (p = 4.08E-05) had the strongest association in the 9p21 region. Conclusions While we observed substantial heritability for CAC in AA, we failed to identify loci for CAC at genome-wide significant levels despite having adequate power to detect alleles with moderate to large effects. Although suggestive signals in AA were apparent at 9p21 and additional CAC and CAD EA loci, overall the data suggest that even larger samples and an ethnic specific focus will be required for GWAS discoveries for CAC in AA populations. PMID:23870195

  14. Serum magnesium is inversely associated with coronary artery calcification in the Genetics of Atherosclerotic Disease (GEA) study.

    PubMed

    Posadas-Sánchez, Rosalinda; Posadas-Romero, Carlos; Cardoso-Saldaña, Guillermo; Vargas-Alarcón, Gilberto; Villarreal-Molina, María Teresa; Pérez-Hernández, Nonanzit; Rodríguez-Pérez, José Manuel; Medina-Urrutia, Aida; Jorge-Galarza, Esteban; Juárez-Rojas, Juan Gabriel; Torres-Tamayo, Margarita

    2016-03-01

    Serum magnesium is inversely associated to coronary artery calcification (CAC) in patients with chronic kidney disease. There is little information on this association in a general healthy population. The aim of this study was to examine the cross-sectional association of serum magnesium levels with CAC. We included 1276 Mexican-mestizo subjects (50 % women), aged 30-75 years, free of symptomatic cardiovascular disease. CAC was quantified by multidetector computed tomography using the method described by Agatston. Cross-sectional associations of serum magnesium with cardiometabolic factors and subclinical atherosclerosis defined as a CAC score > 0, were examined in logistic regression models adjusted for age, sex, education, smoking status, body mass index, systolic blood pressure, physical activity, elevated abdominal visceral tissue, fasting insulin and glucose, alcohol consumption, menopausal status (women only), low (LDL-C) and high density lipoprotein cholesterol (HDL-C), triglycerides, diuretic use, type 2 diabetes mellitus (DM2), and family history of DM2. After full adjustment, subjects in the highest quartile of serum magnesium had 48 % lower odds of hypertension (p = 0.028), 69 % lower odds of DM2 (p = 0.003), and 42 % lower odds of CAC score > 0 (p = 0.016) compared to those with the lowest serum magnesium. The analyses also showed that a 0.17 mg/dL (1SD) increment in serum magnesium was independently associated with 16 % lower CAC (OR 0.84, 95 % CI 0.724-0.986). In a sample of Mexican-mestizo subjects, low serum magnesium was independently associated to higher prevalence not only of hypertension and DM2, but also to coronary artery calcification, which is a marker of atherosclerosis and a predictor of cardiovascular morbidity and mortality.

  15. Calcification of arteries supplying the gastric tube increases the risk of anastomotic leakage after esophagectomy with cervical anastomosis

    PubMed Central

    Zhao, Liang; Zhao, Gefei; Li, Jiagen; Qu, Bin; Shi, Susheng; Feng, Xiaoli; Feng, Hao; Jiang, Jun

    2016-01-01

    Background Anastomotic leak is an important cause of morbidity and mortality after esophagectomy for esophageal cancer patients. Calcification of the arteries supplying the gastric tube has been found to be associated with leakage after esophagectomy with cervical anastomosis in Europeans. The purpose of this study is to evaluate the association between calcifications of the supplying arteries of the gastric tube and the occurrence of anastomotic leakage after esophagectomy with cervical anastomosis in Chinese patients with esophageal cancer. Methods The demographic, clinical, and pathological features as well as the vascular calcification of arteries of 709 esophageal cancer patients who had undergone esophagectomies with cervical anastomosis were analyzed. Univariable and multivariable logistic regression were used to identify the association between the postoperative anastomotic leakage and calcifications of the arteries supplying the gastric tube. Results Among the 709 patients, 122 (17.2%) had developed anastomotic leakage. Thirty-day mortality and length of hospital stay were higher for patients with anastomotic leakage. Upper digestive tract ulcer, peripheral vascular disease, renal insufficiency, American society of Anesthesiologists (ASA) risk class, and calcifications of aorta and celiac axis were found to be independent risk factors for the anastomotic leakage. Conclusions Calcification of the aorta and celiac axis that supply the gastric tube is an independent risk factor for cervical anastomotic leakage after esophagectomy in Chinese esophageal cancer patients. PMID:28149549

  16. A model for quantitative correction of coronary calcium scores on multidetector, dual source, and electron beam computed tomography for influences of linear motion, calcification density, and temporal resolution: a cardiac phantom study.

    PubMed

    Greuter, M J W; Groen, J M; Nicolai, L J; Dijkstra, H; Oudkerk, M

    2009-11-01

    The objective of this study is to quantify the influence of linear motion, calcification density, and temporal resolution on coronary calcium determination using multidetector computed tomography (MDCT), dual source CT (DSCT), and electron beam tomography (EBT) and to find a quantitative method which corrects for the influences of these parameters using a linear moving cardiac phantom. On a robotic arm with artificial arteries with four calcifications of increasing density, a linear movement was applied between 0 and 120 mm/s (step of 10 mm/s). The phantom was scanned five times on 64-slice MDCT, DSCT, and EBT using a standard acquisition protocol. The average Agatston, volume, and mass scores were determined for each velocity, calcification, and scanner. Susceptibility to motion was quantified using a cardiac motion susceptibility (CMS) index. Resemblance to EBT and physical volume and mass was quantified using a Delta index. Increasing motion artifacts were observed at increasing velocities on all scanners, with increasing severity from EBT to DSCT to 64-slice MDCT. The calcium score showed a linear dependency on motion from which a correction factor could be derived. This correction factor showed a linear dependency on the mean calcification density with a good fit for all three scoring methods and all three scanners (0.73 < or = R2 < or = 0.95). The slope and offset of this correction factor showed a linear dependency on temporal resolution with a good fit for all three scoring methods and all three scanners (0.83 < or = R2 < or = 0.98). CMS was minimal for EBT and increasing values were observed for DSCT and highest values for 64-slice MDCT. CMS was minimal for mass score and increasing values were observed for volume score and highest values for Agatston score. For all densities and scoring methods DSCT showed on average the closest resemblance to EBT calcium scores. When using the correction factor, CMS index decreased on average by 15% and Delta index

  17. A model for quantitative correction of coronary calcium scores on multidetector, dual source, and electron beam computed tomography for influences of linear motion, calcification density, and temporal resolution: A cardiac phantom study

    SciTech Connect

    Greuter, M. J. W.; Groen, J. M.; Nicolai, L. J.; Dijkstra, H.; Oudkerk, M.

    2009-11-15

    Purpose: The objective of this study is to quantify the influence of linear motion, calcification density, and temporal resolution on coronary calcium determination using multidetector computed tomography (MDCT), dual source CT (DSCT), and electron beam tomography (EBT) and to find a quantitative method which corrects for the influences of these parameters using a linear moving cardiac phantom. Methods: On a robotic arm with artificial arteries with four calcifications of increasing density, a linear movement was applied between 0 and 120 mm/s (step of 10 mm/s). The phantom was scanned five times on 64-slice MDCT, DSCT, and EBT using a standard acquisition protocol. The average Agatston, volume, and mass scores were determined for each velocity, calcification, and scanner. Susceptibility to motion was quantified using a cardiac motion susceptibility (CMS) index. Resemblance to EBT and physical volume and mass was quantified using a {Delta} index. Results: Increasing motion artifacts were observed at increasing velocities on all scanners, with increasing severity from EBT to DSCT to 64-slice MDCT. The calcium score showed a linear dependency on motion from which a correction factor could be derived. This correction factor showed a linear dependency on the mean calcification density with a good fit for all three scoring methods and all three scanners (0.73{<=}R{sup 2}{<=}0.95). The slope and offset of this correction factor showed a linear dependency on temporal resolution with a good fit for all three scoring methods and all three scanners (0.83{<=}R{sup 2}{<=}0.98). CMS was minimal for EBT and increasing values were observed for DSCT and highest values for 64-slice MDCT. CMS was minimal for mass score and increasing values were observed for volume score and highest values for Agatston score. For all densities and scoring methods DSCT showed on average the closest resemblance to EBT calcium scores. When using the correction factor, CMS index decreased on average by

  18. Serum uric acid is associated with coronary artery calcification.

    PubMed

    Grossman, Chagai; Shemesh, Joseph; Koren-Morag, Nira; Bornstein, Gil; Ben-Zvi, Ilan; Grossman, Ehud

    2014-06-01

    Uric acid (UA) is associated with atherosclerosis, and coronary artery calcium (CAC) is a marker of atherosclerosis. The authors studied the association between UA and CAC. A total of 663 asymptomatic patients (564 men; mean age, 55±7 years) were evaluated for the presence of CAC. The study population was divided into three tertiles according to their UA levels, and the prevalence of CAC was compared between the tertiles. CAC was detected in 349 (53%) patients. Levels of UA were significantly higher in those with CAC than in those without CAC (5.6+1.2 vs 5.3+1.3; P=.003). The odds ratio for the presence of CAC in the highest vs lowest UA tertile was 1.72 (95% confidence interval, 1.17-2.51). The highest UA tertile remained associated with the presence of CAC after adjustment for known cardiovascular risk factors. The results show that high serum UA levels are associated with the presence of CAC.

  19. Idiopathic Infantile Arterial Calcification: A Rare Cause of Sudden Unexpected Death in Childhood

    PubMed Central

    Guimarães, Susana; Lopes, José Manuel; Oliveira, José Bessa; Santos, Agostinho

    2010-01-01

    Unexpected child death investigation is a difficult area of forensic practice in view of the wide range of possible genetic, congenital, and acquired natural and nonnatural causes. Idiopathic infantile arterial calcification (IIAC) is a rare autosomic recessive disease usually diagnosed postmortem. Inactivating mutations of the ENPP1 gene were described in 80% of the cases with IIAC. We report a case of a 5-year-old girl submitted to a forensic autopsy due to sudden death and possible medical negligence/parents child abuse. Major alterations found (intimal proliferation and deposition of calcium hydroxyapatite around the internal elastic lamina and media of arteries; acute myocardial infarct, stenotic and calcified coronary artery; perivascular and interstitial myocardial fibrosis; and subendocardial fibroelastosis) were diagnostic of IIAC. We reviewed IIAC cases published in the English literature and highlight the importance of adequate autopsy evaluation in cases of sudden child death. PMID:21151691

  20. Circulating matrix Gla protein is associated with coronary artery calcification and vitamin K status in healthy women.

    PubMed

    Dalmeijer, Geertje W; van der Schouw, Yvonne T; Vermeer, Cees; Magdeleyns, Elke J; Schurgers, Leon J; Beulens, Joline W J

    2013-04-01

    Matrix Gla protein (MGP) is a vitamin K-dependent protein and an inhibitor of vascular calcification. Vitamin K is required for the carboxylation of MGP and can thereby reduce calcification. Circulating MGP species with different conformations have been investigated as markers for coronary artery calcification (CAC). In high-risk populations, high total uncarboxylated MGP (t-ucMGP) was associated with decreased CAC, while high non-phosphorylated uncarboxylated MGP (dp-ucMGP) was associated with a poor vitamin K status. This cross-sectional study investigated the association of MGP species with CAC, vitamin K status among 200 healthy women. Circulating dp-ucMGP, t-ucMGP and, non-phosphorylated carboxylated MGP (dp-cMGP) levels were measured by ELISA techniques and Agatston score by multi-detector computed tomography. The ratio of uncarboxylated to carboxylated osteocalcin was used as proxy of vitamin K status. A borderline significant (P=.06) association between higher circulating dp-ucMGP levels and high CAC was observed (β=0.091, 95% CI-0.01; 0.19). In the entire study population, high t-ucMGP levels tended to be associated (P=.09) with lower CAC (β=-0.36, 95% CI:-0.78; 0.06). This association strengthened amongst women with CAC to a significant relation between high t-ucMGP levels and lower CAC (β=-0.55, 95% CI-1.01;-0.10). Dp-cMGP was not associated with CAC. Low vitamin K-status was associated with high dp-ucMGP concentrations (β=0.138, 95% CI 0.09; 0.19) but not with other MGP species. These results show that dp-ucMGP may serve as a biomarker of vitamin K status. Circulating dp-ucMGP and t-ucMGP may serve as markers for the extent of CAC, but these findings need to be confirmed.

  1. Analyzing coronary artery disease in patients with low CAC scores by 64-slice MDCT.

    PubMed

    Lu, Nan-Han; Yeh, Lee-Ren; Chen, Tai-Been; Huang, Yung-Hui; Kuo, Chung-Ming; Ding, Hueisch-Jy

    2012-01-01

    Coronary artery calcification (CAC) scores are widely used to determine risk for Coronary Artery Disease (CAD). A CAC score does not have the diagnostic accuracy needed for CAD. This work uses a novel efficient approach to predict CAD in patients with low CAC scores. The study group comprised 86 subjects who underwent a screening health examination, including laboratory testing, CAC scanning, and cardiac angiography by 64-slice multidetector computed tomographic angiography. Eleven physiological variables and three personal parameters were investigated in proposed model. Logistic regression was applied to assess the sensitivity, specificity, and accuracy of when using individual variables and CAC score. Meta-analysis combined physiological and personal parameters by logistic regression. The diagnostic sensitivity of the CAC score was 14.3% when the CAC score was ≤30. Sensitivity increased to 57.13% using the proposed model. The statistically significant variables, based on beta values and P values, were family history, LDL-c, blood pressure, HDL-c, age, triglyceride, and cholesterol. The CAC score has low negative predictive value for CAD. This work applied a novel prediction method that uses patient information, including physiological and society parameters. The proposed method increases the accuracy of CAC score for predicting CAD.

  2. Effect modification of obesity on associations between endogenous steroid sex hormones and arterial calcification in women at midlife.

    PubMed

    El Khoudary, Samar R; Wildman, Rachel P; Matthews, Karen; Powell, Lynda; Hollenberg, Steven M; Edmundowicz, Daniel; Sutton-Tyrrell, Kim

    2011-08-01

    The aim of this study was to examine whether obesity modifies the effects of endogenous steroid sex hormones on arterial calcification in women at midlife. Associations between estradiol, testosterone, sex hormone-binding globulin, and free androgen index and the presence and extent of coronary and aortic calcification were evaluated in 187 obese (body mass index, ≥30 kg/m) and 281 nonobese (body mass index, <30 kg/m) women from the Study of Women's Health Across the Nation. Logistic and linear regressions were used as appropriate. Prevalence rates of coronary and aortic calcification were significantly higher among obese compared with nonobese women (P < 0.001, for both). In multivariable analyses, steroid sex hormones were not associated with the presence of coronary calcification. However, for the extent of coronary calcification, significant interactions were found between obesity and both sex hormone-binding globulin (P < 0.0001) and free androgen index (P = 0.008). In nonobese women, higher sex hormone-binding globulin (P = 0.0006) and lower free androgen index (P = 0.01) were associated with a greater extent of coronary calcification, whereas lower sex hormone-binding globulin was associated with greater extent of coronary calcification in obese women (P = 0.05). For aortic calcification outcomes, higher sex hormone-binding globulin was associated with the presence of aortic calcification among nonobese women (odds ratio, 1.64; 95% CI, 1.16-2.32, for each 1-SD greater sex hormone-binding globulin). Associations between endogenous steroid sex hormones and arterial calcification vary by obesity status among perimenopausal women. Further research is needed to better understand the possible mechanisms of these associations.

  3. Serum Urate Is Not Associated with Coronary Artery Calcification: The NHLBI Family Heart Study

    PubMed Central

    NEOGI, TUHINA; TERKELTAUB, ROBERT; ELLISON, R. CURTIS; HUNT, STEVEN; ZHANG, YUQING

    2011-01-01

    Objective Urate may have effects on vascular remodeling and atherosclerosis. We had shown an association between serum uric acid (SUA) and carotid atherosclerotic plaques. Inflammation and vascular remodeling in atherosclerosis promote coronary artery calcification (CAC), a preclinical marker for atherosclerosis. Here, we examined whether SUA is associated with CAC, using the same study sample and methods as for our previous carotid atherosclerosis study. Methods The National Heart, Lung, and Blood Institute Family Heart Study is a multicenter study designed to assess risk factors for heart disease. Participants were recruited from population-based cohorts in the US states of Massachusetts, North Carolina, Minnesota, Utah, and Alabama. CAC was assessed with helical computed tomography (CT). We conducted sex-specific and family-cluster analyses, as well as additional analyses among persons without risk factors related to both cardiovascular disease and hyperuricemia, adjusting for potential confounders as we had in the previous study of carotid atherosclerosis. Results For the CAC study, 2412 subjects had both SUA and helical CT results available (55% women, age 58 ± 13 yrs, body mass index 27.6 ± 5.3). We found no association of SUA with CAC in men or women [OR in men: 1.0, 1.11, 0.86, 0.90; women: 1.0, 0.83, 1.00, 0.87 for increasing categories of SUA: < 5 (referent group), 5 to < 6, 6 to < 6.8, ≥ 6.8 mg/dl, respectively], nor in subgroup analyses. Conclusion Replicating the methods used to demonstrate an association of SUA with carotid atherosclerosis did not reveal any association between SUA and CAC, suggesting that SUA likely does not contribute to atherosclerosis through effects on arterial calcification. The possibility that urate has divergent pathophysiologic effects on atherosclerosis and artery calcification merits further study. PMID:20889594

  4. Arterial media calcification in end-stage renal disease: impact on all-cause and cardiovascular mortality.

    PubMed

    London, Gérard M; Guérin, Alain P; Marchais, Sylvain J; Métivier, Fabien; Pannier, Bruno; Adda, Hasan

    2003-09-01

    Cross-sectional and follow-up studies on end-stage renal disease patients showed that arterial calcifications are associated with cardiovascular (CV) morbidity and are an independent predictor of all-cause and CV mortality. However, these studies did not examine the impact on prognosis according to the type of calcification, i.e. intimal vs medial. Arterial media calcification (AMC), a non-occlusive condition, affects haemodynamics differently from arterial intima calcification (AIC), which occurs in atherosclerotic plaques. The aim of this study was to investigate the prognostic value of AMC in relationship to all-cause or CV mortality for stable haemodialysis (HD) patients. We included 202 such patients in the present study. At baseline, soft-tissue native radiograms of the pelvis and the thigh were analysed for the presence and type (AMC vs AIC) of arterial calcifications. All patients underwent B-mode ultrasonography of the common carotid artery to determine the presence of atherosclerotic calcified plaques, measurement of aortic pulse wave velocity and echocardiography. AIC was usually observed in older patients with a clinical history of atherosclerosis before starting HD treatment and typical risk factors associated with atherosclerotic disease. AMC was observed in young and middle-aged patients without conventional atherosclerotic risk factors. AMC was closely associated with the duration of HD and calcium-phosphate disorders, including the oral dose of elemental calcium prescribed as phosphate binder (CaCO(3)). Compared to patients with AIC, patients with AMC had a longer survival, but in turn their survival was significantly shorter than that of patients without calcifications. AMC is a strong prognostic marker of all-cause and CV mortality in HD patients, independently of classical atherogenic factors. The principal effect of AMC on arterial function is increased arterial stiffness.

  5. Gender Specific Association between Serum Fibroblast Growth Factor 23/α-Klotho and Coronary Artery and Aortic Valve Calcification.

    PubMed

    Morita, Hideaki; Takeda, Yoshihiro; Fujita, Shu-ichi; Okamoto, Yusuke; Sakane, Kazushi; Teramoto, Kunihiro; Ozeki, Michishige; Tasaki, Ryunosuke; Kizawa, Shun; Sohmiya, Koichi; Hoshiga, Masaaki; Ishizaka, Nobukazu

    2015-01-01

    Fibroblast growth factor 23 (FGF23) and α-Klotho have been recently identified to play a crucial role in calcium/phosphate metabolism. We herein investigated the possible relation between serum FGF23/α-Klotho levels and coronary artery calcification (CAC) and aortic valve calcification (AVC). Among subjects with diagnosed or suspected coronary artery disease (CAD), CAC and AVC were estimated via the Agatston score of 320-detector computed tomography images, and serum FGF23 and α-Klotho levels were measured. In total, 157 subjects were enrolled (75 women and 82 men). We performed logistic regression using CAC as a dependent variable; the highest FGF23 tertile (> 52.5 pg/mL) was significantly positively associated with CAC with an odds ratio of 6.61 versus the lowest FGF23 tertile (< 35.3 pg/mL) in women after the adjustment for potential confounding variables including age, renal function, hypertension, statin use, diuretic use, and calcium/phosphate metabolism related factors. In addition, the highest α-Klotho tertile (> 561 pg/mL) was significantly associated with AVC with an odds ratio of 6.31 versus the lowest α-Klotho tertile (< 306 pg/mL) in men after adjusting for the same variables. On the other hand, the association between FGF23 and CAC/AVC in men or that between α-Klotho and CAC/AVC in women was nonsignificant. Among subjects with diagnosed or suspected CAD, serum FGF23 was positively associated with CAC in women and serum α-Klotho was positively associated with AVC in men independent of the confounding variables, including the renal function and calcium/phosphate metabolism-related factors.

  6. A Preoperative Assessment of Significant Coronary Stenosis Based on a Semiquantitative Analysis of Coronary Artery Calcification on Noncontrast Computed Tomography in Aortic Stenosis Patients Undergoing Aortic Valve Replacement

    PubMed Central

    Hwang, Ji-Won; Kim, Sung Mok; Park, Sung-Ji; Cho, Eun Jeong; Lee, Sans-Chol; Choe, Yeon Hyeon; Park, Seung Woo

    2016-01-01

    Abstract Invasive coronary angiography (ICA) is the recommended assessment for coronary artery disease in patients undergoing elective aortic valve replacement (AVR). Noncontrast computed tomography (CT) is useful for evaluating lung lesions and calcifications at the cannulation site of the ascending aorta. The purpose of this study was to evaluate the role of noncontrast CT in the visual assessment of coronary artery calcification (CAC) in patients undergoing AVR. We retrospectively identified patients with significant aortic stenosis (AS) who were referred for AVR between January 2006 and December 2013. Among these, we included 386 patients (53.6% males, 69.2 ± 8.4 years) who underwent both noncontrast CT and ICA. Significant coronary artery stenosis (CAS) in the ICA was defined as luminal stenosis ≥70%. The 4 main coronary arteries were visually assessed on noncontrast CT and were scored based on the Weston score as follows: 0, no visually detected calcium; 1, a single high-density pixel detected; 3, calcium was dense enough to create a blooming artifact; and 2, calcium in between 1 and 3. Four groups were reclassified by the sum of the Weston scores from each vessel, as follows: noncalcification (0); mild calcification (1–4); moderate calcification (5–8); and severe calcification (9–12). Receiver-operating characteristic (ROC) analysis was generated to identify the cutoff Weston score values for predicting significant CAS. Diagnostic estimates were calculated based on these cutoffs. In the ICA analysis, 62 of the 386 patients (16.1%) had significant CAS. All patients were divided into 4 groups. The noncalcification group had 97 subjects (Weston score 0), the mild degree group had 100 (2.6 ± 1.0), the moderate calcification group had 114 (6.6 ± 1.1), and the severe calcification group had 75 (10.7 ± 1.1). The prevalence of significant CAS in the noncalcification, mild, moderate, and severe groups was 1% (1/97), 5% (5/100), 24% (27

  7. An evaluation of automatic coronary artery calcium scoring methods with cardiac CT using the orCaScore framework.

    PubMed

    Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; Coatrieux, Jean-Louis; Kelm, B Michael; Kondo, Satoshi; Salgado, Rodrigo A; Shahzad, Rahil; Shu, Huazhong; Snoeren, Miranda; Takx, Richard A P; van Vliet, Lucas J; van Walsum, Theo; Willems, Tineke P; Yang, Guanyu; Zheng, Yefeng; Viergever, Max A; Išgum, Ivana

    2016-05-01

    The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular disease (CVD) events. In clinical practice, CAC is manually identified and automatically quantified in cardiac CT using commercially available software. This is a tedious and time-consuming process in large-scale studies. Therefore, a number of automatic methods that require no interaction and semiautomatic methods that require very limited interaction for the identification of CAC in cardiac CT have been proposed. Thus far, a comparison of their performance has been lacking. The objective of this study was to perform an independent evaluation of (semi)automatic methods for CAC scoring in cardiac CT using a publicly available standardized framework. Cardiac CT exams of 72 patients distributed over four CVD risk categories were provided for (semi)automatic CAC scoring. Each exam consisted of a noncontrast-enhanced calcium scoring CT (CSCT) and a corresponding coronary CT angiography (CCTA) scan. The exams were acquired in four different hospitals using state-of-the-art equipment from four major CT scanner vendors. The data were divided into 32 training exams and 40 test exams. A reference standard for CAC in CSCT was defined by consensus of two experts following a clinical protocol. The framework organizers evaluated the performance of (semi)automatic methods on test CSCT scans, per lesion, artery, and patient. Five (semi)automatic methods were evaluated. Four methods used both CSCT and CCTA to identify CAC, and one method used only CSCT. The evaluated methods correctly detected between 52% and 94% of CAC lesions with positive predictive values between 65% and 96%. Lesions in distal coronary arteries were most commonly missed and aortic calcifications close to the coronary ostia were the most common false positive errors. The majority (between 88% and 98%) of correctly identified CAC lesions were assigned to the correct artery. Linearly weighted Cohen's kappa

  8. Progression of coronary artery calcification at the crossroads: sign of progression or stabilization of coronary atherosclerosis?

    PubMed Central

    Carrascosa, Patricia; Bruining, Nico

    2016-01-01

    Coronary artery calcification (CAC) has been strongly established as an independent predictor of adverse events, with a significant incremental prognostic value over traditional risk stratification algorithms. CAC progression has been associated with a higher rate of events. In parallel, several randomized studies and meta-analysis have shown the effectiveness of statins to slow progression and even promote plaque regression. However, evidence regarding the effect of routine medical therapy on CAC has yielded conflicting results, with initial studies showing significant CAC regression, and contemporaneous data showing rather the opposite. Accordingly, there is currently a great controversy on whether progression of CAC is a sign of progression or stabilization of coronary artery disease (CAD). The finding of inexorable CAC progression despite the implementation of intensive contemporaneous medical therapy suggests that further understanding of this phenomenon should be undertaken before the implementation of CAC as a surrogate endpoint for longitudinal studies, or for prospective follow-up of patients under routine medical treatment. PMID:27280088

  9. [Vascular smooth muscle cells from human umbilical artery undergo osteoblast differentiation and calcification in vitro].

    PubMed

    Guo, Yong Ping; Sun, Ming Shu; Qian, Jia Qi; Ni, Zhao Hui

    2008-04-01

    To research if the vascular smooth muscle cells (VSMCs) from human umbilical artery undergo osteoblast differentiation spontaneously in vitro. The growth curve of vascular smooth muscle cells from human umbilical artery was obtained by MTT method. The course of multicell nodule formation spontaneously by VSMCs was observed morphologically. The apoptosis of VSMCs in the nodules was detected by Hoechst 33258 and TUNEL methods respectively. The expression of alkaline phosphotase in the nodules was detected by immunohistochemical method. And the calcification was studied with transmission electron microscope and by alizarin red S respectively. We found that the umbilical artery smooth muscle cells confluenced after 7 days of passage and exhibited typical "hill and valley" pattern under light microscope. The cells grew into aggregation and formed nodules at the "hill" region with culture-time prolongation. After 4-5 weeks culture, these nodules built up and calcified spontaneously. We also found alkaline phosphotase expression and apoptosis of VSMCs in these nodules at the same time. We conclude that the vascular smooth muscle cells from human umbilical artery just like from aortic artery can undergo osteoblast differentiation spontaneously in vitro, and apoptosis participate this procedure probably.

  10. Detection of common carotid artery calcifications on panoramic radiographs: prevalence and reliability

    PubMed Central

    Alves, Nilton; Deana, Naira F; Garay, Ivonne

    2014-01-01

    The aim of this study was to determine the prevalence of common carotid artery calcifications (CCAC) detected by panoramic radiographs (PR) in the population and main risk factors with review of the literature. Furthermore, the reliability of PR was verified to detect these calcifications. CCAC detected on PR was powerful markers for future cardiovascular or cerebrovascular events. We found that the prevalence of CCAC identified by PR may range from 0.43% to 9.4%, depending on the age and lifestyle of the population studied. In individuals with systemic diseases the prevalence was higher than in the general population, reaching up to 38.8%. The radiopaque masses compatible with CCAC identified by PR were more common in women and occurred unilaterally or both sides, without preference for one or the other. According to the literature reviewed PR had low sensitivity and acceptable accuracy for detecting CCAC. We conclude that calcified atheroma in the common carotid artery can be demonstrated in PR, and this is an important tool for early detection of CCAC. However, it is always necessary to refer the patient to a cardiology service to confirm the findings, determine the real extent of the disease and establish its corresponding treatment. PMID:25232373

  11. Evaluating the Association between Breast Arterial Calcification and Carotid Plaque Formation

    PubMed Central

    Yağtu, Mehmet

    2015-01-01

    Objective We aimed to evaluate the association between breast arterial calcification (BAC) and carotid plaque formation. Materials and Methods The study group comprised 47 consecutive BAC (+) women, whereas the control group comprised 33 BAC (−) women (total, 80 women). All mammograms were examined by a specialist without being any apartheid that it was come from central or not. For the exist and density of calcification was used classification method. When we evaluate carotid arterial plaque with Doppler US used scale method. For analyzing categorical variables, we used chi-square test, and for numeric variables, we used independent t-test. Results As nearly all BAC+ women had all types of carotid plaques, weighted of them was found that they were fatty plaque type (n=13 %46.4). Only one BAC+ patient was grade 2 and had no carotid plaques (n=1 %3.6). MAK– patients had nearly no plaque types. Conclusion Breast cancer mammographic evaluation is an already important, cheap, and simple imaging method. In our study, we report a similar cheap, simple method that can be useful for evaluating atherothrombotic atherosclerosis, which is the most important cause of ischemic infarct.

  12. Aortic arch calcification on chest X-ray combined with coronary calcium score show additional benefit for diagnosis and outcome in patients with angina

    PubMed Central

    Woo, Jong Shin; Kim, Weon; Kwon, Se Hwan; Youn, Hyo Chul; Kim, Hyun Soo; Kim, Jin Bae; Kim, Soo Joong; Kim, Woo-Shik; Kim, Kwon Sam

    2016-01-01

    Background The coronary artery calcium (CAC) and aortic arch calcification (AoAC) are individually associated with cardiovascular disease and outcome. This study investigated the predictive value of AoAC combined with CAC for cardiovascular diagnosis and outcome in patients with angina. Methods A total of 2018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for four years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0 to 3. Results During the four years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A higher grade of AoAC was associated with a higher CAC score. Cox regression showed that the CAC score, but not AoAC, were associated with adverse events. In patients with CAC score < 400, AoAC showed an additive predictive value in detecting significant coronary artery disease (CAD). A gradual increases in the risk of adverse events were noted if AoAC was present in patients with similar CAC score. Conclusions As AoAC is strongly correlated with the CAC score regardless of age or gender, careful evaluation of CAD would be required in patients with AoAC on conventional chest X-rays. PMID:27103916

  13. Diagnostic Efficacy of Vessel Specific Coronary Calcium Score in Detection of Coronary Artery Stenosis

    PubMed Central

    Motevalli, Marzieh; Ghanaati, Hossein; Firouznia, Kavous; Kargar, Jalal; Aliyari Ghasabeh, Mounes; Shahriari, Mona; Jalali, Amir Hosein; Shakiba, Madjid

    2014-01-01

    Background: Coronary artery calcification which is determined quantitatively by coronary calcium scoring has been known as a sign of coronary stenosis and thus future cardiac events; hence it has been noticed on spotlight of researchers in recent years. Developing different method for early and optimal detection of coronary artery disease (CAD) is really essential as CAD are the first cause of death in population. Objectives: To evaluate predictive value of vessel specific coronary artery calcium (CAC) score in predicting obstructive coronary artery disease. Patients and Methods: In this diagnostic test study we evaluated patients with coronary computed tomography angiography (CCTA) and CAC score which had been referred to two referral radiology center in Tehran, Iran and finally we selected 2525 patients in a single and sequential pattern to create a diagnostic study. The whole-heart CAC scores and vessel specific CAC scores were calculated individually for the 4 major epicardial coronary arteries in 2 distinct group; group A ( patients with previous history of CABG) and group B (patients without history of CABG). For evaluation of obstruction tree cut off points were described: 0 > ; at least 1 segment with any kind of stenosis, ≥ 50; at least 1 segment with stenosis ≥ 50, ≥ 70; at least 1 segment with stenosis ≥ 70. Results: Mean of coronary calcium scores in terms of each coronary artery vessel increase by increasing coronary stenosis grade in group B; LAD, RCA, LCX respectively have mean CAC score 6.06, 6.21 and 5.04 in normal patients and 221.6, 226.7 and 106.6 in patients with complete stenosis. As expected these findings don't work for group A. Also By increasing calcium score cutoff in all four vessels sensitivity decreased and specificity increased but steal LAD had higher sensitivity than other vessels and LM had higher specificity. Thus using calcium score method is useful for ruling out stenosis in LAD while calcium score of LM can predict

  14. Coronary artery calcification and family history of myocardial infarction in the Dallas heart study.

    PubMed

    Paixao, Andre R M; Berry, Jarett D; Neeland, Ian J; Ayers, Colby R; Rohatgi, Anand; de Lemos, James A; Khera, Amit

    2014-07-01

    This study aimed to investigate the independent and joint associations between family history of myocardial infarction (FH) and coronary artery calcification (CAC) with incident coronary heart disease (CHD). FH and CAC are associated with each other and with incident CHD. It is not known whether FH retains its predictive value after CAC results are accounted for. Among 2,390 participants without cardiovascular disease enrolled in the Dallas Heart Study, we assessed FH (myocardial infarction in a first-degree relative) and prevalent CAC by electron-beam computed tomography. The primary outcome, a composite of CHD-related death, myocardial infarction, and percutaneous or surgical coronary revascularization, was assessed over a mean follow-up of 8.0 ± 1.2 years. The individual and joint associations with the CHD composite outcome were determined for FH and CAC. The mean age of the population was 44 ± 9 years; 32% had FH and 47% had a CAC score of 0. In multivariate models adjusted for traditional risk factors, FH was independently associated with CHD (adjusted hazard ratio: 2.6; 95% confidence interval: 1.6 to 4.2; p < 0.001). Further adjustment for prevalent CAC did not diminish this association (adjusted hazard ratio: 2.6; 95% confidence interval: 1.6 to 4.2; p < 0.001). FH and CAC were additive: CHD event rates in those with both FH and CAC were 8.8% vs. 3.3% in those with prevalent CAC alone (p < 0.001). CHD rates were 1.9% in those with FH alone compared with 0.4% in those with neither FH nor CAC (p < 0.017). Among subjects without CAC, FH characterized a group with a more unfavorable cardiometabolic profile. FH provided prognostic information that was independent of and additive to CAC. Among those with CAC, FH identified subjects at particularly high short-term risk, and, among those without it, selected a group with an adverse risk-factor profile. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  15. Cardiac health for astronauts: coronary calcification scores and CRP as criteria for selection and retention.

    PubMed

    Hamilton, Douglas R; Murray, Jocelyn D; Ball, Chad G

    2006-04-01

    Due to the limited treatment and return capabilities of most space vehicles, an in-flight cardiac event could result in significant mission impact or even failure. The current literature supports including electron-beam computed tomography (EBCT) and highly selective C-reactive protein (hsCRP) for diagnosis of coronary artery disease (CAD) in asymptomatic, low-pretest probability cohorts. This paper will examine the issues surrounding adding these tests to astronaut retention and selection algorithms. An evidenced-based literature review was performed and consensus obtained from subject-matter experts to create novel cardiac screening algorithms for astronaut applicants and the current astronaut corps. The main focus of this paper is to derive an evidenced-based approach for improving the diagnosis of significant CAD using EBCT and hsCRP testing. The recommended initial astronaut selection and long-duration mission assignment screening algorithms use EBCT-derived calcium scores and serum hsCRP levels to screen for CAD and predict individual cardiac risk. The current medical evidence is compelling for the international space medicine community to consider: (1) Astronaut candidates with a coronary artery calcium score >0 should be disqualified from initial selection; (2) Astronauts with a coronary artery calcium score >100 should be disqualified from selection for long-duration missions; (3) Elevated hsCRP is a reliable risk factor for helping predict future cardiac events that should warrant primary prevention but not necessarily medical disqualification.

  16. Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study.

    PubMed

    Nicoll, Rachel; Zhao, Ying; Wiklund, Urban; Diederichsen, Axel; Mickley, Hans; Ovrehus, Kristian; Zamorano, Jose; Gueret, Pascal; Schmermund, Axel; Maffei, Erica; Cademartiri, Filippo; Budoff, Matt; Henein, Michael

    2017-07-01

    Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score. From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring. Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively. In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. The RANKL/RANK/OPG Signaling Pathway Mediates Medial Arterial Calcification in Diabetic Charcot Neuroarthropathy

    PubMed Central

    Ndip, Agbor; Williams, Alfred; Jude, Edward B.; Serracino-Inglott, Ferdinand; Richardson, Steve; Smyth, J.V.; Boulton, Andrew J.M.; Alexander, M. Yvonne

    2011-01-01

    OBJECTIVE The receptor activator of nuclear factor-κB (RANK), RANK ligand (RANKL), and osteoprotegerin (OPG) signaling pathway (RANKL/RANK/OPG signaling) is implicated in the osteolysis associated with diabetic Charcot neuroarthropathy (CN); however, the links with medial arterial calcification (MAC) seen in people with CN are unclear. This study aimed to investigate the role of RANKL/OPG in MAC in patients with CN. RESEARCH DESIGN AND METHODS Enzyme-linked immunosorbent assay and Bio-plex multiarray technology were used to quantify a range of cytokines, including RANKL and OPG in sera from 10 patients with diabetes, 12 patients with CN, and 5 healthy volunteers. Human tibial artery segments were immunohistochemically stained with Alizarin red and human RANKL antibody. Human vascular smooth muscle cells (VSMCs) were also explanted from arterial segments for in vitro studies. RESULTS We demonstrate colocalization and upregulation of RANKL expression in areas displaying MAC. Systemic levels of RANKL, OPG, and inflammatory cytokines (interleukin-8, granulocyte colony–stimulating factor) were elevated in those with CN compared with diabetic patients and healthy control subjects. Human VSMCs cultured in CN serum showed accelerated osteoblastic differentiation (alkaline phosphatase activity) and mineralization (alizarin red staining) compared with cells treated with diabetic or control serum (P < 0.05). Coincubation with OPG, the decoy receptor for RANKL, attenuated osteogenic differentiation of VSMCs and was independent of a high calcium-phosphate milieu. The accelerated mineralization induced by RANKL and CN serum correlated with nuclear translocation of nuclear factor-κB, a process abrogated by OPG. CONCLUSIONS Our data provide direct evidence that RANKL/RANK/OPG signaling is modulated in patients with CN and plays a role in vascular calcification. This study highlights this pathway as a potential target for intervention. PMID:21659498

  18. Cardiac Society of Australia and New Zealand Position Statement: Coronary Artery Calcium Scoring.

    PubMed

    Liew, Gary; Chow, Clara; van Pelt, Niels; Younger, John; Jelinek, Michael; Chan, Jonathan; Hamilton-Craig, Christian

    2017-06-16

    Coronary Artery Calcium Scoring (CAC) is a non-invasive quantitation of coronary artery calcification using computed tomography (CT). It is a marker of atherosclerotic plaque burden and an independent predictor of future myocardial infarction and mortality. Coronary Artery Calcium Scoring provides incremental risk information beyond traditional risk calculators (eg. Framingham Risk Score). Its use for risk stratification is confined to primary prevention of cardiovascular events, and can be considered as "individualized coronary risk scoring" for those not considered to be of high or low risk. Medical practitioners should carefully counsel patients prior to CAC. Coronary Artery Calcium Scoring should only be undertaken if an alteration in therapy including embarking on pharmacotherapy is being considered based on the test result. Patient Groups to Consider Coronary Calcium Scoring: Patient Groups in Whom Coronary Calcium Scoring Should Not be Considered: Coronary Artery Calcium Scoring is not recommended for patients who are: Interpretation of CAC CAC=0 A zero score confers a very low risk of death, <1% at 10 years. CAC=1-100 Low risk, <10% CAC=101-400 Intermediate risk, 10-20% CAC=101-400 & >75th centile. Moderately high risk, 15-20% CAC >400 High risk, >20% Management Recommendations Based on CAC Optimal diet and lifestyle measures are encouraged in all risk groups and form the basis of primary prevention strategies. Patients with moderately-high or high risk based on CAC score are recommended to receive preventative medical therapy such as aspirin and statins. The evidence for pharmacotherapy is less robust in patients at intermediate levels of CAC 100-400, with modest benefit for aspirin use; though statins maybe reasonable if they are above 75th centile. Aspirin and statins are generally not recommended in patients with CAC <100. Repeat CAC Testing In patients with a CAC of 0, a repeat CAC may be considered in five years but not sooner. In patients with

  19. Clinical implications of the coronary artery calcium score in Japanese patients.

    PubMed

    Yamamoto, Hideya; Kitagawa, Toshiro; Kihara, Yasuki

    2014-01-01

    Coronary artery calcification (CAC) is a well-established surrogate marker of the total burden of coronary atherosclerosis. The CAC score, as measured on coronary computed tomography (CT), is associated with the prevalence of coronary artery disease (CAD) as well as cardiovascular morbidity and mortality. The CAC score is used to reclassify coronary risks in asymptomatic individuals with intermediate risks. However, there are few clinical data regarding the usefulness of the CAC score for identifying high-risk Japanese patients. In this review article, we describe our previous studies of the prognostic value of the CAC score in patients with proven or suspected CAD. In addition, we reanalyzed our previous data for 723 patients with suspected CAD and found both all-cause and cardiovascular disease mortality to be significantly higher among the patients with a CAC score of ≥100 than among those with a CAC score of <100. Several studies from Japan have also shown that the CAC score is associated with the prevalence of obstructive CAD, as demonstrated on invasive coronary angiography or stress myocardial perfusion imaging. Furthermore, the CAC score provides useful information for performing coronary CT angiography, as asymptomatic patients without CAC are expected to have favorable outcomes. In contrast, the diagnostic accuracy is decreased in patients with a high CAC score (>400 or 600). In conclusion, the CAC score may have useful clinical applications in symptomatic and asymptomatic Japanese individuals. However, further studies are required to evaluate the prognostic value of this parameter for predicting cardiovascular morbidity and mortality in population-based analyses of asymptomatic Japanese subjects.

  20. Diagnostic Accuracy of CT Coronary Angiography According to Pretest Probability of Coronary Artery Disease and Severity of Coronary Arterial Calcification: The CorE-64 International, Multicenter Study

    PubMed Central

    Arbab-Zadeh, Armin; Miller, Julie M; Rochitte, Carlos E; Dewey, Marc; Niinuma, Hiroyuki; Gottlieb, Ilan; Paul, Narinder; Clouse, Melvin E.; Shapiro, Edward P.; Hoe, John; Lardo, Albert C.; Bush, David E.; de Roos, Albert; Cox, Christopher; Brinker, Jeffrey; Lima, Joăo A. C.

    2012-01-01

    Objectives Assess the impact of patient population characteristics on accuracy by CT angiography (CTA) to detect obstructive coronary artery disease (CAD). Background The ability of CTA to exclude obstructive CAD in patients of different pretest probabilities and in presence of coronary calcification remains uncertain. Methods For the CorE-64 study 371 patients underwent CTA and cardiac catheterization for the detection of obstructive CAD defined as 50% or greater luminal stenosis by quantitative coronary angiography (QCA). This analysis includes 80 initially excluded patients with a calcium score ≥ 600. Area under the receiver-operating-characteristics curve (AUC) was used to evaluate CTA diagnostic accuracy compared to QCA in patients according to calcium score and pretest probability of CAD. Results Analysis of patient-based quantitative CTA accuracy revealed an AUC of 0.93 (95% confidence interval [CI] 0.90-0.95). AUC remained 0.93 (0.90-0.96) after excluding patients with known CAD but decreased to 0.81 (0.71-0.89) in patients with calcium score ≥ 600 (p=0.077). While AUC were similar (0.93, 0.92, and 0.93, respectively) for patients with intermediate, high pretest probability for CAD, and known CAD, negative predictive values were different: 0.90, 0.83, and 0.50, respectively. Negative predictive values decreased from 0.93 to 0.75 for patients with calcium score < or ≥ 100, respectively (p= 0.053). Conclusions Both pretest probability for CAD and coronary calcium scoring should be considered before using CTA for excluding obstructive CAD. CTA is less effective for this purpose in patients with calcium score ≥ 600 and in patients with a high pretest probability for obstructive CAD. PMID:22261160

  1. Hypophosphatemic rickets developed after treatment with etidronate disodium in a patient with generalized arterial calcification in infancy.

    PubMed

    Miyai, Kentaro; Ariyasu, Daisuke; Numakura, Chikahiko; Yoneda, Kaori; Nakazato, Hitoshi; Hasegawa, Yukihiro

    2015-12-01

    Ectonucleotide pyrophosphatase/phosphodiesterase 1 (ENPP1) was originally reported as a responsible gene for generalized arterial calcification in infancy (GACI). Though the prognosis of GACI patients is poor because of myocardial infarction and heart failure in relation to medial calcification of the coronary arteries, some patients rescued by bisphosphonate treatment have been reported. Recently, ENPP1 is also reported as responsible for autosomal recessive hypophosphatemic rickets type 2. We show here a boy with homozygous ENPP1 mutations diagnosed as having GACI in early infancy. After the diagnosis, he was treated with etidronate disodium (EHDP) in combination with antihypertensive drugs. The calcification of major arteries was diminished and disappeared by the age of eight months. He also showed mild hypophosphatemia (2.6-3.7 mg/dl) from the age of one year. After the treatment with EHDP for five years, he showed genu valgum with hypophosphatemia (2.6 mg/dl). He was diagnosed as having hypophosphatemic rickets at the age of seven years. The findings that hyper-mineralization of the arteries and hypo-mineralization of the bone observed in the same patient are noteworthy. ENPP1 could be regarded as a controller of the calcification of the whole body at least in part.

  2. Plasma apolipoprotein C-III levels, triglycerides, and coronary artery calcification in type 2 diabetics.

    PubMed

    Qamar, Arman; Khetarpal, Sumeet A; Khera, Amit V; Qasim, Atif; Rader, Daniel J; Reilly, Muredach P

    2015-08-01

    Triglyceride-rich lipoproteins have emerged as causal risk factors for developing coronary heart disease independent of low-density lipoprotein cholesterol levels. Apolipoprotein C-III (ApoC-III) modulates triglyceride-rich lipoprotein metabolism through inhibition of lipoprotein lipase and hepatic uptake of triglyceride-rich lipoproteins. Mutations causing loss-of-function of ApoC-III lower triglycerides and reduce coronary heart disease risk, suggestive of a causal role for ApoC-III. Little data exist about the relationship of ApoC-III, triglycerides, and atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Here, we examined the relationships between plasma ApoC-III, triglycerides, and coronary artery calcification in patients with T2DM. Plasma ApoC-III levels were measured in a cross-sectional study of 1422 subjects with T2DM but without clinically manifest coronary heart disease. ApoC-III levels were positively associated with total cholesterol (Spearman r=0.36), triglycerides (r=0.59), low-density lipoprotein cholesterol (r=0.16), fasting glucose (r=0.16), and glycosylated hemoglobin (r=0.12; P<0.0001 for all). In age, sex, and race-adjusted analysis, ApoC-III levels were positively associated with coronary artery calcification (Tobit regression ratio, 1.78; 95% confidence interval, 1.27-2.50 per SD increase in ApoC-III; P<0.001). As expected for an intermediate mediator, these findings were attenuated when adjusted for both triglycerides (Tobit regression ratio, 1.43; 95% confidence interval, 0.94-2.18; P=0.086) and separately for very low-density lipoprotein cholesterol (Tobit regression ratio, 1.14; 95% confidence interval, 0.75-1.71; P=0.53). In persons with T2DM, increased plasma ApoC-III is associated with higher triglycerides, less favorable cardiometabolic phenotypes, and higher coronary artery calcification, a measure of subclinical atherosclerosis. Therapeutic inhibition of ApoC-III may thus be a novel strategy for reducing plasma

  3. Fetuin-A is Associated to Serum Calcium and AHSG T256S Genotype but Not to Coronary Artery Calcification.

    PubMed

    Bellia, Chiara; Agnello, Luisa; Lo Sasso, Bruna; Milano, Salvatore; Bivona, Giulia; Scazzone, Concetta; Pivetti, Alessia; Novo, Giuseppina; Palermo, Chiara; Bonomo, Vito; La Grutta, Ludovico; Midiri, Massimo; Novo, Salvatore; Ciaccio, Marcello

    2016-06-01

    Vascular calcification has been recently associated to an increased cardiovascular risk and mortality. In few studies, Fetuin-A showed an association to coronary artery calcification (CAC), although the physiopathological mechanism underlying this association has not been fully established yet. Seventy-four patients with one or more cardiovascular risk factor and asymptomatic for coronary vasculopathy were included in the study. CAC was evaluated by Agatston score. Serum Fetuin-A levels were determined by ELISA. Molecular analysis of AHSG T256S gene variant (rs4918) was performed by PCR-RFLP. Serum Fetuin-A was correlated to serum calcium (r = 0,321; P = 0,018), but not to serum phosphorous. Multivariate linear regression analysis confirmed this association and showed that calcium and AHSG genotype were independent predictors of Fetuin-A (P = 0.037, P = 0.014, respectively). In particular, subjects carrying the SS genotype had lower levels of Fetuin-A and calcium (P = 0.037 and P = 0.038, respectively). When we compare subjects with CAC 0-10 with subjects with CAC > 10, we found that only age and male gender (P < 0.001, P = 0.035, respectively), but not Fetuin-A, were associated to CAC. Fetuin-A is not associated to CAC in subjects with low cardiovascular risk profile and asymptomatic for coronary vasculopathy, suggesting that in this setting Fetuin-A, although correlated to serum levels of calcium, could be not involved in mineral deposition on coronary vessels.

  4. A history of preeclampsia is associated with a risk for coronary artery calcification 3 decades later.

    PubMed

    White, Wendy M; Mielke, Michelle M; Araoz, Philip A; Lahr, Brian D; Bailey, Kent R; Jayachandran, Muthuvel; Miller, Virginia M; Garovic, Vesna D

    2016-04-01

    A history of preeclampsia is an independent risk factor for cardiac events and stroke. Changes in vasculature structure that contribute to these associations are not well understood. The aim of this study was to quantify coronary artery calcification (CAC), a known risk factor for cardiac events, in a prospective cohort of women with and without histories of preeclampsia. Women without prior cardiovascular events (40 with and 40 without histories of preeclampsia, matched for parity and age at index birth) were recruited from a large population-based cohort of women who were residents of Olmsted County, Minnesota, and who delivered from 1976 through 1982. Computed tomography was performed to measure CAC in Agatston units. All pregnancy histories and covariates were confirmed by review of the medical records. Current clinical variables were assessed at the time of imaging. Differences between women with and without histories of preeclampsia were examined using χ(2) tests and tests; CAC, in particular, was compared as a categorical and ordinal variable, with a χ(2) test and with Wilcoxon 2-sample tests and ordinal logistic regression, as appropriate. Mean age (SD) at imaging was 59.5 (±4.6) years. Systolic and diastolic blood pressures, hyperlipidemia, and current diabetes status did not differ between women with and without histories of preeclampsia. However, the frequencies of having a current clinical diagnosis of hypertension (60% vs 20%, P < .001) and higher body mass index in kg/m(2) (expressed as median [25th-75th percentile], 29.8 [25.9-33.7] vs 25.3 [23.1-32.0], P = .023) were both greater in the women with histories of preeclampsia compared to those without. The frequency of a CAC score >50 Agatston units was also greater in the preeclampsia group (23% vs 0%, P = .001). Compared to women without preeclampsia, the odds of having a higher CAC score was 3.54 (confidence interval [CI], 1.39-9.02) times greater in women with prior preeclampsia without

  5. Arterial Wave Reflection and Aortic Valve Calcification in an Elderly Community-Based Cohort

    PubMed Central

    Sera, Fusako; Russo, Cesare; Iwata, Shinichi; Jin, Zhezhen; Rundek, Tatjana; Elkind, Mitchell S.V.; Homma, Shunichi; Sacco, Ralph L.; Di Tullio, Marco R.

    2015-01-01

    Background Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established. Methods To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study. Participants were divided into 4 categories based on the severity and extent of AVC: 1) none or mild focal AVC; 2) mild diffuse AVC; 3) moderate-severe focal AVC; and 4) moderate-severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry. Results Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and eGFR), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariable logistic regression analysis revealed that augmentation pressure (odds ratio per mmHg = 1.14; 95% confidence interval, 1.02–1.27; P = .02) and augmentation index (odds ratio per percentage point = 1.07; 95% confidence interval, 1.01–1.13; P = .02) were associated with an increase risk of moderate-severe diffuse AVC, even when central blood pressure value was included in the same model. Conclusions Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC. PMID:25600036

  6. Arterial wave reflection and aortic valve calcification in an elderly community-based cohort.

    PubMed

    Sera, Fusako; Russo, Cesare; Iwata, Shinichi; Jin, Zhezhen; Rundek, Tatjana; Elkind, Mitchell S V; Homma, Shunichi; Sacco, Ralph L; Di Tullio, Marco R

    2015-04-01

    Aortic valve calcification (AVC) without stenosis is common in the elderly, is associated with cardiovascular morbidity and mortality, and may progress to aortic valve stenosis. Arterial stiffness and pulse-wave reflection are important components of proximal aortic hemodynamics, but their relationship with AVC is not established. To investigate the relationship of arterial wave reflection and stiffness with AVC, pulse wave analysis and AVC evaluation by echocardiography were performed in 867 participants from the Cardiovascular Abnormalities and Brain Lesions study. Participants were divided into four categories on the basis of the severity and extent of AVC: (1) none or mild focal AVC, (2) mild diffuse AVC, (3) moderate to severe focal AVC, and (4) moderate to severe diffuse AVC. Central blood pressures and pulse pressure, total arterial compliance, augmentation index, and time to wave reflection were assessed using applanation tonometry. Indicators of arterial stiffness and wave reflection were significantly associated with AVC severity, except for central systolic and diastolic pressures and time to reflection. After adjustment for pertinent covariates (age, sex, race/ethnicity, and estimated glomerular filtration rate), only augmentation pressure (P = .02) and augmentation index (P = .002) were associated with the severity of AVC. Multivariate logistic regression analysis revealed that augmentation pressure (odds ratio per mm Hg, 1.14; 95% confidence interval, 1.02-1.27; P = .02) and augmentation index (odds ratio per percentage point, 1.07; 95% confidence interval, 1.01-1.13; P = .02) were associated with an increased risk for moderate to severe diffuse AVC, even when central blood pressure value was included in the same model. Arterial wave reflection is associated with AVC severity, independent of blood pressure values. Increased contribution of wave reflection to central blood pressure could be involved in the process leading to AVC. Copyright © 2015

  7. Association of the vitamin D metabolism gene CYP24A1 with coronary artery calcification

    PubMed Central

    Shen, Haiqing; Bielak, Lawrence F.; Ferguson, Jane F.; Streeten, Elizabeth A.; Yerges-Armstrong, Laura M.; Liu, Jie; Post, Wendy; O'Connell, Jeffery R.; Hixson, James E.; Kardia, Sharon L.R.; Sun, Yan V.; Jhun, Mina A.; Wang, Xuexia; Mehta, Nehal N.; Li, Mingyao; Koller, Daniel L.; Hakonarson, Hakan; Keating, Brendan J.; Rader, Daniel J.; Shuldiner, Alan R.; Peyser, Patricia A.; Reilly, Muredach P.; Mitchell, Braxton D.

    2010-01-01

    Objective The Vitamin D endocrine system is essential for calcium homeostasis, and low levels of vitamin D metabolites have been associated with cardiovascular disease risk. We hypothesized that DNA sequence variation in genes regulating vitamin D metabolism and signaling pathways might influence variation in coronary artery calcification (CAC). Methods and Results We genotyped single nucleotide polymorphisms (SNPs) in GC, CYP27B1, CYP24A1, and VDR and tested their association with CAC quantity, as measured by electron beam computed tomography. Initial association studies were carried out in a discovery sample comprised of 697 Amish subjects and SNPs nominally associated with CAC quantity (4 SNPs in CYP24A1, P = 0.008-0.00003) were then tested for association with CAC quantity in two independent cohorts of subjects of European Caucasian ancestry (Genetic Epidemiology Network of Arteriopathy (GENOA) Study (n = 916) and The Penn Coronary Artery Calcification (PennCAC) sample (n = 2,061)). One of the four SNPs, rs2762939, was associated with CAC quantity in both GENOA (P = 0.007) and PennCAC (P = 0.01). In all three populations the rs2762939 C allele was associated with lower CAC quantity. Meta-analysis for the association of this SNP with CAC quantity across all three studies yielded a P value of 2.9 × 10-6. Conclusion A common SNP in the CYP24A1 gene was associated with CAC quantity in three independent populations. This result suggests a role for vitamin D metabolism in the development of CAC quantity. PMID:20847308

  8. Identification of candidate genes involved in coronary artery calcification by transcriptome sequencing of cell lines

    PubMed Central

    2014-01-01

    Background Massively-parallel cDNA sequencing (RNA-Seq) is a new technique that holds great promise for cardiovascular genomics. Here, we used RNA-Seq to study the transcriptomes of matched coronary artery disease cases and controls in the ClinSeq® study, using cell lines as tissue surrogates. Results Lymphoblastoid cell lines (LCLs) from 16 cases and controls representing phenotypic extremes for coronary calcification were cultured and analyzed using RNA-Seq. All cell lines were then independently re-cultured and along with another set of 16 independent cases and controls, were profiled with Affymetrix microarrays to perform a technical validation of the RNA-Seq results. Statistically significant changes (p < 0.05) were detected in 186 transcripts, many of which are expressed at extremely low levels (5–10 copies/cell), which we confirmed through a separate spike-in control RNA-Seq experiment. Next, by fitting a linear model to exon-level RNA-Seq read counts, we detected signals of alternative splicing in 18 transcripts. Finally, we used the RNA-Seq data to identify differential expression (p < 0.0001) in eight previously unannotated regions that may represent novel transcripts. Overall, differentially expressed genes showed strong enrichment (p = 0.0002) for prior association with cardiovascular disease. At the network level, we found evidence for perturbation in pathways involving both cardiovascular system development and function as well as lipid metabolism. Conclusions We present a pilot study for transcriptome involvement in coronary artery calcification and demonstrate how RNA-Seq analyses using LCLs as a tissue surrogate may yield fruitful results in a clinical sequencing project. In addition to canonical gene expression, we present candidate variants from alternative splicing and novel transcript detection, which have been unexplored in the context of this disease. PMID:24628908

  9. Association between Density of Coronary Artery Calcification and Serum Magnesium Levels among Patients with Chronic Kidney Disease

    PubMed Central

    Sakaguchi, Yusuke; Hamano, Takayuki; Nakano, Chikako; Obi, Yoshitsugu; Matsui, Isao; Kusunoki, Yasuo; Mori, Daisuke; Oka, Tatsufumi; Hashimoto, Nobuhiro; Takabatake, Yoshitsugu; Takahashi, Atsushi; Kaimori, Jun-Ya; Moriyama, Toshiki; Yamamoto, Ryohei; Horio, Masaru; Sugimoto, Ken; Yamamoto, Koichi; Rakugi, Hiromi; Isaka, Yoshitaka

    2016-01-01

    Background The Agatston score, commonly used to quantify coronary artery calcification (CAC), is determined by the plaque area and density. Despite an excellent predictability of the Agatston score for cardiovascular events, the density of CAC has never been studied in patients with pre-dialysis chronic kidney disease (CKD). This study aimed to analyze the CAC density and its association with serum mineral levels in CKD. Methods We enrolled patients with pre-dialysis CKD who had diabetes mellitus, prior cardiovascular disease history, elevated low-density lipoprotein cholesterol levels, or smoking history. The average CAC density was calculated by dividing the Agatston score by the total area of CAC. Results The mean estimated glomerular filtration rate (eGFR) of 109 enrolled patients was 35.7 mL/min/1.73 m2. The correlation of the Agatston score with density was much weaker than that with the total area (R2 = 0.19, P < 0.001; and R2 = 0.99, P < 0.001, respectively). Multivariate analyses showed that serum magnesium level was inversely associated with the density, but not with the total area, after adjustment for demographics and clinical factors related to malnutrition-inflammation-atherosclerosis syndrome and mineral and bone disorders including fibroblast growth factor 23 (P = 0.006). This inverse association was pronounced among patients with higher serum phosphate levels (P for interaction = 0.02). Conclusion CAC density was inversely associated with serum magnesium levels, particularly in patients with higher serum phosphate levels. PMID:27662624

  10. New Conclusions Regarding Comparison of Sevelamer and Calcium-Based Phosphate Binders in Coronary-Artery Calcification for Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Li, Shaomin; Chen, Yanbing; Wang, Yanni; Lou, Tanqi

    2015-01-01

    Background Sevelamer hydrochloride is used widely, but its impact upon cardiovascular calcification, cardiovascular mortality, all-cause mortality and hospitalization is not known. Outcomes Primary outcome was cardiovascular calcification (coronary artery calcification scores (CACS) and aortic calcification scores (ACS)). Secondary outcomes were serum characteristics, hospitalization, cardiovascular mortality and all-cause mortality. Risk ratio (RR), mean differences and standard mean difference with 95% confidence intervals (CIs) were pooled using random- or fixed-effects models. Results We identified 31 studies (on 23 randomized controlled trials with 4395 participants). An analysis pooling showed a significant decrease in serum levels of phosphate with calcium-based phosphate binders (CBPBs) by 0.17 mg/dL [mean difference (MD), 95% CI, 0.03, 0.31] than sevelamer. A significant difference in the change of CACS by –102.66 [MD: 95% CI, –159.51, –45.80] and ACS by –1008.73 [MD, 95% CI, –1664.75, –352.72] between sevelamer and CBPBs was observed. Prevalence of hypercalcemia (serum levels of calcium >10.2–10.5 mg/dL and >11.0 mg/dL) was significantly smaller for sevelamer (RR = 0.44, 95% CI, 0.33, 0.58; RR = 0.24, 95% CI, 0.14, 0.40). No significant difference was found in hospitalization, all-cause mortality or cardiovascular mortality. Conclusions This meta-analysis suggests that sevelamer benefits dialysis patients in terms of CACS, ACS and hypercalcemia. PMID:26230677

  11. Prognostic Value of Gai's Plaque Score and Agatston Coronary Artery Calcium Score for Functionally Significant Coronary Artery Stenosis

    PubMed Central

    Zhang, Chuang; Yang, Shuang; Gai, Lu-Yue; Han, Zhi-Qi; Xin, Qian; Yang, Xiao-Bo; Yang, Jun-Jie; Jin, Qin-Hua

    2016-01-01

    Background: The prognostic values of the coronary computed tomography angiography (CCTA) score for predicting future cardiovascular events have been previously demonstrated in numerous studies. However, few studies have used the rich information available from CCTA to detect functionally significant coronary lesions. We sought to compare the prognostic values of Gai's plaque score and the coronary artery calcium score (CACS) of CCTA for predicting functionally significant coronary lesions, using fractional flow reserve (FFR) as the gold standard. Methods: We retrospectively analyzed 107 visually assessed significant coronary lesions in 88 patients (mean age, 59.6 ± 10.2 years; 76.14% of males) who underwent CCTA, invasive coronary angiography, and invasive FFR measurement. An FFR <0.80 indicated hemodynamically significant coronary stenosis. Lesions were divided into two groups using an FFR cutoff value of 0.80. We compared Gai's plaque scores and CACS between the two groups and evaluated the correlations of these scores with FFR. The statistical methods included unpaired t-test, Mann-Whitney U-test, and Spearman's correlation coefficients. Results: Coronary lesions with FFR <0.80 had higher Gai's scores than those with FFR ≥0.80. Gai's score had the strongest correlation with FFR (r = −0.48, P < 0.01) and had a greater area under the curve = 0.72 (95% confidence interval: 0.61–0.82; P < 0.01) than the CACS of whole arteries and a single artery. Conclusions: Both CACS in a single artery and Gai's plaque score demonstrated a good capacity to assess functionally significant coronary artery stenosis when compared to the gold standard FFR. However, Gai's plaque score was more predictive of FFR <0.80. Gai's score can be easily calculated in daily clinical practice and could be used when considering revascularization. PMID:27900990

  12. Outcomes of Patients With a History of Coronary Artery Bypass Grafting Who Underwent Orbital Atherectomy for Severe Coronary Artery Calcification.

    PubMed

    Lee, Michael S; Shlofmitz, Evan; Nayeri, Arash; Hollowed, John; Shlofmitz, Richard A

    2017-10-01

    We assess the angiographic and clinical outcomes of patients with a history of coronary artery bypass graft (CABG) surgery who underwent orbital atherectomy for the treatment of severely calcified coronary lesions. The presence of severe coronary artery calcification (CAC) increases the complexity of percutaneous coronary intervention (PCI) and is associated with worse clinical outcomes. Patients with a history of CABG who undergo PCI often have comorbidities and are at higher risk for ischemic complications. Of the 458 patients who underwent orbital atherectomy, 77 patients (17%) had a history of CABG and 381 (83%) did not. The primary endpoint was rate of 30-day major adverse cardiac and cerebrovascular events (MACCE), comprised of cardiac death, myocardial infarction (MI), target-vessel revascularization (TVR), and stroke. The CABG group had a higher prevalence of hypertension, chronic renal insufficiency, history of PCI, and unstable angina. The primary endpoint was similar in the CABG and non-CABG groups (1% vs 2%; P=.56), as were the individual endpoints of cardiac death (0% vs 2%; P=.27), MI (1% vs 1%; P=.85), TVR (0% vs 0%; P>.99), and stroke (0% vs 0%; P=.65). The rates of angiographic complications and stent thrombosis were similarly low in both groups. Despite a higher-risk baseline profile, patients with a history of CABG had similar angiographic and clinical outcomes compared with patients who had no previous history of CABG. Further studies are needed to clarify the role of orbital atherectomy in these patients.

  13. Relationship of aortic valve calcification with coronary artery calcium severity: the Multi-Ethnic Study of Atherosclerosis (MESA).

    PubMed

    Nasir, Khurram; Katz, Ronit; Al-Mallah, Mouaz; Takasu, Junichiro; Shavelle, David M; Carr, Jeffery J; Kronmal, Richard; Blumenthal, Roger S; O'Brien, Kevin; Budoff, Matthew J

    2010-01-01

    Aortic valve calcification (AVC) and atherosclerosis share causative and pathologic features. We evaluated the relationship between AVC and coronary artery calcium (CAC) severity in the Multi-Ethnic Study of Atherosclerosis (MESA). Men and women aged 45-84 years (n=6809; mean age, 62 years) were studied. The presence and burden of AVC and CAC were determined by noncontrast cardiac computed tomography. Relative risk regression was used to model the probability of AVC as a function of CAC > 0 as well as CAC categories (0, 1-99, 100-399, and > or = 400) with the reference group being CAC=0. The prevalence of AVC and CAC was 13% and 50%, respectively. Among those without CAC, the prevalence of AVC was 5% and increased across levels of CAC severity such that 14%, 25%, and 38% had AVC with increasing CAC scores of 1-99, 100-399, and > or = 400, respectively (P for trend<0.0001). After controlling for patient demographic factors and cardiovascular risk factors, the prevalence ratio of AVC among those with mild CAC (1-99) was 1.83 (95% CI, 1.45-2.31) and increased to 3.36 (95% CI, 2.56-4.42) for CAC > or = 400. Similar statistically significant increased risk of AVC was found when CAC was assessed as a continuous variable. Our study shows that AVC is independently associated with increasing severity of CAC. 2010 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  14. A novel biomarker of coronary atherosclerosis: serum DKK1 concentration correlates with coronary artery calcification and atherosclerotic plaques.

    PubMed

    Kim, Kwang-Il; Park, Kyoung Un; Chun, Eun Ju; Choi, Sang Il; Cho, Young-Seok; Youn, Tae-Jin; Cho, Goo-Yeong; Chae, In-Ho; Song, Junghan; Choi, Dong-Ju; Kim, Cheol-Ho

    2011-09-01

    DKK1 modulates Wnt signaling, which is involved in the atherosclerosis. However, no data exist regarding the usefulness of measuring serum DKK1 concentration in predicting coronary atherosclerosis. A total of 270 consecutive patients (62.8 ± 11.2 yr; 70% male) were included. A contrast-enhanced 64-slice coronary MDCT was performed to identify the presence of atherosclerotic plaques. Agatston calcium scores (CS) were calculated to quantify the coronary artery calcification (CAC). DKK1 concentrations were measured by enzyme-linked immunosorbent assay. For each subsequent DKK1 quartile, there was a significant increase in CAC (P = 0.004) and the number of segments with coronary atherosclerosis (P < 0.001). In addition, DKK1 concentration was significantly higher in patients with atherosclerotic plaques, regardless of plaque composition (P = 0.01). Multivariate analysis identified DKK1 as an independent risk factor for the presence of coronary atherosclerotic plaque. The adjusted odds ratio for coronary atherosclerotic plaque was 4.88 (95% CI, 1.67 to 14.25) for highest versus lowest quartile of the DKK1 levels. Furthermore, patients with DKK1 concentrations ≥ 68.6 pg/mL demonstrated coronary atherosclerotic plaques even when they had low CS. Serum DKK1 concentrations correlate with the coronary atherosclerosis and play an independent role in predicting the presence of coronary atherosclerosis.

  15. Classification of coronary artery calcifications according to motion artifacts in chest CT using a convolutional neural network

    NASA Astrophysics Data System (ADS)

    Šprem, Jurica; de Vos, Bob D.; de Jong, Pim A.; Viergever, Max A.; Išgum, Ivana

    2017-02-01

    Coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events (CVEs). CAC can be quantified in chest CT scans acquired in lung screening. However, in these images the reproducibility of CAC quantification is compromised by cardiac motion that occurs during scanning, thereby limiting the reproducibility of CVE risk assessment. We present a system for the identification of CACs strongly affected by cardiac motion artifacts by using a convolutional neural network (CNN). This study included 125 chest CT scans from the National Lung Screening Trial (NLST). Images were acquired with CT scanners from four different vendors (GE, Siemens, Philips, Toshiba) with varying tube voltage, image resolution settings, and without ECG synchronization. To define the reference standard, an observer manually identified CAC lesions and labeled each according to the presence of cardiac motion: strongly affected (positive), mildly affected/not affected (negative). A CNN was designed to automatically label the identified CAC lesions according to the presence of cardiac motion by analyzing a patch from the axial CT slice around each lesion. From 125 CT scans, 9201 CAC lesions were analyzed. 8001 lesions were used for training (19% positive) and the remaining 1200 (50% positive) were used for testing. The proposed CNN achieved a classification accuracy of 85% (86% sensitivity, 84% specificity). The obtained results demonstrate that the proposed algorithm can identify CAC lesions that are strongly affected by cardiac motion. This could facilitate further investigation into the relation of CAC scoring reproducibility and the presence of cardiac motion artifacts.

  16. [Prevalence and extension of coronary artery calcification in cardiovascular asymptomatic mexican population: Genetics of Atherosclerotic Disease study].

    PubMed

    Posadas-Romero, Carlos; López-Bautista, Fabiola; Rodas-Díaz, Marco A; Posadas-Sánchez, Rosalinda; Kimura-Hayama, Eric; Juárez-Rojas, Juan G; Medina-Urrutia, Aida X; Cardoso-Saldaña, Guillermo C; Vargas-Alarcón, Gilberto; Jorge-Galarza, Esteban

    2017-01-25

    The prevalence of coronary artery calcification (CAC), a specific marker of atherosclerosis, is unknown in Mexico. Our aim was to investigate the prevalence and quantity of CAC and its associations with cardiovascular risk factors in Mexican population. CAC was measured by multidetector computed tomography in asymptomatic subjects who participated in the Genetics of Atherosclerotic Disease study. Cardiovascular risk factors and medication were recorded. The sample included 1,423 individuals (49.5% men), aged 53.7±8.4 years. Those with CAC showed higher prevalence of dyslipidemia, diabetes, hypertension and other risk factors. The prevalence of CAC>0 Agatston units was significantly higher among men (40%) than among women (13%). Mean values of CAC score increased consistently with increasing age and were higher in men than women in each age group. Age and high low density lipoprotein cholesterol were independently associated with prevalence of CAC>0 in men and women; while increasing systolic blood pressure in women and age in both genders, showed independent association with CAC extension. In Mexican population the prevalence and extension of CAC were much higher in men than in women and strongly increased with age. Independent predictors of CAC prevalence were age and LDL-C. Copyright © 2016 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  17. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis

    PubMed Central

    Russo, Domenico; Corrao, Salvatore; Battaglia, Yuri; Andreucci, Michele; Caiazza, Antonella; Carlomagno, Angelo; Lamberti, Monica; Pezone, Nicoletta; Pota, Andrea; Russo, Luigi; Sacco, Maurizio; Scognamiglio, Bernadette

    2011-01-01

    We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population. PMID:21451461

  18. Progression of coronary artery calcification and cardiac events in patients with chronic renal disease not receiving dialysis.

    PubMed

    Russo, Domenico; Corrao, Salvatore; Battaglia, Yuri; Andreucci, Michele; Caiazza, Antonella; Carlomagno, Angelo; Lamberti, Monica; Pezone, Nicoletta; Pota, Andrea; Russo, Luigi; Sacco, Maurizio; Scognamiglio, Bernadette

    2011-07-01

    We tested for the presence of coronary calcifications in patients with chronic renal disease not on dialysis and studied its progression in 181 consecutive non-dialyzed patients who were followed for a median of 745 days. Coronary calcifications (calcium score) were tallied in Agatston units by computed tomography, and the patients were stratified into two groups by their baseline calcium score (100 U or less and over 100 U). Survival was measured by baseline calcium score and its progression. Cardiac death and myocardial infarction occurred in 29 patients and were significantly more frequent in those patients with calcium scores over 100 U (hazard ratio of 4.11). With a calcium score of 100 U or less, the hazard ratio for cardiac events was 0.41 and 3.26 in patients with absent and accelerated progression, respectively. Thus, in non-dialyzed patients, the extent of coronary calcifications was associated to cardiac events, and progression was an independent predictive factor of cardiac events mainly in less calcified patients. Hence, assessment of coronary calcifications and progression might be useful for earlier management of risk factors and guiding decisions for prevention of cardiac events in this patient population.

  19. Mutant Enpp1asj mice as a model for generalized arterial calcification of infancy.

    PubMed

    Li, Qiaoli; Guo, Haitao; Chou, David W; Berndt, Annerose; Sundberg, John P; Uitto, Jouni

    2013-09-01

    Generalized arterial calcification of infancy (GACI), an autosomal recessive disorder, is characterized by early mineralization of blood vessels, often diagnosed by prenatal ultrasound and usually resulting in demise during the first year of life. It is caused in most cases by mutations in the ENPP1 gene, encoding an enzyme that hydrolyzes ATP to AMP and inorganic pyrophosphate, the latter being a powerful anti-mineralization factor. Recently, a novel mouse phenotype was recognized as a result of ENU mutagenesis - those mice developed stiffening of the joints, hence the mutant mouse was named 'ages with stiffened joints' (asj). These mice harbor a missense mutation, p.V246D, in the Enpp1 gene. Here we demonstrate that the mutant ENPP1 protein is largely absent in the liver of asj mice, and the lack of enzymatic activity results in reduced inorganic pyrophosphate (PPi) levels in the plasma, accompanied by extensive mineralization of a number of tissues, including arterial blood vessels. The progress of mineralization is highly dependent on the mineral composition of the diet, with significant shortening of the lifespan on a diet enriched in phosphorus and low in magnesium. These results suggest that the asj mouse can serve as an animal model for GACI.

  20. Effects of etidronate on the Enpp1⁻/⁻ mouse model of generalized arterial calcification of infancy.

    PubMed

    Huesa, Carmen; Staines, Katherine A; Millán, Jose Luis; MacRae, Vicky E

    2015-07-01

    Generalized arterial calcification of infancy (GACI) is an autosomal recessive disorder of spontaneous infantile arterial and periarticular calcification which is attributed to mutations in the ectonucleotide pyrophosphatase/phosphodiesterase 1 (Enpp1) gene. Whilst the bisphosphonate, etidronate, is currently used off-label for the treatment for GACI, recent studies have highlighted its detrimental effects on bone mineralisation. In the present study, we used the Enpp1-/- mouse model of GACI to examine the effects of etidronate treatment (100 µg/kg), on vascular and skeletal calcification. Micro-computed tomography (µCT) analysis revealed a significant decrease in trabecular bone mass, as reflected by the decrease in trabecular bone volume/tissue volume (BV/TV; %), trabecular thickness, trabecular separation, trabecular number and pattern factor (P<0.05) in the Enpp1-/- mice in comparison to the wild-type (WT) mice. Mechanical testing revealed that in the WT mice, treatment with etidronate significantly improved work to fracture and increased work post-failure (P<0.05, in comparison to the vehicle-treated WT mice). This significant increase, however, was not observed in the Enpp1-/- mice. Treatment with etidronate had no effect on bone parameters in the WT mice; however, the Enpp1-/- mice displayed an increased structural model index (SMI; P<0.05). We used a recently developed 3D µCT protocol to reconstruct and quantify the extensive aortic calcification in Enpp1-/- mice in comparison to the WT mice. However, treatment with etidronate did not prevent de novo calcification, and did not arrest the progression of established calcification of the aorta.

  1. Obesity and Coronary Artery Calcium in Diabetes: The Coronary Artery Calcification in Type 1 Diabetes (CACTI) Study

    PubMed Central

    Rodrigues, Ticiana C.; Veyna, Adrienne M.; Haarhues, Michelle D.; Kinney, Gregory L.; Rewers, Marian

    2011-01-01

    Abstract Background The aim was to examine whether excess weight is associated with coronary artery calcium (CAC), independent of metabolic parameters in adults with type 1 diabetes (T1D). Methods Subjects between 19 and 56 years of age with T1D (n=621) from the Coronary Artery Calcification in Type 1 Diabetes study were classified as abnormal on four metabolic parameters: blood pressure ≥130/85 mm Hg or on antihypertensive treatment; high-density lipoprotein-cholesterol of <40 mg/dL for men or <50 mg/dL for women; triglycerides of ≥150 mg/dL; or C-reactive protein of ≥3 μg/mL. Study participants with two or more abnormal parameters were classified as metabolically abnormal. Weight categories by body mass index were normal (<25 kg/m2), overweight (25 to <30 kg/m2), and obese (≥30 kg/m2). CAC was measured at two visits 6.0±0.5 years apart. Progression of CAC was defined as an increase in square root transformed CAC volume of ≥2.5 mm3 or development of clinical coronary artery disease. Results Among subjects with T1D, 48% of normal, 61% of overweight, and 73% of obese participants were classified as metabolically abnormal (P<0.0001). Overweight and obesity were independently associated with presence of CAC, independent of presence of metabolically abnormal. Obesity but not overweight was associated with CAC progression, independent of the other cardiovascular risk factors. Conclusions Although obesity is known to increase cardiovascular disease risk through inducing metabolic abnormalities such as dyslipidemia, hypertension, and inflammation, it is also a strong predictor of subclinical atherosclerosis progression in adults with T1D independent of these factors. PMID:21770813

  2. Vitamin K antagonism aggravates chronic kidney disease-induced neointimal hyperplasia and calcification in arterialized veins: role of vitamin K treatment?

    PubMed

    Zaragatski, Emma; Grommes, Jochen; Schurgers, Leon J; Langer, Stephan; Kennes, Lieven; Tamm, Miriam; Koeppel, Thomas A; Kranz, Jennifer; Hackhofer, Tina; Arakelyan, Karen; Jacobs, Michael J; Kokozidou, Maria

    2016-03-01

    Arteriovenous fistula (AVF) is the common vascular access type for a hemodialysis patient. Its failure is due to neointimal hyperplasia. Vitamin K antagonists are given to lower thrombosis tendency, but have side effects that enhance arterial calcifications. Here, we investigated the effects of vitamin K antagonists and vitamin K2 (K2) treatment on neointimal hyperplasia development and calcification in rats and in arterialized human veins. AVF was generated in female rats while chronic kidney disease (CKD) was induced using an adenine-enriched diet. Arterialization, CKD, and vitamin K antagonists all significantly enhanced venous neointimal hyperplasia. K2 treatment, additional to vitamin K antagonists, significantly reduced neointimal hyperplasia in arterialized veins in healthy rats but not in rats with CKD. Arterialization, CKD, and vitamin K antagonism all significantly increased, whereas K2 supplementation attenuated calcification in healthy rats and rats with CKD. K2 significantly enhanced matrix Gla protein carboxylation in control rats and rats with CKD. Arterialized human vein samples contained inactive matrix Gla protein at calcification and neointimal hyperplasia sites, indicating local vitamin K deficiency. Thus, vitamin K antagonists have detrimental effects on AVF remodeling, whereas K2 reduced neointimal hyperplasia and calcification indicating vasoprotective effects. Hence, K2 administration may be useful to prevent neointimal hyperplasia and calcification in arterialized veins

  3. Increased association of coronary artery calcification in apparently healthy Korean adults with hypertriglyceridemic waist phenotype: The Kangbuk Samsung Health Study.

    PubMed

    Moon, Byung Sub; Park, Hye-Jeong; Lee, Min-Kyung; Jeon, Won Seon; Park, Se Eun; Park, Cheol-Young; Lee, Won-Yong; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

    2015-09-01

    Hypertriglyceridemic waist phenotype is a simple screening parameter to identify people at increased risk for cardiovascular disease. We evaluated whether hypertriglyceridemic waist (HTGW) phenotype increases the risk for coronary artery calcification (CAC) in apparently healthy Korean adults. A total of 32,186 participants (mean age 41.3, 80.2% men) in a health screening program, in whom the coronary artery calcium score (CACS) was measured, were analyzed. Subjects were divided into four groups: 1) normal waist circumference (WC)-normal triglyceride (TG) (NWNT), 2) normal WC-high TG (NWHT), 3) enlarged WC-normal TG (EWNT), and 4) enlarged WC-high TG (EWHT). Enlarged WC was defined as WC ≥ 90 cm for men and ≥ 85 cm for women; high serum TG was defined as TG ≥ 150 mg/dL. The presence of CAC was defined by CACS >0, and CACS was analyzed in a logarithmized form of CACS plus 1 {ln(CACS+1)}. A total of 14.9% of the participants had CAC. The EWHT group showed the highest mean value for ln(CACS+1) among the four groups. The EWHT group showed the highest odds ratio for CAC, with NWHT group the second, and with EWNT group the third compared with the NWNT group after adjusting for confounding variables (1.579, 1.302, and 1.266 vs. NWNT). The EWHT group showed the highest association for CAC, suggesting this HTGW phenotype as a useful marker for the detection of subjects with high cardiometabolic risk in healthy Korean adults. Copyright © 2015. Published by Elsevier Ireland Ltd.

  4. Generalized Arterial Calcification in a Recipient Twin: Discordant Fetal Hemodynamics Result in Differing Phenotypes in Monozygotic Twins with an ABCC6 Mutation.

    PubMed

    Votava-Smith, Jodie K; Pitukcheewanont, Pisit; Randolph, Linda M; Chmait, Ramen H

    2017-01-01

    Recipients of the twin-twin transfusion syndrome (TTTS) often develop cardiac manifestations, but arterial calcification has rarely been reported. Generalized arterial calcification of infancy (GACI) is a genetic disorder with high infantile mortality. We report the case of a TTTS recipient with moderate cardiomyopathy at diagnosis who developed progressive calcification of the pulmonary arteries and aorta after successful in utero laser therapy. Postnatally, both twins were diagnosed with a heterozygous ABCC6 gene mutation associated with GACI. The recipient had progressive supravalvular pulmonary and aortic stenosis, was treated with bisphosphonate therapy, and successfully underwent cardiac surgery at 4 months of age. The donor twin with the same mutation remained phenotypically normal at 15 months of age. This case illustrates monozygotic fetuses with discordant in utero hemodynamics, with subsequent development of phenotypic differences. TTTS recipients with arterial calcifications should undergo genetic testing for GACI. © 2016 S. Karger AG, Basel.

  5. Runx2 Expression in Smooth Muscle Cells Is Required for Arterial Medial Calcification in Mice

    PubMed Central

    Lin, Mu-En; Chen, Theodore; Leaf, Elizabeth M.; Speer, Mei Y.; Giachelli, Cecilia M.

    2016-01-01

    Arterial medial calcification (AMC) is a hallmark of aging, diabetes, and chronic kidney disease. Smooth muscle cell (SMC) transition to an osteogenic phenotype is a common feature of AMC, and is preceded by expression of runt-related transcription factor 2 (Runx2), a master regulator of bone development. Whether SMC-specific Runx2 expression is required for osteogenic phenotype change and AMC remains unknown. We therefore created an improved targeting construct to generate mice with floxed Runx2 alleles (Runx2f/f) that do not produce truncated Runx2 proteins after Cre recombination, thereby preventing potential off-target effects. SMC-specific deletion using SM22–recombinase transgenic allele mice (Runx2ΔSM) led to viable mice with normal bone and arterial morphology. After vitamin D overload, arterial SMCs in Runx2f/f mice expressed Runx2, underwent osteogenic phenotype change, and developed severe AMC. In contrast, vitamin D–treated Runx2ΔSM mice had no Runx2 in blood vessels, maintained SMC phenotype, and did not develop AMC. Runx2 deletion did not affect serum calcium, phosphate, fibroblast growth factor-23, or alkaline phosphatase levels. In vitro, Runx2f/f SMCs calcified to a much greater extent than those derived from Runx2ΔSM mice. These data indicate a critical role of Runx2 in SMC osteogenic phenotype change and mineral deposition in a mouse model of AMC, suggesting that Runx2 and downstream osteogenic pathways in SMCs may be useful therapeutic targets for treating or preventing AMC in high-risk patients. PMID:25987250

  6. Reduction of Dialysate Calcium Level Reduces Progression of Coronary Artery Calcification and Improves Low Bone Turnover in Patients on Hemodialysis

    PubMed Central

    Asci, Gulay; Bayraktaroglu, Selen; Toz, Huseyin; Ozkahya, Mehmet; Yilmaz, Mumtaz; Kircelli, Fatih; Sevinc Ok, Ebru; Ceylan, Naim; Duman, Soner; Cirit, Mustafa; Monier-Faugere, Marie-Claude; Malluche, Hartmut H.

    2016-01-01

    Exposure to high Ca concentrations may influence the development of low–turnover bone disease and coronary artery calcification (CAC) in patients on hemodialysis (HD). In this randomized, controlled study, we investigated the effects of lowering dialysate Ca level on progression of CAC and histologic bone abnormalities in patients on HD. Patients on HD with intact parathyroid hormone levels ≤300 pg/ml receiving dialysate containing 1.75 or 1.50 mmol/L Ca (n=425) were randomized to the 1.25-mmol/L Ca (1.25 Ca; n=212) or the 1.75-mmol/L Ca (1.75 Ca; n=213) dialysate arm. Primary outcome was a change in CAC score measured by multislice computerized tomography; main secondary outcome was a change in bone histomorphometric parameters determined by analysis of bone biopsy specimens. CAC scores increased from 452±869 (mean±SD) in the 1.25 Ca group and 500±909 in the 1.75 Ca group (P=0.68) at baseline to 616±1086 and 803±1412, respectively, at 24 months (P=0.25). Progression rate was significantly lower in the 1.25 Ca group than in the 1.75 Ca group (P=0.03). The prevalence of histologically diagnosed low bone turnover decreased from 85.0% to 41.8% in the 1.25 Ca group (P=0.001) and did not change in the 1.75 Ca group. At 24 months, bone formation rate, trabecular thickness, and bone volume were higher in the 1.25 Ca group than in the 1.75 Ca group. Thus, lowering dialysate Ca levels slowed the progression of CAC and improved bone turnover in patients on HD with baseline intact parathyroid hormone levels ≤300 pg/ml. PMID:26701977

  7. Hypophosphatemia, Hyperphosphaturia, and Bisphosphonate Treatment Are Associated With Survival Beyond Infancy in Generalized Arterial Calcification of Infancy

    PubMed Central

    Rutsch, Frank; Böyer, Petra; Nitschke, Yvonne; Ruf, Nico; Lorenz-Depierieux, Bettina; Wittkampf, Tanja; Weissen-Plenz, Gabriele; Fischer, Rudolf-Josef; Mughal, Zulf; Gregory, John W.; Davies, Justin H.; Loirat, Chantal; Strom, Tim M.; Schnabel, Dirk; Nürnberg, Peter; Terkeltaub, Robert

    2009-01-01

    Background Generalized arterial calcification of infancy has been reported to be frequently lethal, and the efficiency of any therapy, including bisphosphonates, is unknown. A phosphate-poor diet markedly increases survival of NPP1 null mice, a model of generalized arterial calcification of infancy. Methods and Results We performed a multicenter genetic study and retrospective observational analysis of 55 subjects affected by generalized arterial calcification of infancy to identify prognostic factors. Nineteen (34%) patients survived the critical period of infancy. In all 8 surviving patients tested, hypophosphatemia due to reduced renal tubular phosphate reabsorption developed during childhood. Eleven of 17 (65%) patients treated with bisphosphonates survived. Of 26 patients who survived their first day of life and were not treated with bisphosphonates only 8 (31%) patients survived beyond infancy. Forty different homozygous or compound heterozygous mutations, including 16 novel mutations in ENPP1, were found in 41 (75%) of the 55 patients. Twenty-nine (71%) of these 41 patients died in infancy (median, 30 days). Seven of the 14 (50%) patients without ENPP1 mutations died in infancy (median, 9 days). When present on both alleles, the mutation p.P305T was associated with death in infancy in all 5 cases; otherwise, no clear genotype-phenotype correlation was seen. Conclusion ENPP1 coding region mutations are associated with generalized arterial calcification of infancy in ≈75% of subjects. Except for the p.P305T mutation, which was universally lethal when present on both alleles, the identified ENPP1 mutations per se have no discernable effect on survival. However, survival seems to be associated with hypophosphatemia linked with hyperphosphaturia and also with bisphosphonate treatment. PMID:20016754

  8. Associations of Coffee, Tea, and Caffeine Intake with Coronary Artery Calcification and Cardiovascular Events.

    PubMed

    Miller, P Elliott; Zhao, Di; Frazier-Wood, Alexis C; Michos, Erin D; Averill, Michelle; Sandfort, Veit; Burke, Gregory L; Polak, Joseph F; Lima, Joao A C; Post, Wendy S; Blumenthal, Roger S; Guallar, Eliseo; Martin, Seth S

    2017-02-01

    Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain. We examined 6508 ethnically diverse participants with available coffee and tea data from the Multi-Ethnic Study of Atherosclerosis. Intake for each was classified as never, occasional (<1 cup per day), and regular (≥1 cup per day). A coronary artery calcium progression ratio was derived from mixed effect regression models using loge(calcium score+1) as the outcome, with coefficients exponentiated to reflect coronary artery calcium progression ratio versus the reference. Cox proportional hazards analyses were used to evaluate the association between beverage intake and incident cardiovascular events. Over a median follow-up of 5.3 years for coronary artery calcium and 11.1 years for cardiovascular events, participants who regularly drank tea (≥1 cup per day) had a slower progression of coronary artery calcium compared with never drinkers after multivariable adjustment. This correlated with a statistically significant lower incidence of cardiovascular events for ≥1 cup per day tea drinkers (adjusted hazard ratio 0.71; 95% confidence interval 0.53-0.95). Compared with never coffee drinkers, regular coffee intake (≥1 cup per day) was not statistically associated with coronary artery calcium progression or cardiovascular events (adjusted hazard ratio 0.97; 95% confidence interval 0.78-1.20). Caffeine intake was marginally inversely associated with coronary artery calcium progression. Moderate tea drinkers had slower progression of coronary artery calcium and reduced risk for cardiovascular events. Future research is needed to understand the potentially protective nature of moderate tea intake. Published by Elsevier Inc.

  9. The Absence of Coronary Calcification Does Not Exclude Obstructive Coronary Artery Disease or the Need for Revascularization in Patients Referred for Conventional Coronary Angiography

    PubMed Central

    Gottlieb, Ilan; Miller, Julie M.; Arbab-Zadeh, Armin; Dewey, Marc; Clouse, Melvin E.; Sara, Leonardo; Niinuma, Hiroyuki; Bush, David E.; Paul, Narinder; Vavere, Andrea L.; Texter, John; Brinker, Jeffery; Lima, João A. C.; Rochitte, Carlos E.

    2012-01-01

    Objectives This study was designed to evaluate whether the absence of coronary calcium could rule out ≥50% coronary stenosis or the need for revascularization. Background The latest American Heart Association guidelines suggest that a calcium score (CS) of zero might exclude the need for coronary angiography among symptomatic patients. Methods A substudy was made of the CORE64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) multicenter trial comparing the diagnostic performance of 64-detector computed tomography to conventional angiography. Patients clinically referred for conventional angiography were asked to undergo a CS scan up to 30 days before. Resutls In all, 291 patients were included, of whom 214 (73%) were male, and the mean age was 59.3 ± 10.0 years. A total of 14 (5%) patients had low, 218 (75%) had intermediate, and 59 (20%) had high pre-test probability of obstructive coronary artery disease. The overall prevalence of ≥50% stenosis was 56%. A total of 72 patients had CS = 0, among whom 14 (19%) had at least 1 ≥50% stenosis. The overall sensitivity for CS = 0 to predict the absence of ≥50% stenosis was 45%, specificity was 91%, negative predictive value was 68%, and positive predictive value was 81%. Additionally, revascularization was performed in 9 (12.5%) CS = 0 patients within 30 days of the CS. From a total of 383 vessels without any coronary calcification, 47 (12%) presented with ≥50% stenosis; and from a total of 64 totally occluded vessels, 13 (20%) had no calcium. Conclusions The absence of coronary calcification does not exclude obstructive stenosis or the need for revascularization among patients with high enough suspicion of coronary artery disease to be referred for coronary angiography, in contrast with the published recommendations. Total coronary occlusion frequently occurs in the absence of any detectable calcification. PMID:20170786

  10. Genetic polymorphisms associated with carotid artery intima-media thickness and coronary artery calcification in women of the Kronos Early Estrogen Prevention Study

    PubMed Central

    Petterson, Tanya M.; Jeavons, Elysia N.; Lnu, Abhinita S.; Rider, David N.; Heit, John A.; Cunningham, Julie M.; Huggins, Gordon S.; Hodis, Howard N.; Budoff, Matthew J.; Santoro, Nanette; Hopkins, Paul N.; Lobo, Rogerio A.; Manson, JoAnn E.; Naftolin, Frederick; Taylor, Hugh S.; Harman, S. Mitchell; de Andrade, Mariza

    2013-01-01

    Menopausal hormone treatment (MHT) may limit progression of cardiovascular disease (CVD) but poses a thrombosis risk. To test targeted candidate gene variation for association with subclinical CVD defined by carotid artery intima-media thickness (CIMT) and coronary artery calcification (CAC), 610 women participating in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial of MHT to prevent progression of CVD, were genotyped for 13,229 single nucleotide polymorphisms (SNPs) within 764 genes from anticoagulant, procoagulant, fibrinolytic, or innate immunity pathways. According to linear regression, proportion of European ancestry correlated negatively, but age at enrollment and pulse pressure correlated positively with CIMT. Adjusting for these variables, two SNPs, one on chromosome 2 for MAP4K4 gene (rs2236935, β = 0.037, P value = 2.36 × 10−06) and one on chromosome 5 for IL5 gene (rs739318, β = 0.051, P value = 5.02 × 10−05), associated positively with CIMT; two SNPs on chromosome 17 for CCL5 (rs4796119, β = −0.043, P value = 3.59 × 10−05; rs2291299, β = −0.032, P value = 5.59 × 10−05) correlated negatively with CIMT; only rs2236935 remained significant after correcting for multiple testing. Using logistic regression, when we adjusted for waist circumference, two SNPs (rs11465886, IRAK2, chromosome 3, OR = 3.91, P value = 1.10 × 10−04; and rs17751769, SERPINA1, chromosome 14, OR = 1.96, P value = 2.42 × 10−04) associated positively with a CAC score of >0 Agatston unit; one SNP (rs630014, ABO, OR = 0.51, P value = 2.51 × 10−04) associated negatively; none remained significant after correcting for multiple testing. Whether these SNPs associate with CIMT and CAC in women randomized to MHT remains to be determined. PMID:23188791

  11. Genetic polymorphisms associated with carotid artery intima-media thickness and coronary artery calcification in women of the Kronos Early Estrogen Prevention Study.

    PubMed

    Miller, Virginia M; Petterson, Tanya M; Jeavons, Elysia N; Lnu, Abhinita S; Rider, David N; Heit, John A; Cunningham, Julie M; Huggins, Gordon S; Hodis, Howard N; Budoff, Matthew J; Santoro, Nanette; Hopkins, Paul N; Lobo, Rogerio A; Manson, JoAnn E; Naftolin, Frederick; Taylor, Hugh S; Harman, S Mitchell; de Andrade, Mariza

    2013-01-15

    Menopausal hormone treatment (MHT) may limit progression of cardiovascular disease (CVD) but poses a thrombosis risk. To test targeted candidate gene variation for association with subclinical CVD defined by carotid artery intima-media thickness (CIMT) and coronary artery calcification (CAC), 610 women participating in the Kronos Early Estrogen Prevention Study (KEEPS), a clinical trial of MHT to prevent progression of CVD, were genotyped for 13,229 single nucleotide polymorphisms (SNPs) within 764 genes from anticoagulant, procoagulant, fibrinolytic, or innate immunity pathways. According to linear regression, proportion of European ancestry correlated negatively, but age at enrollment and pulse pressure correlated positively with CIMT. Adjusting for these variables, two SNPs, one on chromosome 2 for MAP4K4 gene (rs2236935, β = 0.037, P value = 2.36 × 10(-06)) and one on chromosome 5 for IL5 gene (rs739318, β = 0.051, P value = 5.02 × 10(-05)), associated positively with CIMT; two SNPs on chromosome 17 for CCL5 (rs4796119, β = -0.043, P value = 3.59 × 10(-05); rs2291299, β = -0.032, P value = 5.59 × 10(-05)) correlated negatively with CIMT; only rs2236935 remained significant after correcting for multiple testing. Using logistic regression, when we adjusted for waist circumference, two SNPs (rs11465886, IRAK2, chromosome 3, OR = 3.91, P value = 1.10 × 10(-04); and rs17751769, SERPINA1, chromosome 14, OR = 1.96, P value = 2.42 × 10(-04)) associated positively with a CAC score of >0 Agatston unit; one SNP (rs630014, ABO, OR = 0.51, P value = 2.51 × 10(-04)) associated negatively; none remained significant after correcting for multiple testing. Whether these SNPs associate with CIMT and CAC in women randomized to MHT remains to be determined.

  12. Omentin-1 attenuates arterial calcification and bone loss in osteoprotegerin-deficient mice by inhibition of RANKL expression.

    PubMed

    Xie, Hui; Xie, Ping-Li; Wu, Xian-Ping; Chen, San-Mei; Zhou, Hou-De; Yuan, Ling-Qing; Sheng, Zhi-Feng; Tang, Si-Yuan; Luo, Xiang-Hang; Liao, Er-Yuan

    2011-11-01

    Omentin-1 (also known as intelectin-1) is a recently identified visceral adipose tissue-derived cytokine that is inversely related to obesity. Our previous study showed that omentin-1 inhibits osteoblastic differentiation of calcifying vascular smooth muscle cells (CVSMCs) in vitro. This study was undertaken to investigate the effects of omentin-1 on arterial calcification and bone metabolism in vivo. In vitro, omentin-1 stimulated production of osteoprotegerin (OPG) and inhibited production of receptor activator for nuclear factor κB ligand (RANKL) in both CVSMCs and osteoblasts. In vivo, adenovirus-mediated over-expression of omentin-1 attenuated arterial calcification and bone loss in OPG(-/-) mice. All these in vitro and in vivo actions were abrogated by blockade of the PI3K-Akt signalling pathway. Furthermore, omentin-1 reduced serum levels of RANKL, tartarate-resistant acid phosphatase-5b and osteocalcin, all of which are increased dramatically in OPG(-/-) mice. These data suggest that omentin-1 ameliorates arterial calcification and bone loss in vivo through the regulation of the RANK signalling pathway.

  13. Associations between Thyroid Hormones, Calcification Inhibitor Levels and Vascular Calcification in End-Stage Renal Disease

    PubMed Central

    Meuwese, Christiaan Lucas; Olauson, Hannes; Qureshi, Abdul Rashid; Ripsweden, Jonaz; Barany, Peter; Vermeer, Cees; Drummen, Nadja; Stenvinkel, Peter

    2015-01-01

    Introduction Vascular calcification is a common, serious and elusive complication of end-stage renal disease (ESRD). As a pro-calcifying risk factor, non-thyroidal illness may promote vascular calcification through a systemic lowering of vascular calcification inhibitors such as matrix-gla protein (MGP) and Klotho. Methods and Material In 97 ESRD patients eligible for living donor kidney transplantation, blood levels of thyroid hormones (fT3, fT4 and TSH), total uncarboxylated MGP (t-ucMGP), desphospho-uncarboxylated MGP (dp-ucMGP), descarboxyprothrombin (PIVKA-II), and soluble Klotho (sKlotho) were measured. The degree of coronary calcification and arterial stiffness were assessed by means of cardiac CT-scans and applanation tonometry, respectively. Results fT3 levels were inversely associated with coronary artery calcification (CAC) scores and measures of arterial stiffness, and positively with dp-ucMGP and sKlotho concentrations. Subfractions of MGP, PIVKA-II and sKlotho did not associate with CAC scores and arterial stiffness. fT4 and TSH levels were both inversely associated with CAC scores, but not with arterial stiffness. Discussion The positive associations between fT3 and dp-ucMGP and sKlotho suggest that synthesis of MGP and Klotho is influenced by thyroid hormones, and supports a link between non-thyroidal illness and alterations in calcification inhibitor levels. However, the absence of an association between serum calcification inhibitor levels and coronary calcification/arterial stiffness and the fact that MGP and Klotho undergo post-translational modifications underscore the complexity of this association. Further studies, measuring total levels of MGP and membrane bound Klotho, should examine this proposed pathway in further detail. PMID:26147960

  14. Value of coronary artery calcium score to predict severity or complexity of coronary artery disease

    PubMed Central

    Gökdeniz, Tayyar; Kalaycıoğlu, Ezgi; Aykan, Ahmet Çağrı; Boyacı, Faruk; Turan, Turhan; Gül, İlker; Çavuşoğlu, Gökhan; Dursun, İhsan

    2014-01-01

    Background Prediction of severity or complexity of coronary artery disease (CAD) is valuable owing to increased risk for cardiovascular events. Although the association between total coronary artery calcium (CAC) score and severity of CAD, Gensini score was not used, it has been previously demonstrated. There is no information about the association between total CAC score and complexity of CAD. Objectives To investigate the association between severity or complexity of coronary artery disease (CAD) assessed by Gensini score and SYNTAX score (SS), respectively, and coronary artery calcium (CAC) score, which is a noninvasive method for CAD evaluation in symptomatic patients with accompanying significant CAD. Methods Two-hundred-fourteen patients were enrolled. Total CAC score was obtained before angiography. Severity and complexity of CAD was assessed by Gensini score and SS, respectively. Associations between clinical and angiographic parameters and total CAC score were analyzed. Results Median total CAC score was 192 (23.0-729.8), and this was positively correlated with both Gensini score (r: 0.299, p<0.001) and SS (r: 0.577, p<0.001). At multivariate analysis, it was independently associated with age (ß: 0.154, p: 0.027), male gender (ß: 0.126, p: 0.035) and SS (ß: 0.481, p< 0.001). Receiver-operating characteristic (ROC) curve analysis revealed a cut-off value > 809 for SS >32 (high SS tertile). Conclusion In symptomatic patients with accompanying significant CAD, total CAC score was independently associated with SS and patients with SS >32 may be detected through high Agatston score. PMID:24676367

  15. Increased intrathoracic and hepatic visceral adipose tissue independently correlates with coronary artery calcification in asymptomatic patients.

    PubMed

    Patil, Harshal R; Patil, Nirav T; King, Samantha I; O'Keefe, Evan; Chhabra, Rajiv; Ansari, Shaya; Kennedy, Kevin F; Dey, Damini; O'Keefe, James H; Helzberg, John H; Thompson, Randall C

    2014-10-01

    Visceral adipose tissue (VAT) is associated with cardiac events, but it is not clear which, if any of the various measures of VAT independently correlate with coronary artery disease (CAD). We studied 400 patients undergoing computed tomography to determine coronary artery calcium (CAC) score. VAT was measured in the form of epicardial adipose tissue (EAT) volume and thickness, intrathoracic adipose tissue volume (ITAV), and hepatic steatosis. Of the 400 subjects, the average CAC score was 112.2 ± 389.3. When each measure of VAT (EAT volume and thickness, ITAV, hepatic steatosis) was added to the traditional model (they were independently associated with greater risk of CAC score ≥100 AU as measured by IDI/NRI (P < .05). On univariable logistic regression analysis, each of the 4 measures of VAT showed association with greater risk of a CAC score of ≥100 AU (OR > 1). Each measure of VAT is a strong correlate of CAC score ≥100 AU in asymptomatic subjects-these VAT assessments correlate more significantly than do traditional CAD risk factors. This incremental power in the predictive models is likely the result of measurement of a fundamental expression of the metabolic syndrome and consequent proatherogenic derangements.

  16. Hyperphosphatemia and hs-CRP Initiate the Coronary Artery Calcification in Peritoneal Dialysis Patients

    PubMed Central

    Shang, Da; Xie, Qionghong; Shang, Bin; Zhang, Min; You, Li; Hao, Chuan-Ming

    2017-01-01

    Background. Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly. Methods. Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients. Results. 70 patients recruited to our study were split into a noninitiation group (n = 37) and an initiation group (n = 33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments. Conclusions. Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients. PMID:28321403

  17. Hyperphosphatemia and hs-CRP Initiate the Coronary Artery Calcification in Peritoneal Dialysis Patients.

    PubMed

    Shang, Da; Xie, Qionghong; Shang, Bin; Zhang, Min; You, Li; Hao, Chuan-Ming; Zhu, Tongying

    2017-01-01

    Background. Coronary artery calcification (CAC) contributes to high risk of cardiocerebrovascular diseases in dialysis patients. However, the risk factors for CAC initiation in peritoneal dialysis (PD) patients are not known clearly. Methods. Adult patients with baseline CaCS = 0 and who were followed up for at least 3 years or until the conversion from absent to any measurable CAC detected were included in this observational cohort study. Binary logistic regression was performed to identify the risk factors for CAC initiation in PD patients. Results. 70 patients recruited to our study were split into a noninitiation group (n = 37) and an initiation group (n = 33) according to the conversion of any measurable CAC during their follow-up or not. In univariate analysis, systolic blood pressure, serum phosphorus, fibrinogen, hs-CRP, serum creatinine, and triglycerides were positively associated with the initiation of CAC, while the high density lipoprotein and nPCR did the opposite function. Multivariate analysis revealed that hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation after adjustments. Conclusions. Hyperphosphatemia and hs-CRP were the independent risk factors for CAC initiation in PD patients. These results suggested potential clinical strategies to prevent the initiation of CAC in PD patients.

  18. Relationship between arterial vascular calcifications seen on screening mammograms and biochemical markers of endothelial injury.

    PubMed

    Pidal, Diego; Sánchez Vidal, M Teresa; Rodríguez, Juan Carlos; Corte, M Daniela; Pravia, Paz; Guinea, Oscar; Pidal, Iván; Bongera, Miguel; Escribano, Dámaso; González, Luis O; Díez, M Cruz; Venta, Rafael; Vizoso, Francisco J

    2009-01-01

    To assess whether breast arterial calcifications (BAC) are associated with altered serum markers of cardiovascular risk, mammograms and records from 1759 women (age range: 45-65 years) screened for breast cancer were revised. One hundred and forty seven (8.36%) women showed BAC. A total of 136 women with BAC and controls (mean age: 57 and 55 years, respectively) accepted entering the study. There were no significant differences in serum levels of urea, glucose, uric acid, creatinine, total cholesterol, HDL-C, LDL-C, folic acid, vitamin B(12), TSH or cysteine, between both groups of patients. However, women with BAC showed higher serum levels of triglycerides (p=0.006), homocysteine (p=0.002) and hs-CRP (p=0.003) than women without BAC. Likewise, we found a significantly higher percentage of cases with an elevated LDL-C/HDL-C ratio (coronary risk index >2) amongst women with BAC than in women without BAC (56.7 and 38.2%, respectively; p=0.04). Our results indicate that the finding of BAC identify women showing altered serum markers of cardiovascular risk.

  19. Effects of low calcium dialysate on the progression of coronary artery calcification in hemodialysis patients: An open-label 12-month randomized clinical trial.

    PubMed

    Kim, Soo Jin; Lee, Young-Ki; Oh, Jieun; Cho, AJin; Noh, Jung Woo

    2017-09-15

    The association between the dialysate calcium level and coronary artery calcification (CAC) has not yet been evaluated in hemodialysis patients. The objective of this study was to determine whether lowering the dialysate calcium levels would decrease the progression of coronary artery calcification (CAC) compared to using standard calcium dialysate. We conducted an open-label randomized trial with parallel groups. The patients were randomly assigned to either 12-month treatment with low calcium dialysate (LCD; 1.25mmol/L, n=36) or standard calcium dialysate (SCD; 1.5mmol/L, n=40). The primary outcome was the change in the CAC scores assessed by 64-slice multidetector computed tomography after 12months. During the treatment period, CAC scores increased in both groups, especially significant in LCD group (402.5±776.8, 580.5±1011.9, P=0.004). When we defined progressors as patients at second and third tertiles of CAC changes, progressor group had a higher proportion of LCD-treated patients than SCD-treated patients (P=0.0229). In multivariate analysis, LCD treatment is a significant risk factor for increase in CAC scores (odds ratio=5.720, 95% CI: 1.219-26.843, P=0.027). Use of LCD may accelerate the progression of CAC in patients with chronic hemodialysis over a 12-month period. Clinical Research Information Service [Internet]; Osong (Chungcheongbuk-do): Korea Centers for Disease Control and Prevention, Ministry of Health and Welfare (Republic of Korea), 2010: KCT0000942. Available from: https://cris.nih.go.kr/cris/search/search_result_st01_kren.jsp?seq=3572&sLeft=2&type=my. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  20. Real‐World Multicenter Registry of Patients with Severe Coronary Artery Calcification Undergoing Orbital Atherectomy

    PubMed Central

    Shlofmitz, Evan; Kaplan, Barry; Alexandru, Dragos; Meraj, Perwaiz; Shlofmitz, Richard

    2016-01-01

    Objectives We evaluated the safety and efficacy of orbital atherectomy in real‐world patients with severe coronary artery calcification (CAC). Background The presence of severe CAC increases the complexity of percutaneous coronary intervention as it may impede stent delivery and optimal stent expansion. Atherectomy may be an indispensable tool for uncrossable or undilatable lesions by modifying severe CAC. Although the ORBIT I and II trials report that orbital atherectomy was safe and effective for the treatment of severe CAC, patients with kidney disease, recent myocardial infarction, long diffuse disease, severe left ventricular dysfunction, and unprotected left main disease were excluded. Methods This retrospective study included 458 consecutive patients with severe CAC who underwent orbital atherectomy followed by stenting from October 2013 to December 2015 at 3 centers. Results The primary endpoint of major adverse cardiac and cerebrovascular events at 30 days was 1.7%. Low rates of 30‐day all‐cause mortality (1.3%), myocardial infarction (1.1%), target vessel revascularization (0%), stroke (0.2%), and stent thrombosis (0.9%) were observed. Angiographic complications were low: perforation was 0.7%, dissection 0.9%, and no‐reflow 0.7%. Emergency coronary artery bypass graft surgery was performed in 0.2% of patients. Conclusion In the largest real‐world study of patients who underwent orbital atherectomy, including high‐risk patients who were not surgical candidates as well as those with very complex coronary anatomy, acute and short‐term adverse clinical event rates were low. A randomized clinical trial is needed to identify the ideal treatment strategy for patients with severe CAC. PMID:27358246

  1. Extracoronary Thoracic and Coronary Artery Calcifications on Chest CT for Lung Cancer Screening: Association with Established Cardiovascular Risk Factors - The "CT-Risk" Trial.

    PubMed

    Dirrichs, Timm; Penzkofer, Tobias; Reinartz, Sebastian D; Kraus, Thomas; Mahnken, Andreas H; Kuhl, Christiane K

    2015-07-01

    To investigate the correlation between prevalence and degree of coronary artery calcification (CAC) and extracoronary calcifications (ECCs), scored quantitatively according to Agatston and semiquantitatively by visual analysis, in chest computed tomography (CT) studies obtained for lung cancer screening in asymptomatic subjects and in patients with known coronary heart disease (CHD), and to compare the association of ECC and CAC to established cardiovascular risk factors. Prospective study on 501 males (67 ± 8 years) with a history of working dust exposure who underwent nongated low-dose chest CT for lung cancer screening. Of these, 63 (12.6%) had a history of CHD, the remaining 438 subjects (87.4%) were clinically asymptomatic and without a history of CHD. On the day of the CT study, subjects underwent a thorough clinical examination including blood tests and completed a standardized questionnaire to establish a complete medical history. ECC and CAC scores were quantified according to Agatston and, in addition, by visual rating of calcium load of individual vessel territories on a five-point scale from "absent" to "extensive." Results were correlated with the respective subjects' cardiovascular risk factors and with the presence or absence of CHD. ECC scores correlated significantly with CAC scores (two-sided Spearman 0.515; P < .001). ECC scores were associated significantly (P < .001) with cardiovascular risk factors (smoking history, hypertension, diabetes, and hypercholesterolemia) and with subjects' Framingham/prospective cardiovascular münster study scores, whereas CAC scores were associated only with the presence of hypercholesterolemia. CAC scores were strongly associated with CHD than ECC scores (area under the curve, 0.88 vs. 0.66 at receiver operating characteristic analysis). Visual scoring of ECC/CAC load correlated closely with the respective Agatston values (P < .001) and revealed the same association (or lack thereof) with cardiovascular risk

  2. The Involvement of miR-29b-3p in Arterial Calcification by Targeting Matrix Metalloproteinase-2

    PubMed Central

    Jiang, Wenhong; Zhang, Zhanman; Yang, Han; Lin, Qiuning; Han, Chuangye

    2017-01-01

    Vascular calcification is a risk predictor and common pathological change in cardiovascular diseases that are associated with elastin degradation and phenotypic transformation of vascular smooth muscle cells via gelatinase matrix metalloproteinase-2 (MMP2). However, the mechanisms involved in this process remain unclear. In this study, we investigated the relationships between miR-29b-3p and MMP2, to confirm miR-29b-3p-mediated MMP2 expression at the posttranscriptional level in arterial calcification. In male Sprague Dawley rats, arterial calcification was induced by subcutaneous injection of a toxic dose of cholecalciferol. In vivo, the quantitative real-time polymerase chain reaction (qRT-PCR) showed that MMP2 expression was upregulated in calcified arterial tissues, and miR-29b-3p expression was downregulated. There was a negative correlation between MMP2 mRNA expression and miR-29b-3p levels (P = 0.0014, R2 = 0.481). Western blotting showed that MMP2 expression was significantly increased in rats treated with cholecalciferol. In vitro, overexpression of miR-29b-3p led to decreased MMP2 expression in rat vascular smooth muscle cells, while downregulation of miR-29b-3p expression led to increased MMP2 expression. Moreover, the luciferase reporter assay confirmed that MMP2 is the direct target of miR-29b-3p. Together, our results demonstrated that a role of miR-29b-3p in vascular calcification involves targeting MMP2. PMID:28164126

  3. The relationship between inhibitors of the Wnt signalling pathway (Dickkopf-1(DKK1) and sclerostin), bone mineral density, vascular calcification and arterial stiffness in post-menopausal women.

    PubMed

    Hampson, Geeta; Edwards, Sylvie; Conroy, Soraya; Blake, Glen M; Fogelman, Ignac; Frost, Michelle L

    2013-09-01

    Epidemiological studies have shown an association between bone loss/osteoporosis and vascular calcification (VC). Recent studies have implicated the Wnt signalling pathway in the pathogenesis of VC. We investigated the association between circulating concentrations of Wnt inhibitors; DKK1 and sclerostin with bone mineral density (BMD), abdominal aortic calcification (AAC) and arterial stiffness in post-menopausal women. One hundred and forty six post-menopausal women aged (mean [SD]) 61.5[6.5] years were studied. Sclerostin and DKK1 were measured in serum. BMD was measured at the lumbar spine (LS), femoral neck (FN), total hip (TH). AAC was detected by Vertebral Fracture Assessment (VFA) imaging and quantified using an 8- and 24- point scoring methods. Arterial stiffness was determined by aortic pulse wave velocity (PWV). A significant positive correlation was observed between sclerostin and BMD at the FN (r = 0.166, p = 0.043) and TH (r = 0.165, p = 0.044). The association remained significant at the FN (p = 0.045) and TH (p = 0.026) following adjustment for confounders. No significant correlation was observed between DKK1 and BMD. In contrast, there was a significant negative correlation between log DKK1 and AAC (24-point score: r = -0.25, p = 0.008 and 8-point score: r = -0.21, p = 0.024). Subjects with AAC score of 1 or less had significantly higher DKK1 (p = 0.01). The association between DKK1 and AAC remained significant following correction for age, blood pressure, cholesterol (24-point score: p = 0.017, 8-point score: p = 0.044). In adjusted linear regression analysis, sclerostin was positively associated with AAC (24-point score: p = 0.048, 8-point score: p = 0.031). Subjects with a PWV>9 m/s had significantly higher sclerostin than those with PWV <9 m/s: 23.8[12.3], vs 29.7 [14] pmol/l, p = 0.03). No association was observed between DKK1 and PWV. The opposite association between AAC and the 2 Wnt signaling inhibitors is of interest and merits further

  4. Coronary artery calcification is inversely related to body morphology in patients with significant coronary artery disease: a three-dimensional intravascular ultrasound study.

    PubMed

    Dangas, George D; Maehara, Akiko; Evrard, Solene M; Sartori, Samantha; Li, Jennifer R; Chirumamilla, Amala P; Nomura-Kitabayashi, Aya; Gukathasan, Nilusha; Hassanin, Ahmed; Baber, Usman; Fahy, Martin; Fuster, Valentin; Mintz, Gary S; Kovacic, Jason C

    2014-02-01

    Emerging data have indicated unexpected complexity in the regulation of vascular and bone calcification. In particular, several recent studies have challenged the concept of a universally positive relationship between body morphology [weight, height, body mass index (BMI), body surface area (BSA)] and the extent of vascular calcification. We sought to clarify these discrepancies and investigated the relationship between index lesion coronary artery calcification (CAC) and body morphology in patients undergoing percutaneous coronary intervention (PCI) using three-dimensional intravascular ultrasound (IVUS). We analysed CAC in patients who underwent PCI with pre-intervention IVUS imaging. The main outcome measure was the calcium index (CalcIndex); a three-dimensional IVUS-derived measure of total calcification per obstructive coronary lesion. A total of 346 patients (65.3 ± 10.6 years; 29.5% females) underwent PCI with IVUS-based CAC assessment. CalcIndex was categorized as zero-low (0-0.1399; n = 152) or intermediate-high (0.1400-1.2541; n = 194). All measures of body morphology were lower in patients with intermediate-high CalcIndex (height, P = 0.024; weight, P = 0.008; BMI, P = 0.064; BSA, P = 0.005). In adjusted multivariable models, weight and BSA were independent inverse predictors of intermediate-high CalcIndex [weight: odds ratio (OR) 0.986, P = 0.017; BSA: OR 0.323, P = 0.012] while CalcIndex also trended towards an inverse association with both height (P = 0.068) and BMI (P = 0.064). These independent inverse associations were consistent across multiple clinical subgroups, including stratification by age, race, gender, diabetes, and renal impairment. Using three-dimensional IVUS to assess vascular calcification, these data confirm an independent, inverse relationship between body size and index lesion CAC in patients with obstructive coronary artery disease.

  5. Coronary artery calcification is inversely related to body morphology in patients with significant coronary artery disease: a three-dimensional intravascular ultrasound study

    PubMed Central

    Dangas, George D.; Maehara, Akiko; Evrard, Solene M.; Sartori, Samantha; Li, Jennifer R.; Chirumamilla, Amala P.; Nomura-Kitabayashi, Aya; Gukathasan, Nilusha; Hassanin, Ahmed; Baber, Usman; Fahy, Martin; Fuster, Valentin; Mintz, Gary S.; Kovacic, Jason C.

    2014-01-01

    Aims Emerging data have indicated unexpected complexity in the regulation of vascular and bone calcification. In particular, several recent studies have challenged the concept of a universally positive relationship between body morphology [weight, height, body mass index (BMI), body surface area (BSA)] and the extent of vascular calcification. We sought to clarify these discrepancies and investigated the relationship between index lesion coronary artery calcification (CAC) and body morphology in patients undergoing percutaneous coronary intervention (PCI) using three-dimensional intravascular ultrasound (IVUS). Methods and results We analysed CAC in patients who underwent PCI with pre-intervention IVUS imaging. The main outcome measure was the calcium index (CalcIndex); a three-dimensional IVUS-derived measure of total calcification per obstructive coronary lesion. A total of 346 patients (65.3 ± 10.6 years; 29.5% females) underwent PCI with IVUS-based CAC assessment. CalcIndex was categorized as zero–low (0–0.1399; n = 152) or intermediate–high (0.1400–1.2541; n = 194). All measures of body morphology were lower in patients with intermediate–high CalcIndex (height, P = 0.024; weight, P = 0.008; BMI, P = 0.064; BSA, P = 0.005). In adjusted multivariable models, weight and BSA were independent inverse predictors of intermediate–high CalcIndex [weight: odds ratio (OR) 0.986, P = 0.017; BSA: OR 0.323, P = 0.012] while CalcIndex also trended towards an inverse association with both height (P = 0.068) and BMI (P = 0.064). These independent inverse associations were consistent across multiple clinical subgroups, including stratification by age, race, gender, diabetes, and renal impairment. Conclusion Using three-dimensional IVUS to assess vascular calcification, these data confirm an independent, inverse relationship between body size and index lesion CAC in patients with obstructive coronary artery disease. PMID:23904334

  6. Preexisting venous calcification prior to dialysis vascular access surgery.

    PubMed

    Lee, Timmy; Safdar, Nida; Mistry, Meenakshi J; Wang, Yang; Chauhan, Vibha; Campos, Begoña; Munda, Rino; Cornea, Virgilius; Roy-Chaudhury, Prabir

    2012-01-01

    Vascular calcification is present in arterial vessels used for dialysis vascular access creation prior to surgical creation. Calcification in the veins used to create a new vascular access has not previously been documented. The objective of this study was to describe the prevalence of venous calcification in samples collected at the time of vascular access creation. Sixty-seven vein samples were studied. A von Kossa stain was performed to quantify calcification. A semi-quantitative scoring system from 0 to 4+ was used to quantify the percentage positive area for calcification as a fraction of total area (0: 0; 1+: 1-10%; 2+: 11-25%; 3+: 26-50%; 4+: >50% positive). Twenty-two of 67 (33%) samples showed evidence of venous calcification. Histologic examination showed varying degrees of calcification within each cell layer. Among the subset of patients with calcification, 4/22 (18%), 19/22 (86%), 22/22 (100%), and 7/22 (32%) had calcification present within the endothelium, intima, media, and adventitia, respectively. The mean semi-quantitative scores of the 22 samples with calcification were 0.18 ± 0.08, 1.2 ± 0.14, 1.6 ± 0.13, and 0.36 ± 0.12 for the endothelium, intima, media, and adventitia, respectively. Our results demonstrate that vascular calcification is present within veins used to create new dialysis vascular access, and located predominately within the neointimal and medial layers. © 2012 Wiley Periodicals, Inc.

  7. Calcium/vitamin D supplementation and coronary artery calcification in the Women's Health Initiative.

    PubMed

    Manson, JoAnn E; Allison, Matthew A; Carr, J Jeffrey; Langer, Robert D; Cochrane, Barbara B; Hendrix, Susan L; Hsia, Judith; Hunt, Julie R; Lewis, Cora E; Margolis, Karen L; Robinson, Jennifer G; Rodabough, Rebecca J; Thomas, Asha M

    2010-07-01

    Coronary artery calcified plaque is a marker for atheromatous plaque burden and predicts future risk of cardiovascular events. The relationship between calcium plus vitamin D (calcium/D) supplementation and coronary artery calcium (CAC) has not been previously assessed in a randomized trial setting. We compared CAC scores after trial completion between women randomized to calcium/vitamin D supplementation and women randomized to placebo. In an ancillary substudy of women randomized to calcium carbonate (1,000 mg of elemental calcium daily) plus vitamin D3 (400 IU daily) or placebo, nested within the Women's Health Initiative trial of estrogen among women who underwent hysterectomy, we measured CAC with cardiac CT in 754 women aged 50 to 59 years at randomization. Imaging for CAC was performed at 28 of 40 centers after a mean of 7 years of treatment, and scans were read centrally. CAC scores were measured by a central reading center with masking to randomization assignments. Posttrial CAC measurements were similar in women randomized to calcium/D supplementation and those receiving placebo. The mean CAC score was 91.6 for women receiving calcium/D and 100.5 for women receiving placebo (rank test P value = 0.74). After adjustment for coronary risk factors, multivariate odds ratios for increasing CAC score cutpoints (CAC >0, > or =10, and > or =100) for calcium/D versus placebo were 0.92 (95% CI, 0.64-1.34), 1.29 (0.88-1.87), and 0.90 (0.56-1.44), respectively. Corresponding odds ratios among women with a 50% or higher adherence to study pills and for higher levels of CAC (>300) were similar. Treatment with moderate doses of calcium plus vitamin D3 did not seem to alter coronary artery calcified plaque burden among postmenopausal women. Whether higher or lower doses would affect this outcome remains uncertain.

  8. Significant inverse association of equol-producer status with coronary artery calcification but not dietary isoflavones in healthy Japanese men.

    PubMed

    Ahuja, Vasudha; Miura, Katsuyuki; Vishnu, Abhishek; Fujiyoshi, Akira; Evans, Rhobert; Zaid, Maryam; Miyagawa, Naoko; Hisamatsu, Takashi; Kadota, Aya; Okamura, Tomonori; Ueshima, Hirotsugu; Sekikawa, Akira

    2017-01-01

    Equol, a metabolite of the dietary isoflavone daidzein, is produced by the action of gut bacteria in some individuals who are termed as equol-producers. It is proposed to have stronger atheroprotective properties than dietary isoflavones. We examined a cross-sectional association of dietary isoflavones and equol-producer status with coronary artery calcification (CAC), a biomarker of coronary atherosclerosis, among men in Japan. A population-based sample of 272 Japanese men aged 40-49 years recruited from 2004 to 2007 was examined for serum isoflavones, serum equol, CAC and other factors. Equol-producers were classified as individuals having a serum level of equol >83 nm. The presence of CAC was defined as a coronary Ca score ≥10 Agatston units. The associations of dietary isoflavones and equol-producers with CAC were analysed using multiple logistic regression. The median of dietary isoflavones, equol and CAC were 512·7 (interquartile range (IQR) 194·1, 1170·0), 9·1 (IQR 0·10, 33·1) and 0·0 (IQR 0·0, 1·0) nm, respectively. Prevalence of CAC and equol-producers was 9·6 and 16·0 %, respectively. Dietary isoflavones were not significantly associated with CAC. After multivariable adjustment, the OR for the presence of CAC in equol-producers compared with equol non-producers was 0·10 (95 % CI 0·01, 0·90, P<0·04). Equol-producers had significantly lower CAC than equol non-producers, but there was no significant association between dietary isoflavones and CAC, suggesting that equol may be a key factor for atheroprotective properties of isoflavones in Japanese men. This finding must be confirmed in larger studies or clinical trials of equol that is now available as a dietary supplement.

  9. The protective effect of GLP-1 analogue in arterial calcification through attenuating osteoblastic differentiation of human VSMCs.

    PubMed

    Zhan, Jun-Kun; Wang, Yan-Jiao; Wang, Yi; Tang, Zhi-Yong; Tan, Pan; Huang, Wu; Liu, You-Shuo

    2015-06-15

    Arterial calcification is a common event in cardiovascular pathogenesis. Osteoblastic differentiation of vascular smooth muscle cells (VSMCs) is the most important cytopathologic foundation of arterial calcification. Glucagon-like peptide-1 (GLP-1) exerts multiple cardioprotective actions beyond insulinotropic effects through GLP-1 receptor (GLP-1R). However, whether GLP-1 regulates osteoblastic differentiation of VSMCs and associated molecular mechanisms has not been clarified. The human VSMC differentiation model was established by beta-glycerophosphate (β-GP) induction. The mineralization was measured by Alizarin Red S staining. Protein expression and phosphorylation were detected by Western blot or immunofluorescence. GLP-1R gene expression was silenced by siRNA. The GLP-1 analogue liraglutide dose- and time-dependently inhibited the protein expression of osteoblastic differentiation markers alkaline phosphatase (ALP), osteocalcin (OC), and Runt-related transcription factor 2 (Runx2), phosphorylation of PI3K, Akt, mTOR, and S6K1. Silencing of GLP-1R gene expression by siRNA significantly blocked the effects of liraglutide in ALP protein expression and PI3K/Akt phosphorylation. GLP-1 analogue liraglutide attenuates the osteoblastic differentiation and calcification of human VSMCs through its receptor and subsequent activation of PI3K/Akt/mTOR/S6K1 signaling. GLP-1 analogues may be potential agents for the treatment of cardiovascular diseases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  10. Targeted chelation therapy with EDTA-loaded albumin nanoparticles regresses arterial calcification without causing systemic side effects.

    PubMed

    Lei, Yang; Nosoudi, Nasim; Vyavahare, Naren

    2014-12-28

    Elastin-specific medial arterial calcification (MAC) is an arterial disease commonly referred as Monckeberg's sclerosis. It causes significant arterial stiffness, and as yet, no clinical therapy exists to prevent or reverse it. We developed albumin nanoparticles (NPs) loaded with disodium ethylene diaminetetraacetic acid (EDTA) that were designed to target calcified elastic lamina when administrated by intravenous injection. We optimized NP size, charge, and EDTA-loading efficiency (150-200 nm, zeta potential of -22.89--31.72 mV, loading efficiency for EDTA~20%) for in vivo targeting in rats. These NPs released EDTA slowly for up to 5 days. In both ex-vivo study and in vivo study with injury-induced local abdominal aortic calcification, we showed that elastin antibody-coated and EDTA-loaded albumin NPs targeted the damaged elastic lamina while sparing healthy artery. Intravenous NP injections reversed elastin-specific MAC in rats after four injections over a 2-week period. EDTA-loaded albumin NPs did not cause the side effects observed in EDTA injection alone, such as decrease in serum calcium (Ca), increase in urine Ca, or toxicity to kidney. There was no bone loss in any treated groups. We demonstrate that elastin antibody-coated and EDTA-loaded albumin NPs might be a promising nanoparticle therapy to reverse elastin-specific MAC and circumvent side effects associated with systemic EDTA chelation therapy. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Targeted chelation therapy with EDTA-loaded albumin nanoparticles regresses arterial calcification without causing systemic side effects

    PubMed Central

    Lei, Yang; Nosoudi, Nasim; Vyavahare, Naren

    2014-01-01

    Background and aims Elastin-specific medial arterial calcification (MAC) is an arterial disease commonly referred as Monckeberg’s sclerosis. It causes significant arterial stiffness, and as yet, no clinical therapy exists to prevent or reverse it. We developed albumin nanoparticles (NPs) loaded with disodium ethylene diaminetetraacetic acid (EDTA) that were designed to target calcified elastic lamina when administrated by intravenous injection. Methods and Results We optimized NP size, charge, and EDTA-loading efficiency (150~200 nm, zeta potential of − 22.89 ~ − 31.72 mV, loading efficiency for EDTA ~20 %) for in vivo targeting in rats. These NPs released EDTA slowly for up to 5 days. In both ex-vivo study and in vivo study with injury-induced local abdominal aortic calcification, we showed that elastin antibody-coated and EDTA-loaded albumin NPs targeted the damaged elastic lamina while sparing healthy artery. Intravenous NP injections reversed elastin-specific MAC in rats after four injections over a 2-week period. EDTA-loaded albumin NPs did not cause the side effects observed in EDTA injection alone, such as decrease in serum calcium (Ca), increase in urine Ca, or toxicity to kidney. There was no bone loss in any treated groups. Conclusion We demonstrate that elastin antibody-coated and EDTA-loaded albumin NPs might be a promising nanoparticle therapy to reverse elastin-specific MAC and circumvent side effects associated with systemic EDTA chelation therapy. PMID:25285609

  12. Disseminated arterial calcification and enhanced myogenic response are associated with abcc6 deficiency in a mouse model of pseudoxanthoma elasticum.

    PubMed

    Kauffenstein, Gilles; Pizard, A; Le Corre, Y; Vessières, E; Grimaud, L; Toutain, B; Labat, C; Mauras, Y; Gorgels, T G; Bergen, A A; Le Saux, O; Lacolley, P; Lefthériotis, G; Henrion, D; Martin, L

    2014-05-01

    Pseudoxanthoma elasticum is an inherited metabolic disorder resulting from ABCC6 gene mutations. It is characterized by progressive calcification and fragmentation of elastic fibers in the skin, retina, and the arterial wall. Despite calcium accumulation in the arteries of patients with pseudoxanthoma elasticum, functional consequences remain unknown. In the present study, we investigated arterial structure and function in Abcc6(-/-) mice, a model of the human disease. Arterial calcium accumulation was evaluated using alizarin red stain and atomic absorption spectrometry. Expression of genes involved in osteochondrogenic differentiation was measured by polymerase chain reaction. Elastic arterial properties were evaluated by carotid echotracking. Vascular reactivity was evaluated using wire and pressure myography and remodeling using histomorphometry. Arterial calcium accumulation was 1.5- to 2-fold higher in Abcc6(-/-) than in wild-type mice. Calcium accumulated locally leading to punctuate pattern. Old Abcc6(-/-) arteries expressed markers of both osteogenic (Runx2, osteopontin) and chondrogenic lineage (Sox9, type II collagen). Abcc6(-/-) arteries displayed slight increase in arterial stiffness and vasoconstrictor tone in vitro tended to be higher in response to phenylephrine and thromboxane A2. Pressure-induced (myogenic) tone was significantly higher in Abcc6(-/-) arteries than in wild type. Arterial blood pressure was not significantly changed in Abcc6(-/-), despite higher variability. Scattered arterial calcium depositions are probably a result of osteochondrogenic transdifferentiation of vascular cells. Lower elasticity and increased myogenic tone without major changes in agonist-dependent contraction evidenced in aged Abcc6(-/-) mice suggest a reduced control of local blood flow, which in turn may alter vascular homeostasis in the long term.

  13. Ethnic differences in the prognostic value of coronary artery calcification for all-cause mortality.

    PubMed

    Nasir, Khurram; Shaw, Leslee J; Liu, Sandy T; Weinstein, Steven R; Mosler, Tristen R; Flores, Phillip R; Flores, Ferdinand R; Raggi, Paolo; Berman, Daniel S; Blumenthal, Roger S; Budoff, Matthew J

    2007-09-04

    The purpose of this study was to evaluate the prognostic value of coronary artery calcium (CAC), a known marker of subclinical atherosclerosis, in a large, ethnically diverse cohort of 14,812 patients for the prediction of all-cause mortality. Disparities in case fatality rates for heart disease among ethnic groups are well known. In 2001, rates of death from heart disease were 30% higher among African Americans (AA) than non-Hispanic whites (NHW). Some of this variability may be due to differing pathophysiological mechanisms and effects of underlying atherosclerosis. Ten-year death rates from all causes (total deaths = 505) were compared using risk-adjusted Cox proportional hazards models in AA (n = 637), Hispanic (HS, n = 1,334), Asian (AS, n = 1,065), and NHW (n = 11,776) populations. Ethnic minority patients were generally younger (0.3 to 4 years), more often persons with diabetes (p < 0.0001), hypertensive (p < 0.0001), and female (p < 0.0001). The prevalence of CAC scores > or =100 was highest in NHW (31%) and lowest for HS (18%) (p < 0.0001). Overall survival was 96%, 93%, and 92% for AS, NHW, and HS, respectively, as compared with 83% for AA (p < 0.0001). When comparing prognosis by CAC scores in ethnic minorities as compared with NHW, relative risk ratios were highest for AA with CAC scores > or =400 exceeding 16.1 (p < 0.0001). Hispanics with CAC scores > or =400 had relative risk ratios from 7.9 to 9.0, whereas AS with CAC scores > or =1,000 had relative risk ratios 6.6-fold higher than NHW (p < 0.0001). Consistent with population evidence, AA with increasing burden of subclinical coronary artery disease were the highest-risk ethnic minority population. These data support a growing body of evidence noting substantial differences in cardiovascular risk by ethnicity.

  14. Fasting plasma glucose levels and coronary artery calcification in subjects with impaired fasting glucose.

    PubMed

    Eun, Young-Mi; Kang, Sung-Goo; Song, Sang-Wook

    2016-01-01

    Prediabetes is associated with an increased risk of cardiovascular disease (CVD). While the association of impaired glucose tolerance with CVD has been shown in many studies, the relationship between impaired fasting glucose (IFG) and CVD remains unclear. The purpose of this study was to compare the coronary artery calcium (CAC) scores of participants with normal fasting glucose versus those with IFG, according to fasting plasma glucose (FPG) levels, and to assess whether differences in CAC scores were independent of important confounders. Retrospective study. Health Promotion Center of the University Hospital (Gyeonggi-do, South Korea), during the period 2010-2014. Participants were enrolled from the general population who visited for a medical check-up. CAC was assessed in asymptomatic individuals by multidetector computed tomography. Anthropometric parameters and metabolic profiles were also recorded. Subjects were divided into four fasting glucose groups. Participants with a history of CVD or diabetes mellitus were excluded. Correlation between FPG and CAC scores, CAC score categories, and association between CAC score and FPG categories. Of 1112 participants, 346 (34.2%) had a CAC score > 0. FPG values in the IFG patients were positively but weakly correlated with CAC scores (r=0.099, P=.001). The incidence of CAC differed according to FPG level (P < .001) and in Kruskal-Wallis test the mean CAC score differed by FPG group (P < .001). After adjustment for other factors in a multiple logistic regression analysis, those subjects with FPG >=110 mg/dL had a significantly higher risk of CAC than did subjects with normal fasting glucose (110.

  15. Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications

    SciTech Connect

    Mordang, Jan-Jurre Gubern-Mérida, Albert; Karssemeijer, Nico; Heeten, Gerard den

    2016-04-15

    Purpose: In the past decades, computer-aided detection (CADe) systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists’ detection rate. However, due to the high number of false positives marked by these CADe systems, they are not yet suitable as an independent reader. Breast arterial calcifications (BACs) are one of the most frequent false positives marked by CADe systems. In this study, a method is proposed for the elimination of BACs as positive findings. Removal of these false positives will increase the performance of the CADe system in finding malignant microcalcifications. Methods: A multistage method is proposed for the removal of BAC findings. The first stage consists of a microcalcification candidate selection, segmentation and grouping of the microcalcifications, and classification to remove obvious false positives. In the second stage, a case-based selection is applied where cases are selected which contain BACs. In the final stage, BACs are removed from the selected cases. The BACs removal stage consists of a GentleBoost classifier trained on microcalcification features describing their shape, topology, and texture. Additionally, novel features are introduced to discriminate BACs from other positive findings. Results: The CADe system was evaluated with and without BACs removal. Here, both systems were applied on a validation set containing 1088 cases of which 95 cases contained malignant microcalcifications. After bootstrapping, free-response receiver operating characteristics and receiver operating characteristics analyses were carried out. Performance between the two systems was compared at 0.98 and 0.95 specificity. At a specificity of 0.98, the sensitivity increased from 37% to 52% and the sensitivity increased from 62% up to 76% at a specificity of 0.95. Partial areas under the curve in the specificity

  16. Genome-wide association study for coronary artery calcification with follow-up in myocardial infarction.

    PubMed

    O'Donnell, Christopher J; Kavousi, Maryam; Smith, Albert V; Kardia, Sharon L R; Feitosa, Mary F; Hwang, Shih-Jen; Sun, Yan V; Province, Michael A; Aspelund, Thor; Dehghan, Abbas; Hoffmann, Udo; Bielak, Lawrence F; Zhang, Qunyuan; Eiriksdottir, Gudny; van Duijn, Cornelia M; Fox, Caroline S; de Andrade, Mariza; Kraja, Aldi T; Sigurdsson, Sigurdur; Elias-Smale, Suzette E; Murabito, Joanne M; Launer, Lenore J; van der Lugt, Aad; Kathiresan, Sekar; Krestin, Gabriel P; Herrington, David M; Howard, Timothy D; Liu, Yongmei; Post, Wendy; Mitchell, Braxton D; O'Connell, Jeffrey R; Shen, Haiqing; Shuldiner, Alan R; Altshuler, David; Elosua, Roberto; Salomaa, Veikko; Schwartz, Stephen M; Siscovick, David S; Voight, Benjamin F; Bis, Joshua C; Glazer, Nicole L; Psaty, Bruce M; Boerwinkle, Eric; Heiss, Gerardo; Blankenberg, Stefan; Zeller, Tanja; Wild, Philipp S; Schnabel, Renate B; Schillert, Arne; Ziegler, Andreas; Münzel, Thomas F; White, Charles C; Rotter, Jerome I; Nalls, Michael; Oudkerk, Matthijs; Johnson, Andrew D; Newman, Anne B; Uitterlinden, Andre G; Massaro, Joseph M; Cunningham, Julie; Harris, Tamara B; Hofman, Albert; Peyser, Patricia A; Borecki, Ingrid B; Cupples, L Adrienne; Gudnason, Vilmundur; Witteman, Jacqueline C M

    2011-12-20

    Coronary artery calcification (CAC) detected by computed tomography is a noninvasive measure of coronary atherosclerosis, which underlies most cases of myocardial infarction (MI). We sought to identify common genetic variants associated with CAC and further investigate their associations with MI. Computed tomography was used to assess quantity of CAC. A meta-analysis of genome-wide association studies for CAC was performed in 9961 men and women from 5 independent community-based cohorts, with replication in 3 additional independent cohorts (n=6032). We examined the top single-nucleotide polymorphisms (SNPs) associated with CAC quantity for association with MI in multiple large genome-wide association studies of MI. Genome-wide significant associations with CAC for SNPs on chromosome 9p21 near CDKN2A and CDKN2B (top SNP: rs1333049; P=7.58×10(-19)) and 6p24 (top SNP: rs9349379, within the PHACTR1 gene; P=2.65×10(-11)) replicated for CAC and for MI. Additionally, there is evidence for concordance of SNP associations with both CAC and MI at a number of other loci, including 3q22 (MRAS gene), 13q34 (COL4A1/COL4A2 genes), and 1p13 (SORT1 gene). SNPs in the 9p21 and PHACTR1 gene loci were strongly associated with CAC and MI, and there are suggestive associations with both CAC and MI of SNPs in additional loci. Multiple genetic loci are associated with development of both underlying coronary atherosclerosis and clinical events.

  17. Application of Machine Learning Algorithms to Predict Coronary Artery Calcification With a Sibship-Based Design

    PubMed Central

    Sun, Yan V.; Bielak, Lawrence F.; Peyser, Patricia A.; Turner, Stephen T.; Sheedy, Patrick F.; Boerwinkle, Eric; Kardia, Sharon L.R.

    2010-01-01

    As part of the Genetic Epidemiology Network of Arteriopathy study, hypertensive non-Hispanic White sibships were screened using 471 single nucleotide polymorphisms (SNPs) to identify genes influencing coronary artery calcification (CAC) measured by computed tomography. Individuals with detectable CAC and CAC quantity ≥70th age- and sex-specific percentile were classified as having a high CAC burden and compared to individuals with CAC quantity <70th percentile. Two sibs from each sibship were randomly chosen and divided into two data sets, each with 360 unrelated individuals. Within each data set, we applied two machine learning algorithms, Random Forests and RuleFit, to identify the best predictors of having high CAC burden among 17 risk factors and 471 SNPs. Using five-fold cross-validation, both methods had ~70% sensitivity and ~60% specificity. Prediction accuracies were significantly different from random predictions (P-value <0.001) based on 1,000 permutation tests. Predictability of using 287 tagSNPs was as good as using all 471 SNPs. For Random Forests, among the top 50 predictors, the same eight tagSNPs and 15 risk factors were found in both data sets while eight tagSNPs and 12 risk factors were found in both data sets for RuleFit. Replicable effects of two tagSNPs (in genes GPR35 and NOS3) and 12 risk factors (age, body mass index, sex, serum glucose, high-density lipoprotein cholesterol, systolic blood pressure, cholesterol, homocysteine, triglycerides, fibrinogen, Lp(a) and low-density lipoprotein particle size) were identified by both methods. This study illustrates how machine learning methods can be used in sibships to identify important, replicable predictors of subclinical coronary atherosclerosis. PMID:18271057

  18. Evaluation of 18F-FDG uptake and arterial wall calcifications using 18F-FDG PET/CT.

    PubMed

    Ben-Haim, Simona; Kupzov, Ela; Tamir, Ada; Israel, Ora

    2004-11-01

    Glucose metabolic activity expressed as (18)F-FDG uptake may be increased in active atherosclerotic plaque. Calcium depositions are often increased in mature atherosclerotic plaque. The purpose of the present study was to assess the patterns of vascular-wall (18)F-FDG uptake and CT calcifications using combined PET/CT. One hundred twenty-two consecutive patients over the age of 50 (47 women and 75 men; mean age, 66 +/- 9 y) undergoing whole-body (18)F-FDG PET/CT for tumor assessment were retrospectively evaluated. PET, CT, and PET/CT slices were generated for review. Abnormal vascular findings in major arteries in the chest and abdomen were categorized as PET positive (PET+), PET negative (PET-), CT positive (CT+), or CT negative (CT-). The topographic relationship between increased vascular-wall (18)F-FDG uptake on PET and the presence of calcifications on CT was assessed on PET/CT fused images, with abnormal sites further classified as PET+/CT+, PET+/CT-, or PET-/CT+. The presence of CT calcifications and increased vascular-wall (18)F-FDG uptake was correlated with age, sex, presence of cardiovascular risk factors, and cardiovascular disease. Abnormal findings were identified at 349 sites. CT calcifications (CT+) were observed at 320 sites (92%) of 100 patients (82%), more commonly in men (P < 0.03), in older patients (P < 0.0001), in patients with hypertension (P < 0.003) or hyperlipidemia (P < 0.04), and in smokers (P < 0.008). Increased vascular-wall (18)F-FDG uptake (PET+) was observed at 52 sites (15%) of 38 patients (31%), more commonly in men (P < 0.02), in older patients (P < 0.0001), and in patients with hypertension (P < 0.02), and was borderline in patients with cardiovascular disease (P = 0.057). PET+ and CT+ findings correlated in 12 patients, a PET+/CT- pattern was found in 18 patients, and 8 patients had increased vascular-wall (18)F-FDG uptake in sites with and without calcifications (PET+/CT+, CT-). Twenty-two patients (18%) had a PET

  19. Hemoglobin A1c and the Progression of Coronary Artery Calcification Among Adults Without Diabetes

    PubMed Central

    Steffes, Michael W.; Carr, J. Jeffrey; Kim, Yongin; Gross, Myron D.; Carnethon, Mercedes R.; Reis, Jared P.; Loria, Catherine M.; Jacobs, David R.; Lewis, Cora E.

    2015-01-01

    OBJECTIVE Higher levels of hemoglobin A1c (HbA1c) are associated with increased cardiovascular disease risk among individuals without diabetes and may also be positively associated with coronary artery calcification (CAC). This study investigated the association of HbA1c with CAC progression in the Coronary Artery Risk Development in Young Adults study. RESEARCH DESIGN AND METHODS We included 2,076 participants with HbA1c and noncontrast computed tomography (CT) assessed at baseline (2005–2006), and CT repeated 5 years later (2010–2011). CAC progression was defined as 1) incident CAC (increase >0 Agatston units among those with no CAC at baseline), 2) any CAC progression (increase >10 Agatston units between examinations), and 3) advanced CAC progression (increase >100 Agatston units between examinations). RESULTS During the 5-year follow-up period, 12.9% of participants without baseline CAC developed incident CAC; among all participants, 18.2% had any CAC progression and 5.4% had advanced CAC progression. Higher HbA1c was associated with incident CAC (risk ratio [RR] = 1.45; 95% CI 1.02, 2.06), any CAC progression (RR = 1.51; 95% CI 1.16, 1.96), and advanced CAC progression (RR = 2.42; 95% CI 1.47, 3.99) after adjustment for sociodemographic factors. Additional adjustment for cardiovascular risk factors attenuated the associations of HbA1c with incident CAC (RR = 1.05; 95% CI 0.74, 1.49) and any CAC progression (RR = 1.13; 95% CI 0.87, 1.47). In contrast, the association of HbA1c with advanced CAC progression persisted in multivariable adjusted models (RR = 1.78; 95% CI 1.08, 2.95). CONCLUSIONS Higher HbA1c was independently associated with advanced CAC progression among individuals without diabetes, while the associations with incident CAC and any CAC progression were accounted for by other established cardiovascular risk factors. PMID:25325881

  20. Association of the Interaction Between Smoking and Depressive Symptom Clusters With Coronary Artery Calcification: The CARDIA Study.

    PubMed

    Carroll, Allison J; Auer, Reto; Colangelo, Laura A; Carnethon, Mercedes R; Jacobs, David R; Stewart, Jesse C; Widome, Rachel; Carr, John Jeffrey; Liu, Kiang; Hitsman, Brian

    2017-01-01

    Depressive symptom clusters are differentially associated with prognosis among patients with cardiovascular disease (CVD). Few studies have prospectively evaluated the association between depressive symptom clusters and risk of CVD. Previously, we observed that smoking and global depressive symptoms were synergistically associated with coronary artery calcification (CAC). The purpose of this study was to determine whether the smoking by depressive symptoms interaction, measured cumulatively over 25 years, differed by depressive symptom cluster (negative affect, anhedonia, and somatic symptoms) in association with CAC. Participants (N = 3,189: 54.5% female; 51.5% Black; average age = 50.1 years) were followed from 1985-1986 through 2010-2011 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking exposure was measured by cumulative cigarette pack-years (cigarette packs smoked per day × number of years smoking; year 0 through year 25). Depressive symptoms were measured using a 14-item, 3-factor (negative affect, anhedonia, somatic symptoms) model of the Center for Epidemiologic Studies Depression (CES-D) Scale (years 5, 10, 15, 20, and 25). CAC was assessed at year 25. Logistic regression models were used to evaluate the association between the smoking by depressive symptom clusters interactions with CAC ( = 0 vs. > 0), adjusted for CVD-related sociodemographic, behavioral, and clinical covariates. 907 participants (28% of the sample) had CAC > 0 at year 25. The depressive symptom clusters did not differ significantly between the two groups. Only the cumulative somatic symptom cluster by cumulative smoking exposure interaction was significantly associated with CAC > 0 at year 25 (p = .028). Specifically, adults with elevated somatic symptoms (score 9 out of 18) who had 10, 20, or 30 pack-years of smoking exposure had respective odds ratios (95% confidence intervals) of 2.06 [1.08, 3.93], 3.71 [1.81, 7.57], and 6.68 [2.87, 15.53], ps < .05

  1. Increased risk for development of coronary artery calcification in subjects with non-alcoholic fatty liver disease and systemic inflammation.

    PubMed

    Kim, Jihyun; Lee, Da Young; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

    2017-01-01

    Recent studies have suggested the importance of non-alcoholic fatty liver disease (NAFLD) and systemic inflammation in the development of atherosclerosis. The aim of this study was to compare the risk for coronary artery calcification (CAC) development according to the status of NAFLD and inflammation over four years of follow-up in subjects without baseline CAC. A total of 1,575 participants in a health screening program were divided into four groups according to baseline NAFLD state and high-sensitivity C-reactive protein (hs-CRP) (median 0.06 mg/L) levels as follows: no NAFLD and hs-CRP <0.06 mg/L, no NAFLD and hs-CRP ≥0.06 mg/L, NAFLD and hs-CRP <0.06 mg/L, and NAFLD and hs-CRP ≥0.06 mg/L. Coronary artery calcium score (CACS) was repeatedly measured by multi-detector computed tomography at four-year intervals and CAC development during those intervals was monitored in subjects with baseline CACS = 0. Over four years, 148 subjects (9.4%) developed CAC. The proportion of subjects who developed CAC was significantly higher in subjects with NAFLD at baseline compared with those without NAFLD at baseline (6.8 vs. 12.4%, p<0.01), and it was also higher in subjects with hs-CRP ≥0.06 mg/L compared with those with hs-CRP <0.06 mg/L (7.2 vs. 11.5%, p<0.01). In addition, the proportion of subjects who developed CAC was highest in subjects with NAFLD and hs-CRP ≥0.06 mg/dL, followed by subjects with NAFLD, subjects without NAFLD and hs-CRP ≥0.06 mg/L, and subjects without NALFD and hs-CRP <0.05 mg/L at baseline, in that order (13.7, 10.0, 8.3, and 5.8%, respectively; p for trend<0.01). The odds ratio for CAC development was highest in subjects with NAFLD and hs-CRP ≥0.06 mg/L (1.67, 95% CI 1.01-2.77), though it was attenuated after adjustment for body mass index. The concomitant presence of NAFLD and systemic inflammation as assessed by hs-CRP increases the risk of CAC development over four years.

  2. Spiral CT Quantification of Aorto-Renal Calcification and Its Use in the Detection of Atheromatous Renal Artery Stenosis: A Study in 42 Patients

    SciTech Connect

    Gayard, Pierre; Garcier, Jean-Marc; Boire, Jean-Yves; Ravel, Anne; Perez, Nessim; Privat, Christian; Lucien, Pascal; Viallet, Jean-Francois; Boyer, Louis

    2000-01-15

    Purpose: To investigate whether a correlation exists between aortic and renal arterial calcifications detected with spiral CT and significant angiographic renal artery stenosis (RAS).Methods: Forty-two patients (mean age 67 years, range 37-84 years), of whom 24 were hypertensive, prospectively underwent abdominal helical CT and aortic and renal arteriography. The 3-mm thickness CT scans (pitch = 1) were reconstructed each millimeter. A manual outline of the renal artery including its ostial portion was produced. Calcific hyperdensities were defined as areas of density more than 130 HU. CT data were compared with the presence or absence of RAS on angiography (24 cases); hypertension and age were taken into account (Mann-Whitney U-test).Results: CT detection and quantification appeared to be reliable and reproductible. We did not find any correlation between aortic and renal arterial calcifications and RAS, even for the patients above 65 years, with or without hypertension. There was no correlation either between calcifications and hypertension in patients without RAS. Conclusion: In this population, aortic and renal arterial calcifications have no predictive value for RAS.

  3. Association of Anti-Citrullinated Peptide Antibodies With Coronary Artery Calcification in Rheumatoid Arthritis.

    PubMed

    Geraldino-Pardilla, Laura; Giles, Jon T; Sokolove, Jeremy; Zartoshti, Afshin; Robinson, William H; Budoff, Matthew; Detrano, Robert; Bokhari, Sabahat; Bathon, Joan M

    2017-08-01

    Citrullinated proteins have been found within atherosclerotic plaque. However, studies evaluating the association between anti-citrullinated protein antibodies (ACPAs) and imaging measures of atherosclerosis in patients with rheumatoid arthritis (RA) have been limited to seroreactive citrullinated fibrinogen or citrullinated vimentin and have rendered contradictory results. Therefore, our objective was to evaluate this association using an extended panel of ACPAs in a larger sample of RA patients without clinical cardiovascular disease (CVD). ACPAs were identified using a custom Bio-Plex bead assay in 270 patients from 2 independent RA cohorts without clinical CVD, with the first one consisting of 195 patients and the other of 75 patients. Coronary artery calcium (CAC) was assessed by computed tomography as a measure of coronary artery disease. High levels of anti-citrullinated histone H2B antibodies were strongly associated with higher CAC scores, compared with lower antibody levels (P = 0.001); this remained significant after adjustment for traditional CV and RA-specific risk factors (P = 0.03). No association between levels of ACPAs and CAC progression at 3 years was seen (P = 0.09); however, the number of progressors was small (n = 92). Higher levels of ACPAs targeting Cit-histone H2B were associated with higher CAC scores when compared to lower antibody levels, suggesting a potential role for histone citrullination seroreactivity in atherosclerosis. © 2016, American College of Rheumatology.

  4. An alternative method for quantifying coronary artery calcification: the multi-ethnic study of atherosclerosis (MESA)

    PubMed Central

    2012-01-01

    Background Extent of atherosclerosis measured by amount of coronary artery calcium (CAC) in computed tomography (CT) has been traditionally assessed using thresholded scoring methods, such as the Agatston score (AS). These thresholded scores have value in clinical prediction, but important information might exist below the threshold, which would have important advantages for understanding genetic, environmental, and other risk factors in atherosclerosis. We developed a semi-automated threshold-free scoring method, the spatially weighted calcium score (SWCS) for CAC in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods Chest CT scans were obtained from 6814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). The SWCS and the AS were calculated for each of the scans. Cox proportional hazards models and linear regression models were used to evaluate the associations of the scores with CHD events and CHD risk factors. CHD risk factors were summarized using a linear predictor. Results Among all participants and participants with AS > 0, the SWCS and AS both showed similar strongly significant associations with CHD events (hazard ratios, 1.23 and 1.19 per doubling of SWCS and AS; 95% CI, 1.16 to 1.30 and 1.14 to 1.26) and CHD risk factors (slopes, 0.178 and 0.164; 95% CI, 0.162 to 0.195 and 0.149 to 0.179). Even among participants with AS = 0, an increase in the SWCS was still significantly associated with established CHD risk factors (slope, 0.181; 95% CI, 0.138 to 0.224). The SWCS appeared to be predictive of CHD events even in participants with AS = 0, though those events were rare as expected. Conclusions The SWCS provides a valid, continuous measure of CAC suitable for quantifying the extent of atherosclerosis without a threshold, which will be useful for examining novel genetic and environmental risk factors for atherosclerosis. PMID:22747658

  5. An alternative method for quantifying coronary artery calcification: the multi-ethnic study of atherosclerosis (MESA).

    PubMed

    Liang, C Jason; Budoff, Matthew J; Kaufman, Joel D; Kronmal, Richard A; Brown, Elizabeth R

    2012-07-02

    Extent of atherosclerosis measured by amount of coronary artery calcium (CAC) in computed tomography (CT) has been traditionally assessed using thresholded scoring methods, such as the Agatston score (AS). These thresholded scores have value in clinical prediction, but important information might exist below the threshold, which would have important advantages for understanding genetic, environmental, and other risk factors in atherosclerosis. We developed a semi-automated threshold-free scoring method, the spatially weighted calcium score (SWCS) for CAC in the Multi-Ethnic Study of Atherosclerosis (MESA). Chest CT scans were obtained from 6814 participants in the Multi-Ethnic Study of Atherosclerosis (MESA). The SWCS and the AS were calculated for each of the scans. Cox proportional hazards models and linear regression models were used to evaluate the associations of the scores with CHD events and CHD risk factors. CHD risk factors were summarized using a linear predictor. Among all participants and participants with AS > 0, the SWCS and AS both showed similar strongly significant associations with CHD events (hazard ratios, 1.23 and 1.19 per doubling of SWCS and AS; 95% CI, 1.16 to 1.30 and 1.14 to 1.26) and CHD risk factors (slopes, 0.178 and 0.164; 95% CI, 0.162 to 0.195 and 0.149 to 0.179). Even among participants with AS = 0, an increase in the SWCS was still significantly associated with established CHD risk factors (slope, 0.181; 95% CI, 0.138 to 0.224). The SWCS appeared to be predictive of CHD events even in participants with AS = 0, though those events were rare as expected. The SWCS provides a valid, continuous measure of CAC suitable for quantifying the extent of atherosclerosis without a threshold, which will be useful for examining novel genetic and environmental risk factors for atherosclerosis.

  6. Very low density lipoprotein cholesterol associates with coronary artery calcification in type 2 diabetes beyond circulating levels of triglycerides.

    PubMed

    Prenner, Stuart B; Mulvey, Claire K; Ferguson, Jane F; Rickels, Michael R; Bhatt, Anish B; Reilly, Muredach P

    2014-10-01

    While recent genomic studies have focused attention on triglyceride (TG) rich lipoproteins in cardiovascular disease (CVD), little is known of very low-density lipoprotein cholesterol (VLDL-C) relationship with atherosclerosis and CVD. We examined, in a high-risk type-2 diabetic population, the association of plasma VLDL-C with coronary artery calcification (CAC). The Penn Diabetes Heart Study (PDHS) is a cross-sectional study of CVD risk factors in type-2 diabetics (n = 2118, mean age 59.1 years, 36.5% female, 34.1% Black). Plasma lipids including VLDL-C were calculated (n = 1879) after ultracentrifugation. In Tobit regression, VLDL-C levels were positively associated with increasing CAC after adjusting for age, race, gender, Framingham risk score, body mass index, C-reactive protein, exercise, medication and alcohol use, hemoglobin A1c, and diabetes duration [Tobit ratio (TR) and 95% confidence interval (CI) 0.38 (0.12-0.65), P = 0.005] and even after inclusion of apolipoprotein B data [TR 0.31 (0.03-0.58), P = 0.030]. Approximately 3-fold stronger effect was observed in women [TR 0.75 (0.16-1.34), P = 0.013] than men [TR 0.20 (-0.10-0.50), P = 0.189; gender interaction P = 0.034]. Plasma VLDL-C was related more strongly to CAC scores than TG levels (e.g., Akaike information criteria of 7263.65 vs. 7263.94) and had stronger CAC association in individuals with TGs >150 mg/dl (TR 0.80, P = 0.010) vs. those with TGs <150 mg/dl (TR 0.27, P = 0.185). In PDHS, VLDL-C is associated with CAC independent of established CVD risk factors, particularly in women, and may have value even beyond apolipoprotein B levels and in patients with elevated TGs. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  7. Second-hand tobacco smoke in never smokers is a significant risk factor for coronary artery calcification.

    PubMed

    Yankelevitz, David F; Henschke, Claudia I; Yip, Rowena; Boffetta, Paolo; Shemesh, Joseph; Cham, Matthew D; Narula, Jagat; Hecht, Harvey S

    2013-06-01

    The aim of this study was to assess the relationship of the extent of subclinical atherosclerosis measured by coronary artery calcification (CAC) to the extent of second-hand tobacco smoke (SHTS) exposure in asymptomatic people who never smoked. An association between SHTS and CAC was recently reported in a single study, but the quantitative aspects of the relationship are not known. A cohort of 3,098 never smokers 40 to 80 years of age, enrolled in the FAMRI-IELCAP (Flight Attendant Medical Research Institute International Early Lung Cancer Action Program) screening program, completed a SHTS questionnaire, and had a low-dose nongated computed tomography scan. The questionnaire provided a quantitative score for total SHTS exposure, as well as separately as a child and as an adult at home and at work; 4 categories of exposure to SHTS were identified (minimal, low, moderate, and high exposure). CAC was graded using a previously validated ordinal scale score that ranged from 0 to 12. Logistic regression analysis of the prevalence and ordered logistic regression analysis of the extent of CAC were performed to assess the independent contribution of SHTS adjusted for age, sex, diabetes, hypercholesterolemia, hypertension, and renal disease. Linear and quadratic regression analyses of CAC and SHTS were performed. The prevalence of CAC was 24.3% (n = 754) and was significantly higher in those with more than minimal SHTS exposure compared with those with minimal SHTS exposure (26.4% vs. 18.5%, p < 0.0001). The adjusted odds ratios for CAC prevalence were 1.54 (95% confidence interval: 1.17 to 2.20) for low SHTS exposure, 1.60 (95% confidence interval: 1.21 to 2.10) for moderate exposure, and 1.93 (95% confidence interval: 1.49 to 2.51) for high exposure. The association of the extent of SHTS with the extent of CAC was confirmed by the adjusted odds ratio (p < 0.0001). The presence and extent of CAC were associated with extent of SHTS exposure even when adjusted for other

  8. The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion.

    PubMed

    Alemseged, Fana; Shah, Darshan G; Diomedi, Marina; Sallustio, Fabrizio; Bivard, Andrew; Sharma, Gagan; Mitchell, Peter J; Dowling, Richard J; Bush, Steven; Yan, Bernard; Caltagirone, Carlo; Floris, Roberto; Parsons, Mark W; Levi, Christopher R; Davis, Stephen M; Campbell, Bruce C V

    2017-03-01

    Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score. A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography-based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of ≤3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score. The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7-0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6-0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of <7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4-21; P=0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4-33; P=0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2-18; P=0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8-0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (P=0.04). The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients. © 2017

  9. Ankle-brachial index (ABI), abdominal aortic calcification (AAC), and coronary artery calcification (CAC): the Jackson heart study.

    PubMed

    Tullos, Bobby W; Sung, Jung Hye; Lee, Jae Eun; Criqui, Michael H; Mitchell, Marc E; Taylor, Herman A

    2013-04-01

    To examine the associations of peripheral atherosclerosis, assessed by the ABI at baseline with the extent of AAC and with CAC measured by MDCT at follow-up examination in the Jackson Heart Study cohort. Four categories of ABI: <0.90, 0.90-0.99, 1.00-1.39; >1.40. Presence of CAC/AAC was defined as scoring above the 75th percentile among participants with non-zero CT calcium scores. We conducted multivariable log-binomial models for this analysis examining the relationship between ABI and the presence of CAC or AAC using normal ABI (1.0 ≤ ABI ≤ 1.39) as the reference group. We estimated prevalence ratios adjusted for age, smoking, HTN, DM, BMI, LDL, HDL, CRP, systolic and diastolic blood pressure, and use of lipid-lowering medication. There were 2,398 patients in this analysis (women: 65 %, average age 55 years). AAC scores were not significantly different between sex. CAC scores were significantly higher in males than females regardless of ABI groups. The prevalence of significant AAC was 1.7 times higher for ABI < 0.90 (PR = 1.70; 95 % CI = 1.26-2.28; p = 0.0004) and 1.57 times higher for ABI 0.90-0.99 (PR = 1.57; 95 % CI = 1.20-2.03; p = 0.0008) than the normal ABI; AAC prevalence did not differ between subjects with ABI > 1.40 compared to those with normal ABI. The prevalence of the significant CAC was higher for ABI < 0.90 (PR = 1.55; 95 % CI = 1.12-2.14; p value = 0.0081) and ABI 0.90-0.99 (PR = 1.60; 95 % CI = 1.05-2.46; p = 0.0402) compared to normal ABI; CAC prevalence did not differ between subjects with ABI > 1.40 compared to those with normal ABI. Lower ABI was significantly associated with the extent of AAC and CAC in this cohort. ABI can provide clinicians with an inexpensive additional tool to assess vascular health and cardiovascular risk without exposing the patient to ionizing radiation.

  10. Ankle-Brachial Index (ABI), Abdominal Aortic Calcification (AAC), and Coronary Artery Calcification (CAC): the Jackson Heart Study

    PubMed Central

    Tullos, Bobby W.; Sung, Jung Hye; Lee, Jae Eun; Criqui, Michael H.; Mitchell, Marc E.; Taylor, Herman A.

    2013-01-01

    Introduction To examine the associations of peripheral atherosclerosis, assessed by the ABI at baseline with the extent of AAC and with CAC measured by MDCT at follow-up examination in the Jackson Heart Study cohort. Methods Four categories of ABI: <0.90, 0.90–0.99, 1.00–1.39; >1.40. Presence of CAC/AAC was defined as scoring above the 75th percentile among participants with non-zero CT calcium scores. We conducted multivariable log-binomial models for this analysis examining the relationship between ABI and the presence of CAC or AAC using normal ABI (1.0 ≤ ABI ≤ 1.39) as the reference group. We estimated prevalence ratios adjusted for age, smoking, HTN, DM, BMI, LDL, HDL, CRP, systolic and diastolic blood pressure, and use of lipid-lowering medication. Results There were 2,398 patients in this analysis (women: 65%, average age 55 years). AAC scores were not significantly different between sex. CAC scores were significantly higher in males than females regardless of ABI groups. The prevalence of significant AAC was 1.7 times higher for ABI < 0.90 (PR=1.70; 95% CI=1.26–2.28; p=0.0004) and 1.57 times higher for ABI 0.90–0.99 (PR=1.57; 95% CI=1.20–2.03; p=0.0008) than the normal ABI; AAC prevalence did not differ between subjects with ABI > 1.40 compared to those with normal ABI. The prevalence of the significant CAC was higher for ABI <0.90 (PR=1.55; 95% CI=1.12–2.14; p-value=0.0081) and ABI 0.90–0.99 (PR=1.60; 95% CI=1.05–2.46; p=0.0402) compared to normal ABI; CAC prevalence did not differ between subjects with ABI > 1.40 compared to those with normal ABI Conclusion Lower ABI was significantly associated with the extent of AAC and CAC in this cohort. ABI can provide clinicians with an inexpensive additional tool to assess vascular health and cardiovascular risk without exposing the patient to ionizing radiation. PMID:23111408

  11. Does Osteoprotegerin or Receptor Activator of Nuclear Factor-κB Ligand Mediate the Association between Bone and Coronary Artery Calcification?

    PubMed Central

    Bakhireva, Ludmila N.; Laughlin, Gail A.; Bettencourt, Ricki; Barrett-Connor, Elizabeth

    2008-01-01

    Context: Accumulating evidence indicates that vascular and bone mineralization may be related, although the exact mechanism remains unknown. Objective: Our objective was to investigate whether an observed inverse association between bone mineral density (BMD) and coronary artery calcification (CAC) in postmenopausal women currently taking estrogen therapy is mediated by osteoprotegerin (OPG) or receptor activator of nuclear factor-κB ligand (RANKL). Design: Participants were 92 postmenopausal women (aged 58–81 yr) taking estrogen therapy who had hip and spine BMD assessed by dual-energy x-ray absorptiometry and CAC measured by electron-beam computed tomography in 1998–2002 and serum RANKL and OPG levels measured in samples collected in 1997–1999. Total CAC score was dichotomized as none/minimal (≤10) vs. some (>10). Results: OPG serum levels were higher in women who had some CAC compared with those who had none/minimal (126.8 ± 1.08 vs. 102.9 ± 1.07 pg/ml, respectively, P = 0.03); these differences became nonsignificant after adjustment for age and other risk factors (P = 0.51). A 1 sd increase in hip BMD was associated with significantly lower odds of having CAC > 10 (odds ratio = 0.52; 95% confidence interval = 0.29–0.93) independent of age, fat-free mass, high-density lipoprotein cholesterol, current smoking, and use of cholesterol-lowering medications. Other skeletal sites demonstrated a similar pattern. Addition of RANKL and/or OPG to the model had minimal effect on the magnitude or statistical significance of the BMD-CAC association. Additionally, a test of interaction indicated that RANKL and OPG are not significant effect modifiers. Conclusions: Serum OPG and RANKL do not account for the observed association between bone and coronary artery calcification among postmenopausal women using hormone therapy. PMID:18319315

  12. Intracranial Carotid Calcification on Cranial Computed Tomography

    PubMed Central

    Subedi, Deepak; Zishan, Umme Sara; Chappell, Francesca; Gregoriades, Maria-Lena; Sudlow, Cathie; Sellar, Robin

    2015-01-01

    Background and Purpose— Intracranial internal carotid artery calcification is associated with cerebrovascular risk factors and stroke, but few quantification methods are available. We tested the reliability of visual scoring, semiautomated Agatston score, and calcium volume measurement in patients with recent stroke. Methods— We used scans from a prospective hospital stroke registry and included patients with anterior circulation ischemic stroke or transient ischemic stroke whose noncontrast cranial computed tomographic scans were available electronically. Two raters measured semiautomatic quantitative Agatston score, and calcium volume, and performed qualitative visual scoring using the original 4-point Woodcock score and a modified Woodcock score, where each image on which the internal carotid arteries appeared was scored and the slice scores summed. Results— Intra- and interobserver coefficient of variations were 8.8% and 16.5% for Agatston, 8.8% and 15.5% for calcium volume, and 5.7% and 5.4% for the modified Woodcock visual score, respectively. The modified Woodcock visual score correlated strongly with both Agatston and calcium volume quantitative measures (both R2=0.84; P<0.0001); calcium volume increased by 0.47-mm/point increase in modified Woodcock visual score. Intracranial internal carotid artery calcification increased with age by all measures (eg, visual score, Spearman ρ=0.4; P=0.005). Conclusions— Visual scores correlate highly with quantitative intracranial internal carotid artery calcification measures, with excellent observer agreements. Visual intracranial internal carotid artery scores could be a rapid and practical method for epidemiological studies. PMID:26251250

  13. Association of ectopic fat with abdominal aorto-illiac and coronary artery calcification in african ancestry men.

    PubMed

    Kuipers, Allison L; Zmuda, Joseph M; Carr, J Jeffrey; Terry, James G; Nair, Sangeeta; Cvejkus, Ryan; Bunker, Clareann H; Patrick, Alan L; Wassel, Christina L; Miljkovic, Iva

    2017-08-01

    There is strong evidence that fat accumulating in non-adipose sites, "ectopic fat", is associated with cardiovascular disease (CVD), including vascular calcification. Most previous studies of this association have assessed only a single ectopic fat depot. Therefore, our aim was to assess the association of total, regional, and ectopic fat with abdominal aorto-illiac calcification (AAC) and coronary artery calcification (CAC) in 798 African ancestry men. Participants (mean age 62) were from the Tobago Bone Health Study cohort. Adiposity was assessed via clinical examination, dual x-ray absorptiometry, and computed tomography (CT). Ectopic fat depots included: abdominal visceral adipose tissue (VAT), liver attenuation, and calf intermuscular adipose tissue (IMAT). Vascular calcification was assessed by CT and quantified as present versus absent. Associations were tested using multiple logistic regression adjusted for traditional cardiovascular risk factors. Models of ectopic fat were additionally adjusted for total body fat and standing height. All adiposity measures, except VAT, were associated with AAC. Lower liver attenuation or greater calf IMAT was associated with 1.2-1.3-fold increased odds of AAC (p < 0.03 for both), though calf IMAT was a stronger predictor than liver attenuation (p < 0.001) when entered in a single model. No ectopic fat measure was associated with CAC. Greater adiposity in the skeletal muscle and liver, but not in the visceral compartment, was associated with increased odds of AAC in African ancestry men. These results highlight the potential importance of both quantity and location of adiposity accumulation throughout the body. Copyright © 2017 Elsevier B.V. All rights reserved.

  14. Arterial calcification in chronic kidney disease: key roles for calcium and phosphate.

    PubMed

    Shanahan, Catherine M; Crouthamel, Matthew H; Kapustin, Alexander; Giachelli, Cecilia M

    2011-09-02

    Vascular calcification contributes to the high risk of cardiovascular mortality in chronic kidney disease (CKD) patients. Dysregulation of calcium (Ca) and phosphate (P) metabolism is common in CKD patients and drives vascular calcification. In this article, we review the physiological regulatory mechanisms for Ca and P homeostasis and the basis for their dysregulation in CKD. In addition, we highlight recent findings indicating that elevated Ca and P have direct effects on vascular smooth muscle cells (VSMCs) that promote vascular calcification, including stimulation of osteogenic/chondrogenic differentiation, vesicle release, apoptosis, loss of inhibitors, and extracellular matrix degradation. These studies suggest a major role for elevated P in promoting osteogenic/chondrogenic differentiation of VSMC, whereas elevated Ca has a predominant role in promoting VSMC apoptosis and vesicle release. Furthermore, the effects of elevated Ca and P are synergistic, providing a major stimulus for vascular calcification in CKD. Unraveling the complex regulatory pathways that mediate the effects of both Ca and P on VSMCs will ultimately provide novel targets and therapies to limit the destructive effects of vascular calcification in CKD patients.

  15. Arterial Calcification in Chronic Kidney Disease: Key Roles for Calcium and Phosphate

    PubMed Central

    Shanahan, Catherine M.; Crouthamel, Matthew H.; Kapustin, Alexander; Giachelli, Cecilia M.

    2011-01-01

    Vascular calcification contributes to the high risk of cardiovascular mortality in chronic kidney disease (CKD) patients. Dysregulation of calcium (Ca) and phosphate (P) metabolism is common in CKD patients, and drives vascular calcification. In this article, we review the physiological regulatory mechanisms for Ca and P homeostasis and the basis for their dysregulation in CKD. In addition, we highlight recent findings indicating that elevated Ca and P have direct effects on vascular smooth muscle cells (VSMCs) that promote vascular calcification, including stimulation of osteo/chondrogenic differentiation, vesicle release, apoptosis, loss of inhibitors, and ECM matrix degradation. These studies suggest a major role for elevated P in promoting osteo/chondrogenic differentiation of VSMC, whereas elevated Ca has a predominant role in promoting VSMC apoptosis and vesicle release. Furthermore, the effects of elevated Ca and P are synergistic providing a major stimulus for vascular calcification in CKD. Unravelling the complex regulatory pathways that mediate the effects of both Ca and P on VSMCs will ultimately provide novel targets and therapies to limit the destructive effects of vascular calcification in CKD patients. PMID:21885837

  16. Ideal Cardiovascular Health and the Prevalence and Progression of Coronary Artery Calcification in Adults With and Without Type 1 Diabetes

    PubMed Central

    Alman, Amy C.; Maahs, David M.; Rewers, Marian J.; Snell-Bergeon, Janet K.

    2014-01-01

    OBJECTIVE In 2010, the American Heart Association defined seven metrics (smoking, BMI, physical activity, diet, total cholesterol, blood pressure, and fasting plasma glucose) for ideal cardiovascular health (ICH). Subsequent studies have shown that the prevalence of achieving these metrics is very low in the general population. Adults with type 1 diabetes are at increased risk of cardiovascular disease (CVD), but no studies to date have been published on the prevalence of ICH in this population. RESEARCH DESIGN AND METHODS Data for this analysis were collected as part of the prospective Coronary Artery Calcification in Type 1 Diabetes study. This analysis involved 546 subjects with type 1 diabetes and 631 subjects without diabetes who had complete information for calculating the ICH metrics. RESULTS Overall, the prevalence of ICH was low in this population, with none meeting the ideal criteria for all seven metrics. The prevalence of ideal physical activity (10.0%) and diet (1.1%) were particularly low. ICH was significantly associated with both decreased prevalence (odds ratio [OR] 0.70; 95% CI 0.62–0.80) and progression (OR 0.77; 95% CI 0.66–0.90) of coronary artery calcification (CAC). CONCLUSIONS ICH is significantly associated with decreased prevalence and progression of CAC; however, prevalence of ICH metrics was low in adults both with and without type 1 diabetes. Efforts to increase the prevalence of ICH could have a significant impact on reducing the burden of CVD. PMID:24130360

  17. Sugar-sweetened carbonated beverage consumption and coronary artery calcification in asymptomatic men and women.

    PubMed

    Chun, Sohyun; Choi, Yuni; Chang, Yoosoo; Cho, Juhee; Zhang, Yiyi; Rampal, Sanjay; Zhao, Di; Ahn, Jiin; Suh, Byung-Seong; Pastor-Barriuso, Roberto; Lima, Joao A C; Chung, Eun Chul; Shin, Hocheol; Guallar, Eliseo; Ryu, Seungho

    2016-07-01

    Sugar-sweetened carbonated beverage consumption has been linked to obesity, metabolic syndrome, type 2 diabetes, and clinically manifest coronary heart disease, but its association with subclinical coronary heart disease remains unclear. We investigated the relationship between sugar-sweetened carbonated beverage consumption and coronary artery calcium (CAC) in a large study of asymptomatic men and women. This was a cross-sectional study of 22,210 adult men and women who underwent a comprehensive health screening examination between 2011 and 2013 (median age 40 years). Sugar-sweetened carbonated beverage consumption was assessed using a validated food frequency questionnaire, and CAC was measured by cardiac computed tomography. Multivariable-adjusted CAC score ratios and 95% CIs were estimated from robust Tobit regression models for the natural logarithm (CAC score +1). The prevalence of detectable CAC (CAC score >0) was 11.7% (n = 2,604). After adjustment for age; sex; center; year of screening examination; education level; physical activity; smoking; alcohol intake; family history of cardiovascular disease; history of hypertension; history of hypercholesterolemia; and intake of total energy, fruits, vegetables, and red and processed meats, only the highest category of sugar-sweetened carbonated beverage consumption was associated with an increased CAC score compared with the lowest consumption category. The multivariable-adjusted CAC ratio comparing participants who consumed ≥5 sugar-sweetened carbonated beverages per week with nondrinkers was 1.70 (95% CI, 1.03-2.81). This association did not differ by clinical subgroup, including participants at low cardiovascular risk. Our findings suggest that high levels of sugar-sweetened carbonated beverage consumption are associated with a higher prevalence and degree of CAC in asymptomatic adults without a history of cardiovascular disease, cancer, or diabetes. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. In vitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring.

    PubMed

    Gassenmaier, Tobias; Allmendinger, Thomas; Kunz, Andreas S; Veyhl-Wichmann, Maike; Ergün, Süleyman; Bley, Thorsten A; Petritsch, Bernhard

    2017-05-01

    Coronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable. To evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents. An anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart. In general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings. New iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure.

  19. In vitro evaluation of a new iterative reconstruction algorithm for dose reduction in coronary artery calcium scoring

    PubMed Central

    Allmendinger, Thomas; Kunz, Andreas S; Veyhl-Wichmann, Maike; Ergün, Süleyman; Bley, Thorsten A; Petritsch, Bernhard

    2017-01-01

    Background Coronary artery calcium (CAC) scoring is a widespread tool for cardiac risk assessment in asymptomatic patients and accompanying possible adverse effects, i.e. radiation exposure, should be as low as reasonably achievable. Purpose To evaluate a new iterative reconstruction (IR) algorithm for dose reduction of in vitro coronary artery calcium scoring at different tube currents. Material and Methods An anthropomorphic calcium scoring phantom was scanned in different configurations simulating slim, average-sized, and large patients. A standard calcium scoring protocol was performed on a third-generation dual-source CT at 120 kVp tube voltage. Reference tube current was 80 mAs as standard and stepwise reduced to 60, 40, 20, and 10 mAs. Images were reconstructed with weighted filtered back projection (wFBP) and a new version of an established IR kernel at different strength levels. Calcifications were quantified calculating Agatston and volume scores. Subjective image quality was visualized with scans of an ex vivo human heart. Results In general, Agatston and volume scores remained relatively stable between 80 and 40 mAs and increased at lower tube currents, particularly in the medium and large phantom. IR reduced this effect, as both Agatston and volume scores decreased with increasing levels of IR compared to wFBP (P < 0.001). Depending on selected parameters, radiation dose could be lowered by up to 86% in the large size phantom when selecting a reference tube current of 10 mAs with resulting Agatston levels close to the reference settings. Conclusion New iterative reconstruction kernels may allow for reduction in tube current for established Agatston scoring protocols and consequently for substantial reduction in radiation exposure. PMID:28607763

  20. Comprehensive coronary risk determination in primary prevention: an imaging and clinical based definition combining computed tomographic coronary artery calcium score and national cholesterol education program risk score.

    PubMed

    Nasir, Khurram; Vasamreddy, Chandra; Blumenthal, Roger S; Rumberger, John A

    2006-06-16

    Cardiovascular disease (CVD) is the leading cause of mortality and a major cause of morbidity. Coronary heart disease (CHD) accounts for nearly half of all CVD deaths. Currently estimation of risk in primary prevention is based on the Framingham risk equations, which inputs traditional risk factors and is helpful in predicting the development of CHD in asymptomatic individuals. However many individuals suffer events in the absence of established risk factors for atherosclerosis and broad based population risk estimations may have little precision when applied to a given individual. To meet the challenge of CHD risk assessment, several tools have been developed to identify atherosclerotic disease in its preclinical stages. This paper aims to incorporate information from coronary artery calcification (CAC) scoring from a computed tomographic "heartscan" (using Electron Beam Tomography (EBT) as the validated prototype) along with current Framingham risk profiling in order to refine risk on an absolute scale by combining imaging and clinical data to affect a more comprehensive calculation of absolute risk in a given individual. For CAC scores above the 75th percentile but <90th percentile, 10 years is added to chronological age, and for CAC scores above the 90th percentile, 20 years is added to current chronological age. Among those in whom a positive CAC score is the norm such as older individuals (men> or =55 years, women> or =65 years) a CAC = 0 will result in an age point score corresponding to the age-group whose median CAC score is zero i.e., 40-44 years for men and 55-59 years for women. The utilization of CAC scores allows the inclusion of sub-clinical disease definition into the context of modifiable risk factors as well as identifies high-risk individuals requiring aggressive treatment.

  1. Toward early diagnosis of arteriosclerotic diseases: collaborative detection of carotid artery calcifications by computer and dentists on dental panoramic radiographs

    NASA Astrophysics Data System (ADS)

    Muramatsu, Chisako; Takahashi, Ryo; Hara, Takeshi; Hayashi, Tatsuro; Katsumata, Akitoshi; Zhou, Xiangrong; Fujita, Hiroshi

    2014-03-01

    Several studies have reported the presence of carotid artery calcifications (CACs) on dental panoramic radiographs (DPRs) as a possible sign of arteriosclerotic diseases. However, CACs are not easily visible at the common window level for dental examinations, and dentists, in general, are not looking for CACs. Computerized detection of CACs may help dentists in referring patients with a risk of arteriosclerotic diseases to have a detailed examination at a medical clinic. Downside of our previous method was a relatively large number of false positives (FPs). In this study, we attempted to reduce FPs by including an additional feature and selecting effective features for the classifier. A hundred DPRs including 34 cases with calcifications were included. Initial candidates were detected by thresholding the output of top-hat operation. For each candidate, 10 features and a new feature characterizing the relative position of a CAC with reference to the lower mandible edge were determined. After the rule-based FP reduction, candidates were classified into CACs and FPs by a support vector machine. Based on the leave-one-out cross-validation evaluations, an average number of FPs was 3.1 per image at 90.4% sensitivity using seven features selected. Compared to our previous method, the number of FPs was reduced by 38% at the same sensitivity level. The proposed method has a potential in identifying patients with a risk of arteriosclerosis early via general dental examinations.

  2. Predictive value of mitral annular calcification for the diagnosis of coronary artery disease in patients with dilated cardiomyopathy.

    PubMed

    Dincer, I; Ozdol, C; Dandachi, R; Akyurek, O; Atmaca, Y; Kiliçkap, M; Erol, C; Oral, D

    2001-08-01

    Mitral annulus calcification (MAC) is an independent predictor of coronary artery disease (CAD). The present study was designed to determine whether an association exists between MAC and CAD in patients with dilated cardiomyopathy. Among the 286 patients with MAC on echocardiographic examination who underwent coronary angiography, 55 patients with echocardiographic findings of dilated cardiomyopathy (group I) were compared to 60 age-matched controls without MAC and an echocardiographic diagnosis of dilated cardiomyopathy (group II) who underwent coronary angiography during the same time. There were no differences in echocardiographic findings between two groups. The prevalence of CAD was higher in group I when compared to group II (74% vs 28%, p<0.001). With regard to severity of CAD, two-vessel, three-vessel, and left main coronary artery disease were found to be significantly frequent in group I (p<0.001). Multivariate analysis revealed that MAC (p=0.001), diabetes mellitus (p=0.048), and history of anginal chest pain (p=0.009) are the independent predictors for the presence of CAD in patients with dilated cardiomyopathy. In conclusion, MAC may be a marker for the presence of coronary artery disease in patients with dilated cardiomyopathy.

  3. Association of systemic inflammation with epicardial fat and coronary artery calcification.

    PubMed

    Gauss, Sören; Klinghammer, Lutz; Steinhoff, Alina; Raaz-Schrauder, Dorette; Marwan, Mohamed; Achenbach, Stephan; Garlichs, Christoph D

    2015-05-01

    Increased epicardial fat volume (EFV) has been shown to be associated with coronary atherosclerosis. While it is postulated to be an independent risk factor, a possible mechanism is local or systemic inflammation. We analyzed the relationship between coronary atherosclerosis, quantified by coronary calcium in CT, epicardial fat volume and systemic inflammation. Using non-enhanced dual-source CT, we quantified epicardial fat volume (EFV) and coronary artery calcium (CAC) in 391 patients who underwent coronary computed tomography for suspected coronary artery disease. In addition to traditional risk factors, serum markers of systemic inflammation were measured (IL-1α, IL-2, IL-4, IL-6, IL-7, IL-8, IL-10,IL-12, IL-13, IL-15, IL-17, IFN-γ, TNF-α, hs-CRP, GM-CS, G-CSF, MCP-1, MIP-1, Eotaxin and IP-10). In 94 patients follow-up data were obtained after 1.9 ± 0.5 years. The 391 patients had a mean age of 60 ± 10 years, and 69 % were males. Mean EFV was 116 ± 50 mL. Median CAC was 12 (IQR 0; 152). CAC and EFV showed a significant correlation (ρ = 0.37; P < 0.001). EFV and CAC were significantly correlated with the traditional risk factors like age, male gender, diabetes, smoking and hypertension. With regard to biomarkers, CAC was significantly associated (negatively) to G-CSF and IL-13. EFV (median binned) was significantly associated (positively) with IP-10 (P = 0.002) and MCP-1 (ρ = 0.037). In follow-up, EFV showed a mean annualized progression of 6 mL (IQR 3; 9) (P < 0.001); CAC progressed by a mean of six Agatston Units (IQR 0; 30). The progression of CAC was significantly correlated with the extent of EFV (P < 0.001) while there was no significant correlation between progression of EFV or CAC with systemic inflammation markers. Epicardial fat volume and the baseline extent as well as progression of coronary atherosclerosis-measured by the calcium score-are significantly correlated. While both baseline EFV and CAC displayed significant

  4. Racial Differences in the Association between Carotid Plaque and Aortic and Coronary Artery Calcification Among Women Transitioning the Menopause

    PubMed Central

    Woodard, Genevieve A.; Narla, Vinod V.; Ye, Rong; Cauley, Jane A.; Thompson, Trina; Matthews, Karen A.; Sutton-Tyrrell, Kim

    2011-01-01

    Background Carotid atherosclerosis is a marker for atherosclerotic disease in other vascular beds; however, racial differences in this association have not been fully examined. The purpose of this report is to evaluate racial differences in the relationship between carotid plaque and calcification in the aorta and coronary arteries among women transitioning the menopause. Methods 540 African American and White women with a median age of 50 years were evaluated from the Study of Women’s Health Across the Nation. Carotid plaque (none versus any) was assessed with B-mode ultrasound and aortic (AC; 0, >0–100, >100) and coronary artery calcification (CAC; 0, >0–10, >10) with computed tomography. Results For the total cohort, higher prevalence of plaque was significantly associated with higher levels of AC, but not CAC. The interaction of race and carotid plaque was significant in models with AC and CAC as dependent variables (p=0.03, 0.002, respectively). Among African Americans, there was an inverse relationship, although not significant, between carotid plaque and high AC (>100) (OR 0.75, 95%CI: 0.10–5.48), and between plaque and high CAC (>10) (OR 0.20, 95%CI: 0.03–1.52) in fully adjusted models. In contrast, for Whites, significant positive associations existed between carotid plaque and high AC (OR 4.12, 95%CI: 1.29–13.13) and borderline for high CAC (OR 1.83, 95%CI: 0.66–5.19). Conclusions This study demonstrated the presence of carotid plaque appeared to be a marker for AC and potentially CAC in White women during the menopause transition, but not African American middle-aged women. PMID:22037218

  5. Impaired Renal Function Further Increases Odds of 6-Year Coronary Artery Calcification Progression in Adults With Type 1 Diabetes

    PubMed Central

    Maahs, David M.; Jalal, Diana; Chonchol, Michel; Johnson, Richard J.; Rewers, Marian; Snell-Bergeon, Janet K.

    2013-01-01

    OBJECTIVE To determine whether baseline estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) independently predict coronary artery calcification (CAC) progression, and to determine how eGFR changes over 6 years in adults with type 1 diabetes compared with nondiabetic adults. RESEARCH DESIGN AND METHODS The Coronary Artery Calcification in Type 1 Diabetes study participants (n = 1,066) with complete data for eGFR assessment at baseline and 6 years were included. Three Chronic Kidney Disease Epidemiology Collaboration equations (serum creatinine, cystatin C, and both) were used to estimate eGFR. The association of baseline ACR and eGFR with CAC progression was analyzed using multiple logistic regression. RESULTS Increasing categorical baseline ACR (<10, 10–30, and >30 µg/mg) predicted CAC progression in participants with type 1 diabetes (odds ratio [OR], 2.15; 95% CI, 1.50–3.09; 7.19 [3.90–13.26]; and 18.09 [8.48–38.62]), respectively, compared with nondiabetic subjects. Baseline eGFR <60 mL/min/1.73 m2 also predicted CAC progression (OR, 5–7, compared with nondiabetic participants). ORs for CAC progression were higher in women than in men when using the cystatin C–based Chronic Kidney Disease Epidemiology Collaboration equations. Participants with type 1 diabetes had greater eGFR decreases over 6 years than nondiabetic participants using cystatin C–based equations. CONCLUSIONS Although increasing ACR or decreasing eGFR predicts CAC progression, coronary atherosclerosis progresses faster in people with type 1 diabetes even in the absence of diabetic kidney disease. These findings emphasize the interaction between kidney disease and cardiovascular disease in type 1 diabetes and highlight the public health importance of lowering cardiorenal risk in people with type 1 diabetes. PMID:23835686

  6. Lanthanum carbonate delays progression of coronary artery calcification compared with calcium-based phosphate binders in patients on hemodialysis: a pilot study.

    PubMed

    Ohtake, Takayasu; Kobayashi, Shuzo; Oka, Machiko; Furuya, Rei; Iwagami, Masao; Tsutsumi, Daimu; Mochida, Yasuhiro; Maesato, Kyoko; Ishioka, Kunihiro; Moriya, Hidekazu; Hidaka, Sumi

    2013-09-01

    Coronary artery calcification (CAC) is associated with future cardiovascular events and/or death of patients on hemodialysis (HD). We investigated whether progression of CAC in patients on HD could be delayed by switching from a calcium (Ca)-based phosphate (Pi) binder to lanthanum carbonate. The CAC scores were evaluated at study enrollment and after 6 months in 52 patients on HD using calcium carbonate (CC) as a Pi binder. Patients were randomly divided into 2 groups assigned to receive either CC or lanthanum carbonate (LC), and the CAC scores were evaluated after a 6-month treatment period. Progression of CAC was assessed, as were serum levels of Ca, Pi, and intact parathyroid hormone (iPTH). Forty-two patients completed the study (23 receiving CC and 19 receiving LC). In the 6 months prior to randomization, all patients were treated with CC. During this 6-month period, the CAC scores increased significantly in all 42 patients. Once randomized, there was significantly less progression in the group treated with LC than with CC. Changes in CAC scores from 6 to 12 months were significantly smaller in the LC group than the CC group (-288.9 ± 1176.4 vs 107.1 ± 559.6, P = .036), and percentage changes were also significantly different (-6.4% vs 41.2%, P = .024). Serum Ca, Pi, and iPTH levels were similar in both groups during the study period. This pilot study suggested that LC delayed progression of CAC in patients on HD compared with CC.

  7. Analysis of confidence level scores from an ROC study: comparison of three mammographic systems for detection of simulated calcifications

    NASA Astrophysics Data System (ADS)

    Lai, Chao-Jen; Shaw, Chris C.; Whitman, Gary J.; Yang, Wei T.; Dempsey, Peter J.

    2005-04-01

    The purpose of this study is to compare the detection performance of three different mammography systems: screen/film (SF) combination, a-Si/CsI flat-panel (FP-), and charge-coupled device (CCD-) based systems. A 5-cm thick 50% adipose/50% glandular breast tissue equivalent slab phantom was used to provide an uniform background. Calcium carbonate grains of three different size groups were used to simulate microcalcifications (MCs): 112-125, 125-140, and 140-150 μm overlapping with the uniform background. Calcification images were acquired with the three mammography systems. Digital images were printed on hardcopy films. All film images were displayed on a mammographic viewer and reviewed by 5 mammographers. The visibility of the MC was rated with a 5-point confidence rating scale for each detection task, including the negative controls. Scores were averaged over all readers for various detectors and size groups. Receiver operating characteristic (ROC) analysis was performed and the areas under the ROC curves (Az"s) were computed for various imaging conditions. The results shows that (1) the FP-based system performed significantly better than the SF and CCD-based systems for individual size groups using ROC analysis (2) the FP-based system also performed significantly better than the SF and CCD-based systems for individual size groups using averaged confidence scale, and (3) the results obtained from the Az"s were largely correlated with these from confidence level scores. However, the correlation varied slightly among different imaging conditions.

  8. Pre-Existing Venous Calcification Prior to Dialysis Vascular Access Surgery

    PubMed Central

    Lee, Timmy; Safdar, Nida; Mistry, Meenakshi J; Wang, Yang; Chauhan, Vibha; Campos, Begoña; Munda, Rino; Cornea, Virgilius; Roy-Chaudhury, Prabir

    2014-01-01

    Vascular calcification is present in arterial vessels used for dialysis vascular access creation prior to surgical creation. Calcification in the veins used to create a new vascular access has not previously been documented. The objective of this study was to describe the prevalence of venous calcification in samples collected at the time of vascular access creation. 67 vein samples were studied. A von Kossa stain was performed to quantify calcification. A semi-quantitative scoring system from 0–4+ was used to quantify the percentage positive area for calcification as a fraction of total area (0=0; 1+ = 1–10%; 2+ =11–25%; 3+ = 26–50%; 4+ >50% positive). 22/67(33%) samples showed evidence of venous calcification. Histologic examination showed varying degrees of calcification within each cell layer. Among the subset of patients with calcification, 4/22 (18%), 19/22 (86%), 22/22 (100%), and 7/22 (32%) had calcification present within the endothelium, intima, media, and adventitia, respectively. The mean semi-quantitative scores of the 22 samples with calcification were 0.18±0.08, 1.2±0.14, 1.6±0.13, and 0.36±0.12 for the endothelium, intima, media, and adventitia, respectively. Our results demonstrate that vascular calcification is present within veins used to create new dialysis vascular access, and located predominately within the neointimal and medial layers. PMID:22452638

  9. Radiation dose reduction for coronary artery calcium scoring at 320-detector CT with adaptive iterative dose reduction 3D.

    PubMed

    Tatsugami, Fuminari; Higaki, Toru; Fukumoto, Wataru; Kaichi, Yoko; Fujioka, Chikako; Kiguchi, Masao; Yamamoto, Hideya; Kihara, Yasuki; Awai, Kazuo

    2015-06-01

    To assess the possibility of reducing the radiation dose for coronary artery calcium (CAC) scoring by using adaptive iterative dose reduction 3D (AIDR 3D) on a 320-detector CT scanner. Fifty-four patients underwent routine- and low-dose CT for CAC scoring. Low-dose CT was performed at one-third of the tube current used for routine-dose CT. Routine-dose CT was reconstructed with filtered back projection (FBP) and low-dose CT was reconstructed with AIDR 3D. We compared the calculated Agatston-, volume-, and mass scores of these images. The overall percentage difference in the Agatston-, volume-, and mass scores between routine- and low-dose CT studies was 15.9, 11.6, and 12.6%, respectively. There were no significant differences in the routine- and low-dose CT studies irrespective of the scoring algorithms applied. The CAC measurements of both imaging modalities were highly correlated with respect to the Agatston- (r = 0.996), volume- (r = 0.996), and mass score (r = 0.997; p < 0.001, all); the Bland-Altman limits of agreement scores were -37.4 to 51.4, -31.2 to 36.4 and -30.3 to 40.9%, respectively, suggesting that AIDR 3D was a good alternative for FBP. The mean effective radiation dose for routine- and low-dose CT was 2.2 and 0.7 mSv, respectively. The use of AIDR 3D made it possible to reduce the radiation dose by 67% for CAC scoring without impairing the quantification of coronary calcification.

  10. Relation between serum levels of chemotaxis-related factors and the presence of coronary artery calcification as expression of subclinical atherosclerosis.

    PubMed

    Muñoz, Juan Carlos; Martín, Rubén; Alonso, Carmen; Gutiérrez, Beatriz; Nieto, María Luisa

    2017-08-19

    Atherosclerotic plaque formation is characterized by recruitment of monocytes/macrophages, which contributes to its calcification by releasing pro-osteogenic cytokines. Chemotaxis-related proteins, including netrin-1, gremlin-1 and macrophage inflammatory protein-1β (MIP-1β), regulate immune cell migration. However, their relation with the presence of subclinical atherosclerosis, assessed by measures of coronary artery calcifications (CAC) in patients without known coronary artery disease (CAD), remains unclear. To examine whether these chemoattractant-related proteins are associated with the presence of CAC in patients without known CAD. A retrospective case-control observational study was conducted in 120 outpatients without CAD, undergoing a CAC evaluation by computed tomography with the Agatston Calcium score, categorized as CAC(-) (none) and CAC(+) (≥1). Serum biomarkers were quantified by ELISA. Lpa, dyslipidaemia and smoking were significantly higher (p=0.006, p≤0.0001 and p=0.001, respectively) in CAC(+) patients. Serum netrin-1 levels were lower in CAC(+) than in CAC(-) patients (196.8±127.8pg/ml versus 748.3±103.2pg/ml, p≤0.0001), and a similar pattern was found for gremlin-1 (1.14±0.39ng/ml versus 4.33±1.20ng/ml, p≤0.0001). However, TNFα and MIP-1β were strongly upregulated in CAC(+) patients (447.56±74pg/ml versus 1104±144pg/ml and 402.00±94pg/ml versus 905.0±101.6pg/ml, respectively, p≤0.001). Multivariate analyses revealed that low netrin-1 and gremlin-1 levels and high TNFα and MIP-1β amounts were associated with CAC presence, after adjustment for clinical and biochemical variables. We found a netrin-1 and gremlin-1 deficiency and a TNFα and MIP-1β overproduction in CAC(+) patients' serum. These proteins may be used to identify individuals with subclinical atherosclerosis. Further research is warranted in a larger cohort of patients to establish these chemotactic-related proteins as biomarkers that improve CAD risk

  11. Long-term Prognosis for Individuals with Hypertension Undergoing Coronary Artery Calcium Scoring

    PubMed Central

    Valenti, Valentina; Hartaigh, Bríain ó; Heo, Ran; Schulman-Marcus, Joshua; Cho, Iksung; Kalra, Dan K.; Truong, Quynh A.; Giambrone, Ashley E; Gransar, Heidi; Callister, Tracy Q.; Shaw, Leslee J.; Lin, Fay Y.; Chang, Hyuk-Jae; Sciarretta, Sebastiano; Min, James K

    2014-01-01

    Background To examine the performance of coronary artery calcification (CAC) for stratifying long-term risk of death in asymptomatic hypertensive patients. Methods and Results 8905 consecutive asymptomatic individuals without cardiovascular disease or diabetes who underwent CAC testing (mean age 53.3±10.5, 59.3% male) were followed for a mean of 14 years and categorized on the background of hypertension (in accordance with the 2014 Guidelines from the Joint National Committee 8) as well as age above or below 60 years. The prevalence and severity of CAC was higher for those with versus without hypertension (P<0.001), and the extent increased proportionally with advancing age (P<0.001). Following adjustment, the presence of CAC in patients above and below the age of 60 years was associated with worse prognosis for hypertensive (HR 7.74 [95% CI: 5.15-11.63] and HR 3.18 [95% CI: 2.42-4.19]) and normotensive (HR 4.83 [95% CI: 3.18-7.33] and HR 2.14 [95% CI: 1.61-2.85]), respectively. A zero CAC score was associated with a lower but persisting risk of mortality for hypertensives over the age of 60 years (HR 2.48 [95% CI: 1.50-4.08]); albeit, attenuating for those below the age of 60 years (P=0.09). In a “low risk” hypertensive population, a combined presence of hypertension and any CAC was associated with an almost five-fold (HR 4.68 [95% CI: 2.22-9.87]) risk of death. Conclusion Among asymptomatic hypertensive individuals, the presence and extent of CAC effectively identified individuals at heightened risk of mortality beyond conventional cardiovascular risk. PMID:25863296

  12. Clinical decision-making for vitamin K-1 and K-2 deficiency and coronary artery calcification with warfarin therapy: are diet, factor Xa inhibitors or both the answer?

    PubMed

    Wahlqvist, Mark L; Tanaka, Kiyoshi; Tzeng, Bing-Hsiean

    2013-01-01

    Coronary artery calcification is a recognised risk factor for ischaemic heart disease and mortality. Evidence is now strong that Mönckeberg's arteriosclerosis, a form of vascular calcification, can be attributable to vitamin K deficiency, but that vitamin K-2, especially the MK-4 form from foods like cheese can be protective. Warfarin blocks the recycling of hepatic and peripheral vitamin K leading to secondary vitamin K deficiency with adverse effects on vasculature, bone, kidneys, brain and other tissues and systems (inflammatory, immune function and neoplasia at least). There is individual susceptibility to vitamin K deficiency and warfarin sensitivity, partly explicable in terms of genetic polymorphisms, epigenetics, diet and pharmacotherapy. The emergence of extensive coronary calcification in a man with atrial fibrillation treated for a decade with warfarin is described by way of illustration and to raise the present clinical management conundrums. Finally, a putative set of recommendations is provided.

  13. Screening results for subclinical coronary artery calcification in asymptomatic individuals in relation to a detailed parental history of premature coronary heart disease.

    PubMed

    Wahl, Stefanie; Möhlenkamp, Stefan; Erbel, Raimund; Moebus, Susanne; Andrich, Silke; Stang, Andreas; Jöckel, Karl-Heinz; Dragano, Nico

    2013-04-01

    A parental history of premature coronary heart disease (CHD) is an established risk factor for CHD events in descendants. The study aim was to investigate whether subclinical coronary artery calcification (CAC) differs between asymptomatic individuals (a) without a parental CHD history, (b) with a parental history and (c) without knowledge of parental CHD history. The inclusion of individuals without knowledge of parental CHD history is a new approach. We also differentiated between CHD of mother and father to gain insight into their individual contributions. Data was obtained for 4,301 subjects aged 45-75 years free of overt CHD from the baseline screening of the population-based Heinz Nixdorf Recall study. CAC, measured by electron-beam computed tomography, was modeled conducting logistic regressions. Model 1 included family history, Model 2 was adjusted for age (and gender) and Model 3 added common CHD risk factors. The CAC score was dichotomized using the age and sex-specific 75th percentile. The odds ratio (OR) for CAC ≥ age and sex-specific 75th percentile was 1.33 among individuals with parental premature CHD history (95 % confidence interval [95 %CI]: 1.08, 1.63), which did not change after full adjustment (OR 1.40, 95 %CI: 1.13, 1.74). Individuals with an unknown biological father or mother had a high chance of elevated CAC scores (fully adjusted; father: OR 1.38, 95 %CI: 1.01, 1.90, mother: OR 1.86, 95 %CI: 0.90, 3.84) compared to the reference group. The current study showed an association between parental CHD history and CAC independent of common CHD risk factors. This association affirms the use of parental CHD history in cardiovascular risk assessment among asymptomatic adults in routine practice. The observation that individuals who did not know their mother or father are prone to increased CAC scores needs further confirmation in large scale studies.

  14. Affiliation and control during marital disagreement, history of divorce, and asymptomatic coronary artery calcification in older couples.

    PubMed

    Smith, Timothy W; Uchino, Bert N; Florsheim, Paul; Berg, Cynthia A; Butner, Jonathan; Hawkins, Melissa; Henry, Nancy J M; Beveridge, Ryan M; Pearce, Gale; Hopkins, Paul N; Yoon, Hyo-Chun

    2011-05-01

    To examine behavioral observations of affiliation (ie, warmth versus hostility) and control (ie, dominance versus submissiveness) and prior divorce as predictors of coronary artery calcification (CAC) in older couples. In some but not all studies, marital disruption and low marital quality have been shown to confer risk of coronary artery disease (CAD). Inconsistencies might reflect limitations of self-reports of marital quality compared with behavioral observations. Also, aspects of marital quality related to CAD might differ for men and women. Couples underwent computed tomography scans for CAC and marital assessments, including observations of laboratory-based disagreement. Participants were 154 couples (mean age, 63.5 years; mean length of marriage, 36.4 years) free of prior diagnosis of CAD. Controlling traditional risk factors, we found behavioral measures of affiliation (low warmth) accounted for 6.2% of variance in CAC for women, p < .01, but not for men. Controlling behavior (dominance) accounted for 6.0% of variance in CAC for men, p < .02, but not for women. Behavioral measures were related to self-reports of marital quality, but the latter were unrelated to CAC. History of divorce predicted CAC for men and women. History of divorce and behavioral--but not self-report--measures of marital quality were related to CAD, such that low warmth and high dominance conferred risk for women and men, respectively. Prior research might underestimate the role of marital quality in CAD by relying on global self-reports of this risk factor.

  15. Do carotid atheromas on panoramic images prognosticate arterial calcifications on mammograms: acknowledged markers of future adverse cardiovascular events?

    PubMed

    Friedlander, Arthur H; Chang, Tina I; Chantra, Prem K; Aghazadehsanai, Nona; Harada, Nancy D; Garrett, Neal R

    2012-10-01

    The aim of this study was to evaluate the relationship between calcified carotid artery plaque (CCAP) on panoramic images and breast arterial calcifications (BAC) on mammograms, a validated independent risk indicator of fatal myocardial infarctions and strokes. Women ≥55 years old having CCAP diagnosed by their dentists had their mammograms evaluated for BAC by a physician. Other study variables were age, ethnicity, body mass index, and medications for hypertension, diabetes, and dyslipidemia. Descriptive and bivariate statistics and logistic regression were computed. Researchers identified 40 women (mean age 62.2 ± 6.2 years old) with CCAP, of whom 9 (prevalence rate 22.5%) also had BAC. The women with BAC tended to be older (65.1 vs 61.3 years old), more frequently hypertensive (100% vs 80.6%), and more frequently black than those without BAC, although these differences were not statistically significant (P > 0.10). CCAP on panoramic images of women is unrelated to the presence of BAC on mammograms. Published by Mosby, Inc.

  16. Comparison of rubidium-82 myocardial blood flow quantification with coronary calcium score for evaluation of coronary artery stenosis.

    PubMed

    Meintjes, Marguerite; Sathekge, Mike; Makanjee, Chandra R; Dickson, John C; Endozo, Raymond; Rheeder, Paul; Bomanji, Jamshed

    2016-02-01

    PET myocardial perfusion imaging (MPI) is the standard technique for assessing myocardial function, but provides limited information on the anatomy of cardiac structures whereas the coronary artery calcium (CAC) score provides information on calcified plaque burden and the anatomical structure of the coronary arteries. The aim of this study was to determine the relationship between quantitative myocardial blood flow (MBF), CAC, and coronary artery disease (CAD). This work also aims to determine whether MBF quantification and/or CAC add value to relative MPI, and aid in the reclassification of patients with CAD. This way, a 'gatekeeper' study could be identified to predict coronary artery stenosis and improve our clinical service. Rubidium-82 PET/CT MPI, calcium score, and computed tomographic coronary angiography imaging were performed in 128 patients with known or suspected CAD. The presence of ischemia was assessed from qualitative reporting of rubidium-82 MPI, and using the same data, quantitative values of MBF and coronary flow reserve (CFR) were derived. Calcium score images were quantitatively analyzed and categorized into three groups defined by CAC values of 0, 1-400, and >400. Significant stenosis was classified as stenosis of 50% or more on computed tomographic angiography. A total of 120 patients were included in the final analysis (77 men, 43 women). Our results showed an inverse correlation between stress MBF, CFR, and the percentage stenosis as well as an inverse correlation compared with CAC. A direct correlation between CAC and the percentage stenosis was observed, indicating that an increase in coronary calcification in individual coronary arteries is related to the severity of the coronary stenosis. These results proved that the addition of stress MBF to relative MPI (32%) resulted in a significantly higher sensitivity (48%, P=0.002), which increased significantly more with the addition of CFR (58%, P≤0.001). The further addition of CAC resulted

  17. Neointimal hyperplasia and calcification in medium sized arteries in adult patients with chronic kidney disease.

    PubMed

    Chitalia, Nihil; Ross, Louise; Krishnamoorthy, Mahesh; Kapustin, Alexander; Shanahan, Catherine M; Kaski, Juan Carlos; Roy-Chaudhury, Prabir; Chemla, Eric; Banerjee, Debasish

    2015-01-01

    The nature of arterial changes resulting in cardiovascular events and dialysis vascular access failures in adult predialysis patients is not well known. This study examined intimal changes, calcium deposition, and consequent stiffness in brachial and radial arteries of adult CKD patients. Ten brachial-artery and seven radial-artery specimens were obtained during fistula creation from nine predialysis and eight dialysis-dependent, nondiabetic patients; and age-gender matched controls undergoing coronary bypass grafts (6 radial) or kidney donation (6 renal). Arterial stiffness was measured at baseline. Vessel histology, morphometric analysis of intima-media, and direct quantification of calcium load was performed using standard techniques. Both predialysis and dialysis patients demonstrated significant arterial intimal hyperplasia with intima:media ratio higher than controls (0.13 ± 0.12 vs. 0.02 ± 0.05, p = 0.01). Calcium deposition was demonstrated on histology and the calcium content in patients was higher than controls (34.68 ± 26.86 vs. 10.95 ± 9.18 μg/μg, p = 0.003). The blood vessel calcium content correlated with arterial stiffness (r = 0.64, p = 0.018). This study for the first time describes, and suggests mechanistic linkage between, intimal hyperplasia, pathological calcium deposition, and increased functional arterial stiffness in dialysis and predialysis patients. Our research could serve as a unique window into the in vivo status of the uremic vasculature impacting fistula maturation and cardiovascular disease.

  18. Calcification inhibitors and Wnt signaling proteins are implicated in bovine artery smooth muscle cell calcification in the presence of phosphate and vitamin D sterols.

    PubMed

    Shalhoub, V; Shatzen, E; Henley, C; Boedigheimer, M; McNinch, J; Manoukian, R; Damore, M; Fitzpatrick, D; Haas, K; Twomey, B; Kiaei, P; Ward, S; Lacey, D L; Martin, D

    2006-12-01

    Administration of active vitamin D sterols to treat secondary hyperparathyroidism in patients with chronic kidney disease receiving dialysis has been associated with elevated serum calcium and phosphorus levels, which may lead to increased risk of vascular calcification. However, calcimimetics, by binding to the parathyroid gland calcium-sensing receptors, reduce serum parathyroid hormone, calcium, phosphorus, and the calcium-phosphorus product. Using cultured bovine aorta vascular smooth muscle cells (BASMCs), an in vitro model of vascular calcification, we compared calcification levels and gene expression profiles after exposure to the phosphate source ss-glycerolphosphate (BGP), the active vitamin D sterols calcitriol and paricalcitol, the calcimimetic R-568, or BGP with the active vitamin D sterols or R-568. Cells exposed to BGP (10 mM) alone or with calcitriol or paricalcitol showed dose-dependent BASMC calcification. No change in calcification was observed in cultures exposed to BGP with R-568, consistent with the observed lack of calcium-sensing receptor expression. Microarray analysis using total cellular RNA from cultures exposed to vehicle or BGP in the absence and presence of 10(-8) M calcitriol or paricalcitol for 7 days showed that cells exposed to BGP with calcitriol or BGP with paricalcitol had virtually identical gene expression profiles, which differed from those of cells treated with BGP or vehicle alone. Several osteoblast- and chondrocyte-associated genes were modulated by BGP and vitamin D exposure. In this study, exposure of BASMCs to phosphate and active vitamin D sterols induced calcification and changes in expression of genes associated with mineralized tissue.

  19. Association of Advanced Glycation End Products with coronary Artery Calcification in Japanese Subjects with Type 2 Diabetes as Assessed by Skin Autofluorescence

    PubMed Central

    Hangai, Mari; Takebe, Noriko; Honma, Hiroyuki; Sasaki, Atsumi; Chida, Ai; Nakano, Rieko; Togashi, Hirobumi; Nakagawa, Riyuki; Oda, Tomoyasu; Matsui, Mizue; Yashiro, Satoshi; Nagasawa, Kan; Kajiwara, Takashi; Takahashi, Kazuma; Takahashi, Yoshihiko; Satoh, Jo

    2016-01-01

    Aim: Advanced glycation end products (AGE) are considered to be among the critical pathogenic factors involved in the progression of diabetic complications. Skin autofluorescence (AF), a noninvasive measurement of AGE accumulation, has been recognized as a useful and convenient marker for diabetic vascular diseases in Caucasians. This study aimed to evaluate the association of tissue AGE, assessed using skin AF, with coronary artery calcification in Japanese subjects with type 2 diabetes. Methods: In total, 122 Japanese subjects with type 2 diabetes enrolled in this cross-sectional study underwent multi-slice computed tomography for total coronary artery calcium scores (CACS) estimation and examination with a skin AF reader. Results: Skin AF positively correlated with age, sex, diabetes duration, pulse wave velocity, systolic blood pressure, serum creatinine, and CACS. In addition, skin AF results negatively correlated with BMI, eGFR, and serum C-peptide concentration. According to multivariate analysis, age and systolic blood pressure showed strong positive correlation and eGFR showed negative correlation with skin AF values. Multiple linear regression analyses revealed a significant positive correlation between skin AF values and logCACS, independent of age, sex, diabetes duration, HbA1c, BMI, IMT, and blood pressure. However, skin AF showed no association with serum levels of AGE, such as Nε-(carboxymethyl) lysine and 3-deoxyglucosone. Conclusion: Skin AF results positively correlated with CACS in Japanese subjects with type 2 diabetes. This result indicates that AGE plays a role in the pathogenesis of diabetic macrovascular disease. Measurement of skin AF values may be useful for assessing the severity of diabetic complications in Japanese subjects. PMID:26961217

  20. Waist Circumference as a Marker of Obesity Is More Predictive of Coronary Artery Calcification than Body Mass Index in Apparently Healthy Korean Adults: The Kangbuk Samsung Health Study.

    PubMed

    Park, Jongsin; Lee, Eun Seo; Lee, Da Young; Kim, Jihyun; Park, Se Eun; Park, Cheol Young; Lee, Won Young; Oh, Ki Won; Park, Sung Woo; Rhee, Eun Jung

    2016-12-01

    We aimed to assess the risk for coronary artery calcification (CAC) according to groups subdivided by body mass index (BMI) and waist circumference (WC) in apparently healthy Korean adults. Thirty-three thousand four hundred and thirty-two participants (mean age, 42 years) in a health screening program were divided into three groups according to BMI: <23 kg/m² (normal), 23 to 25 kg/m² (overweight), and >25 kg/m² (obese). In addition, the participants were divided into two groups according to WC. Coronary artery calcium score (CACS) was measured with multi-detector computed tomography in all participants. Presence of CAC was defined as CACS >0. When logistic regression analysis was performed with the presence of CAC as the dependent variable, the risk for CAC increased as BMI increased after adjusting for confounding variables (1.102 [95% confidence interval (CI), 1.000 to 1.216]; 1.284 [95% CI, 1.169 to 1.410]; in the overweight and obese groups vs. the normal weight group). When the participants were divided into six groups according to BMI and WC, the subjects with BMI and WC in the obese range showed the highest risk for CAC (1.321 [95% CI, 1.194 to 1.461]) and those with BMI in the overweight range and WC in the obese range showed the second highest risk for CAC (1.235 [95% CI, 1.194 to 1.461]). Participants with obesity defined by both BMI and WC showed the highest risk for CAC. Those with BMIs in the overweight range but with WC in the obese range showed the second highest risk for CAC, suggesting that WC as a marker of obesity is more predictive of CAC than BMI.

  1. Higher association of coronary artery calcification with non-alcoholic fatty liver disease than with abdominal obesity in middle-aged Korean men: the Kangbuk Samsung Health Study.

    PubMed

    Lee, Min-Kyung; Park, Hye-Jeong; Jeon, Won Seon; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

    2015-07-15

    It is uncertain whether non-alcoholic fatty liver disease (NAFLD) or abdominal obesity is more associated with atherosclerosis. The aim of this study was to determine whether NAFLD or abdominal obesity is more strongly associated with subclinical atherosclerosis represented by coronary artery calcification (CAC). A total of 21,335 male participants in a health screening program (mean age 41 years) were enrolled. Ultrasonographic measurements of fatty liver and multi-detector computed tomography were performed to determine the coronary artery calcium score (CACS). The presence of CAC was defined as CACS > 0. Subjects were divided into four groups according to the presence or absence of NAFLD and/or abdominal obesity as assessed by waist-hip ratio (WHR) > 0.9. The presence of CAC was detected in 2,385 subjects (11.2%). The proportion of subjects with CAC was highest in the abdominal obesity only group (23.2%). After adjustment for age, diabetes history, hypertension, cigarette smoking, and physical inactivity, the odds ratio (OR) for CAC was the highest in the group with both abnormalities [1.465 (1.324-1.623)]. The NAFLD only group showed significantly increased OR for CAC compared to that in the abdominal obesity only group [1.286 (1.151-1.436) vs. 1.076 (0.939-1.233)]. Non-alcoholic fatty liver disease is more closely associated with CAC than abdominal obesity as assessed by the WHR. NAFLD could be considered an independent determinant of subclinical atherosclerosis as assessed by CAC.

  2. Waist Circumference as a Marker of Obesity Is More Predictive of Coronary Artery Calcification than Body Mass Index in Apparently Healthy Korean Adults: The Kangbuk Samsung Health Study

    PubMed Central

    Park, Jongsin; Lee, Eun Seo; Lee, Da Young; Kim, Jihyun; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo

    2016-01-01

    Background We aimed to assess the risk for coronary artery calcification (CAC) according to groups subdivided by body mass index (BMI) and waist circumference (WC) in apparently healthy Korean adults. Methods Thirty-three thousand four hundred and thirty-two participants (mean age, 42 years) in a health screening program were divided into three groups according to BMI: <23 kg/m2 (normal), 23 to 25 kg/m2 (overweight), and >25 kg/m2 (obese). In addition, the participants were divided into two groups according to WC. Coronary artery calcium score (CACS) was measured with multi-detector computed tomography in all participants. Presence of CAC was defined as CACS >0. Results When logistic regression analysis was performed with the presence of CAC as the dependent variable, the risk for CAC increased as BMI increased after adjusting for confounding variables (1.102 [95% confidence interval (CI), 1.000 to 1.216]; 1.284 [95% CI, 1.169 to 1.410]; in the overweight and obese groups vs. the normal weight group). When the participants were divided into six groups according to BMI and WC, the subjects with BMI and WC in the obese range showed the highest risk for CAC (1.321 [95% CI, 1.194 to 1.461]) and those with BMI in the overweight range and WC in the obese range showed the second highest risk for CAC (1.235 [95% CI, 1.194 to 1.461]). Conclusion Participants with obesity defined by both BMI and WC showed the highest risk for CAC. Those with BMIs in the overweight range but with WC in the obese range showed the second highest risk for CAC, suggesting that WC as a marker of obesity is more predictive of CAC than BMI. PMID:28029026

  3. Concomitant atherosclerotic disease detected by whole-body MR angiography in relation to coronary artery calcification in patients with coronary artery disease.

    PubMed

    Seng, K; Breuckmann, F; Schlosser, T; Barkhausen, J; Geckeis, K; Budde, T; Hoefs, C; Schmermund, A; Erbel, R; Ladd, S C

    2010-04-01

    Patients with coronary artery disease (CAD) show a high prevalence for concomitant atherosclerotic peripheral arterial disease (PAD). On the other hand, PAD seems to be an additional risk factor for cardiac events. We evaluated the correlation between arterial pathologies as found in whole-body MR angiography and coronary artery calcification (CAC) detected by electron beam computed tomography (EBCT) and multislice CT (MSCT). Two hundred and twenty-eight patients (161 men; 67 women) with suspicion for CAD/known CAD underwent whole-body contrast-enhanced MR angiography (wb-ce-MRA) and EBCT/MSCT. An atherosclerosis index was calculated for each patient Index = (40)Sigma(n=1) w(i) with w(i) being the grading of the stenosis of the i (ten) of 40 arteria segments (grade: 0 - no plaque; 1 - plaque - < or = 50 % stenosis; 2 - > 50 % stenosis - < or = 90 % stenosis; 3 - > 90 % stenosis - < 100 % stenosis; 4 - occlusion). Correlations between CAC and atherosclerosis index were performed. Wb-ce MRA and CAC correlate only moderately in this population. An atherosclerosis index 8 renders a positive predictive value for a CAC 100 of 63.3 %. An atherosclerosis index as defined in this study does not fully correlate with the extent of CAD as revealed by catheter angiography or EBCT/MSCT, but it might theoretically mirror the increased risk by PAD. It thus might be a promising complementary parameter for the prediction of cardiac events. Future studies need to show its possible additional predictive impact. A A Georg Thieme Verlag KG Stuttgart A New York.

  4. The Association Between Physical Activity and Both Incident Coronary Artery Calcification and Ankle Brachial Index Progression: The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Delaney, Joseph A C; Jensky, Nicole E.; Criqui, Michael H.; Whitt-Glover, Melicia C.; Lima, João A. C.; Allison, Matthew A.

    2014-01-01

    Objective Both coronary artery calcification (CAC) and the ankle brachial index (ABI) are measures of subclinical atherosclerotic disease. The influence of physical activity on the longitudinal change in these measures remains unclear. To assess this we examined the association between these measures and self-reported physical activity in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods At baseline, the MESA participants were free of clinically evident cardiovascular disease. We included all participants with an ABI between 0.90 and 1.40 (n=5656). Predictor variables were based on self-reported measures with physical activity being assessed using the Typical Week Physical Activity Survey from which metabolic equivalent-minutes/week of activity were calculated. We focused on physical activity intensity, intentional exercise, sedentary behavior, and conditioning. Incident peripheral artery disease (PAD) was defined as the progression of ABI to values below 0.90 (given the baseline range of 0.90 to 1.40). Incident CAC was defined as a CAC score >0 Agatston units upon follow up with a baseline score of 0 Agatston units. Results Mean age was 61 years, 53% were female, and mean body mass index was 28 kg/m2. After adjusting for traditional cardiovascular risk factors and socioeconomic factors, intentional exercise was protective for incident peripheral artery disease (Relative Risk (RR)= 0.85, 95% Confidence Interval (CI): 0.74 to 0.98). After adjusting for traditional cardiovascular risk factors and socioeconomic factors, there was a significant association between vigorous PA and incident CAC (RR=0.97, 95% CI: 0.94 to 1.00). There was also a significant association between sedentary behavior and increased amount of CAC among participants with CAC at baseline (Δlog(Agatston Units +25)=0.027, 95% CI 0.002, 0.052). Conclusions These data suggest that there is an association between physical activity/sedentary behavior and the progression of two different measures

  5. CT-Detected Growth of Coronary Artery Calcification in Asymptomatic Middle-Aged Subjects and Association With 15 Biomarkers.

    PubMed

    Diederichsen, Søren Zöga; Grønhøj, Mette Hjortdal; Mickley, Hans; Gerke, Oke; Steffensen, Flemming Hald; Lambrechtsen, Jess; Rønnow Sand, Niels Peter; Rasmussen, Lars Melholt; Olsen, Michael Hecht; Diederichsen, Axel

    2017-08-01

    This study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth. CAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved. At baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D3, parathyroid hormone, osteoprotegerin), lipid metabolism (triglyceride, high- and low-density lipoprotein, total cholesterol), inflammation (C-reactive protein, soluble urokinase-type plasminogen activator receptor), kidney function (creatinine, cystatin C, urate), and myocardial necrosis (cardiac troponin I) were analyzed. A second CT scan was scheduled after 5 years. General linear models were performed to examine the association between biomarkers and ΔCAC score, and additionally, sensitivity analyses were performed in terms of binary and ordinal logistic regressions. A total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n = 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with ΔCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n = 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n = 444; IRR: 3.60; 95% CI: 1.42 to 9.11). In this

  6. Pharmacogenomics of estrogens on changes in carotid artery intima-medial thickness and coronary arterial calcification: Kronos Early Estrogen Prevention Study.

    PubMed

    Miller, Virginia M; Jenkins, Gregory D; Biernacka, Joanna M; Heit, John A; Huggins, Gordon S; Hodis, Howard N; Budoff, Matthew J; Lobo, Rogerio A; Taylor, Hugh S; Manson, JoAnn E; Black, Dennis M; Naftolin, Frederick; Harman, S Mitchell; de Andrade, Mariza

    2016-01-01

    Prior to the initiation of menopausal hormone treatment (MHT), genetic variations in the innate immunity pathway were found to be associated with carotid artery intima-medial thickness (CIMT) and coronary arterial calcification (CAC) in women (n = 606) enrolled in the Kronos Early Estrogen Prevention Study (KEEPS). Whether MHT might affect these associations is unknown. The association of treatment outcomes with variation in the same 764 candidate genes was evaluated in the same KEEPS participants 4 yr after randomization to either oral conjugated equine estrogens (0.45 mg/day), transdermal 17β-estradiol (50 μg/day), each with progesterone (200 mg/day) for 12 days each month, or placebo pills and patch. Twenty SNPs within the innate immunity pathway most related with CIMT after 4 yr were not among those associated with CIMT prior to MHT. In 403 women who completed the study in their assigned treatment group, single nucleotide polymorphisms (SNPs) within the innate immunity pathway were found to alter the treatment effect on 4 yr change in CIMT (i.e., significant interaction between treatment and genetic variation in the innate immunity pathway; P < 0.001). No SNPs by treatment effects were observed with changes of CAC >5 Agatston units after 4 yr. Results of this study suggest that hormonal status may interact with genetic variants to influence cardiovascular phenotypes, specifically, the pharmacogenomic effects within the innate immunity pathway for CIMT.

  7. Pharmacogenomics of estrogens on changes in carotid artery intima-medial thickness and coronary arterial calcification: Kronos Early Estrogen Prevention Study

    PubMed Central

    Jenkins, Gregory D.; Biernacka, Joanna M.; Heit, John A.; Huggins, Gordon S.; Hodis, Howard N.; Budoff, Matthew J.; Lobo, Rogerio A.; Taylor, Hugh S.; Manson, JoAnn E.; Black, Dennis M.; Naftolin, Frederick; Harman, S. Mitchell; de Andrade, Mariza

    2015-01-01

    Prior to the initiation of menopausal hormone treatment (MHT), genetic variations in the innate immunity pathway were found to be associated with carotid artery intima-medial thickness (CIMT) and coronary arterial calcification (CAC) in women (n = 606) enrolled in the Kronos Early Estrogen Prevention Study (KEEPS). Whether MHT might affect these associations is unknown. The association of treatment outcomes with variation in the same 764 candidate genes was evaluated in the same KEEPS participants 4 yr after randomization to either oral conjugated equine estrogens (0.45 mg/day), transdermal 17β-estradiol (50 μg/day), each with progesterone (200 mg/day) for 12 days each month, or placebo pills and patch. Twenty SNPs within the innate immunity pathway most related with CIMT after 4 yr were not among those associated with CIMT prior to MHT. In 403 women who completed the study in their assigned treatment group, single nucleotide polymorphisms (SNPs) within the innate immunity pathway were found to alter the treatment effect on 4 yr change in CIMT (i.e., significant interaction between treatment and genetic variation in the innate immunity pathway; P < 0.001). No SNPs by treatment effects were observed with changes of CAC >5 Agatston units after 4 yr. Results of this study suggest that hormonal status may interact with genetic variants to influence cardiovascular phenotypes, specifically, the pharmacogenomic effects within the innate immunity pathway for CIMT. PMID:26508701

  8. [THE CHANGES IN THE STRUCTURAL REMODELING OF THE CAROTID ARTERY IN PATIENTS WITH HYPERTENSION AND HEART VALVE CALCIFICATION UNDER THE INFLUENCE OF TREATMENT].

    PubMed

    Yuzvishina, O V

    2014-01-01

    In patients with essential hypertension (EH) and heart valves calcification (HVC) were studied the dynamics of the structural remodeling of the carotid artery under the influence of different variants of lipid-lowering therapy. Significant decrease in the thickness of the intimamedia, the frequency of new atherosclerotic plaques have been seen in patients with EH and HVC using high-dose atorvastatin compared with less.

  9. Automatic coronary artery calcium scoring in cardiac CT angiography using paired convolutional neural networks.

    PubMed

    Wolterink, Jelmer M; Leiner, Tim; de Vos, Bob D; van Hamersvelt, Robbert W; Viergever, Max A; Išgum, Ivana

    2016-12-01

    The amount of coronary artery calcification (CAC) is a strong and independent predictor of cardiovascular events. CAC is clinically quantified in cardiac calcium scoring CT (CSCT), but it has been shown that cardiac CT angiography (CCTA) may also be used for this purpose. We present a method for automatic CAC quantification in CCTA. This method uses supervised learning to directly identify and quantify CAC without a need for coronary artery extraction commonly used in existing methods. The study included cardiac CT exams of 250 patients for whom both a CCTA and a CSCT scan were available. To restrict the volume-of-interest for analysis, a bounding box around the heart is automatically determined. The bounding box detection algorithm employs a combination of three ConvNets, where each detects the heart in a different orthogonal plane (axial, sagittal, coronal). These ConvNets were trained using 50 cardiac CT exams. In the remaining 200 exams, a reference standard for CAC was defined in CSCT and CCTA. Out of these, 100 CCTA scans were used for training, and the remaining 100 for evaluation of a voxel classification method for CAC identification. The method uses ConvPairs, pairs of convolutional neural networks (ConvNets). The first ConvNet in a pair identifies voxels likely to be CAC, thereby discarding the majority of non-CAC-like voxels such as lung and fatty tissue. The identified CAC-like voxels are further classified by the second ConvNet in the pair, which distinguishes between CAC and CAC-like negatives. Given the different task of each ConvNet, they share their architecture, but not their weights. Input patches are either 2.5D or 3D. The ConvNets are purely convolutional, i.e. no pooling layers are present and fully connected layers are implemented as convolutions, thereby allowing efficient voxel classification. The performance of individual 2.5D and 3D ConvPairs with input sizes of 15 and 25 voxels, as well as the performance of ensembles of these Conv

  10. Associations of coffee, tea, and caffeine intake with coronary artery calcification and cardiovascular events

    USDA-ARS?s Scientific Manuscript database

    Coffee and tea are 2 of the most commonly consumed beverages in the world. The association of coffee and tea intake with coronary artery calcium and major adverse cardiovascular events remains uncertain. We examined 6508 ethnically diverse participants with available coffee and tea data from the Mul...

  11. Dual Effects of Bisphosphonates on Ectopic Skin and Vascular Soft Tissue Mineralization versus Bone Microarchitecture in a Mouse Model of Generalized Arterial Calcification of Infancy.

    PubMed

    Li, Qiaoli; Kingman, Joshua; Sundberg, John P; Levine, Michael A; Uitto, Jouni

    2016-01-01

    Generalized arterial calcification of infancy is an intractable ectopic mineralization disorder caused by mutations in the ENPP1 gene, resulting in reduced plasma inorganic pyrophosphate (PPi) levels. We previously characterized the Enpp1(asj) mutant mouse as a model of generalized arterial calcification of infancy, and we have now explored the potential efficacy of bisphosphonates, nonhydrolyzable PPi analogs, in preventing ectopic mineralization in these mice. The mice were maintained on either basic diet (control) or diets containing etidronate or alendronate in three different concentrations (experimental). Considering low bioavailability of bisphosphonates when administered orally, subsequent studies tested the mice with subcutaneous injections of etidronate. The treatments were initiated at 4 weeks of age, and the degree of mineralization was assessed at 12 weeks of age by quantitation of calcium deposits in the muzzle skin containing dermal sheath of vibrissae and in aorta. We found that bisphosphonate treatments significantly reduced mineralization in skin and aorta. These changes in treated mice were accompanied with restoration of their bone microarchitecture, determined by microcomputed tomography. The inhibitory capacity of bisphosphonates, with mechanistic implications, was confirmed in a cell-based mineralization assay in vitro. Collectively, these results suggest that bisphosphonate treatment may be beneficial by a dual effect for preventing ectopic soft tissue mineralization while correcting decreased bone mineralization in generalized arterial calcification of infancy caused by ENPP1 mutations. Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.

  12. Arterial calcification and bone physiology: role of the bone-vascular axis

    PubMed Central

    Thompson, Bithika; Towler, Dwight A.

    2012-01-01

    Bone never forms without vascular interactions. This simple statement of fact does not adequately reflect the physiological and pharmacological implications of the relationship. The vasculature is the conduit for nutrient exchange between bone and the rest of the body. The vasculature provides the sustentacular niche for development of osteoblast progenitors, and is the conduit for egress of bone marrow cell products arising, in turn, from the osteoblast-dependent hematopoietic niche. Importantly, the second most calcified structure in humans after the skeleton is the vasculature. Once considered a passive process of dead and dying cells, vascular calcification has emerged as an actively regulated form of tissue biomineralization. Skeletal morphogens and osteochondrogenic transcription factors are elaborated by cells within the vessel wall, regulating the deposition of vascular calcium. Osteotropic hormones including parathyroid hormone regulate both vascular and skeletal mineralization. Cellular, endocrine, and metabolic signals flow bidirectionally between the vasculature and bone that are necessary for both bone health and vascular health. Dysmetabolic states including diabetes, uremia, and hyperlipidemia perturb the bone-vascular axis, giving rise to devastating vascular and skeletal disease. A detailed understanding of bone-vascular interactions is needed to address the unmet clinical needs of our increasingly aged and dysmetabolic population. PMID:22473330

  13. Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study

    PubMed Central

    Meedt, Thomas; Jonsson, Fredrik; Henein, Michael Y.

    2016-01-01

    Objective. A long-term follow-up of patients with rheumatoid arthritis (RA) to evaluate factors related to coronary artery calcification (CAC). Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30–36 years) from the original (baseline; n = 39) study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT) and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0–10) and high CAC (>10) was done by orthogonal projection to latent structures (OPLS). Results. Ten patients had CAC 0–10 and 12 had >10 (range 18–1700). Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h) and swollen joint count (2 versus 0). The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%). Conclusions. CAC is related to inflammation in patients with RA. PMID:27648442

  14. Progression of Coronary Artery Calcification in Black and White Women: Do the Stresses and Rewards of Multiple Roles Matter?

    PubMed Central

    Janssen, Imke; Powell, Lynda H.; Jasielec, Mateusz S.; Matthews, Karen A.; Hollenberg, Steven M.; Sutton-Tyrrell, Kim; Everson-Rose, Susan A.

    2013-01-01

    Background Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. Purpose To investigate the effects of multiple roles on 2-year progression of coronary artery calcification (CAC). Methods Subjects were 104 black and 232 white women (mean age 50.8 years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on 5-point scales. CAC progression was defined as an increase of ≥10 Agatston units. Results White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower CAC progression, adjusting for BMI, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to CAC progression. Conclusion Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women. PMID:21901270

  15. Variable patterns of ectopic mineralization in Enpp1asj-2J mice, a model for generalized arterial calcification of infancy

    PubMed Central

    Siu, Sarah Y.; Dyment, Nathaniel A.; Rowe, David W.; Sundberg, John P.; Uitto, Jouni; Li, Qiaoli

    2016-01-01

    Generalized arterial calcification of infancy (GACI) is an autosomal recessive disorder characterized by early onset of extensive mineralization of the cardiovascular system. The classical forms of GACI are caused by mutations in the ENPP1 gene, encoding a membrane-bound pyrophosphatase/phosphodiesterase that hydrolyzes ATP to AMP and inorganic pyrophosphate. The asj-2J mouse harboring a spontaneous mutation in the Enpp1 gene has been characterized as a model for GACI. These mutant mice develop ectopic mineralization in skin and vascular connective tissues as well as in cartilage and collagen-rich tendons and ligaments. This study examined in detail the temporal ectopic mineralization phenotype of connective tissues in this mouse model, utilizing a novel cryo-histological method that does not require decalcification of bones. The wild type, heterozygous, and homozygous mice were administered fluorescent mineralization labels at 4 weeks (calcein), 10 weeks (alizarin complexone), and 11 weeks of age (demeclocycline). Twenty-four hours later, outer ears, muzzle skin, trachea, aorta, shoulders, and vertebrae were collected from these mice and examined for progression of mineralization. The results revealed differential timeline for disease initiation and progression in various tissues of this mouse model. It also highlights the advantages of cryo-histological fluorescent imaging technique to study mineral deposition in mouse models of ectopic mineralization disorders. PMID:27863377

  16. Bone morphogenetic protein-2 activates NADPH oxidase to increase endoplasmic reticulum stress and human coronary artery smooth muscle cell calcification.

    PubMed

    Liberman, Marcel; Johnson, Rebecca C; Handy, Diane E; Loscalzo, Joseph; Leopold, Jane A

    2011-09-30

    Bone morphogenetic protein-2 (BMP-2) increases oxidant stress and endoplasmic reticulum (ER) stress to stimulate differentiation of osteoblasts; however, the role of these signaling pathways in the transition of smooth muscle cells to a calcifying osteoblast-like phenotype remains incompletely characterized. We, therefore, treated human coronary artery smooth muscle cells (HCSMC) with BMP-2 (100ng/mL) and found an increase in NADPH oxidase activity and oxidant stress that occurred via activation of the bone morphogenetic protein receptor 2 and Smad 1 signaling. BMP-2-mediated oxidant stress also increased endoplasmic reticulum (ER) stress demonstrated by increased expression of GRP78, phospho-IRE1α, and the transcription factor XBP1. Analysis of a 1kb segment of the Runx2 promoter revealed an XBP1 binding site; electrophoretic mobility shift and chromatin immunoprecipitation assays demonstrated that XBP1 bound to the Runx2 promoter at this site in BMP-2-treated HCSMC. Inhibition of oxidant stress or ER stress decreased Runx2 expression, intracellular calcium deposition, and mineralization of BMP-2-treated HCSMC. Thus, in HCSMC, BMP-2 increases oxidant stress and ER stress to increase Runx2 expression and promote vascular smooth muscle cell calcification. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. [Ectopic calcification].

    PubMed

    Fukumoto, Seiji

    2014-02-01

    Calcium deposition can be observed in many tissues in addition to bones and teeth which physiologically calcify. This unphysiological calcification can damage several organs. It has been shown that vascular calcification which is a risk factor for cardiovascular events develops through similar mechanisms to physiological calcification. Further studies to clarify detailed mechanisms of calcification are necessary to develop measures that inhibit unphysiological ectopic calcification without affecting physiological calcification in bones and teeth.

  18. Dietary L-lysine prevents arterial calcification in adenine-induced uremic rats.

    PubMed

    Shimomura, Akihiro; Matsui, Isao; Hamano, Takayuki; Ishimoto, Takuya; Katou, Yumiko; Takehana, Kenji; Inoue, Kazunori; Kusunoki, Yasuo; Mori, Daisuke; Nakano, Chikako; Obi, Yoshitsugu; Fujii, Naohiko; Takabatake, Yoshitsugu; Nakano, Takayoshi; Tsubakihara, Yoshiharu; Isaka, Yoshitaka; Rakugi, Hiromi

    2014-09-01

    Vascular calcification (VC) is a life-threatening complication of CKD. Severe protein restriction causes a shortage of essential amino acids, and exacerbates VC in rats. Therefore, we investigated the effects of dietary l-lysine, the first-limiting amino acid of cereal grains, on VC. Male Sprague-Dawley rats at age 13 weeks were divided randomly into four groups: low-protein (LP) diet (group LP), LP diet+adenine (group Ade), LP diet+adenine+glycine (group Gly) as a control amino acid group, and LP diet+adenine+l-lysine·HCl (group Lys). At age 18 weeks, group LP had no VC, whereas groups Ade and Gly had comparable levels of severe VC. l-Lysine supplementation almost completely ameliorated VC. Physical parameters and serum creatinine, urea nitrogen, and phosphate did not differ among groups Ade, Gly, and Lys. Notably, serum calcium in group Lys was slightly but significantly higher than in groups Ade and Gly. Dietary l-lysine strongly suppressed plasma intact parathyroid hormone in adenine rats and supported a proper bone-vascular axis. The conserved orientation of the femoral apatite in group Lys also evidenced the bone-protective effects of l-lysine. Dietary l-lysine elevated plasma alanine, proline, arginine, and homoarginine but not lysine. Analyses in vitro demonstrated that alanine and proline inhibit apoptosis of cultured vascular smooth muscle cells, and that arginine and homoarginine attenuate mineral precipitations in a supersaturated calcium/phosphate solution. In conclusion, dietary supplementation of l-lysine ameliorated VC by modifying key pathways that exacerbate VC.

  19. Dietary l-Lysine Prevents Arterial Calcification in Adenine-Induced Uremic Rats

    PubMed Central

    Shimomura, Akihiro; Matsui, Isao; Hamano, Takayuki; Ishimoto, Takuya; Katou, Yumiko; Takehana, Kenji; Inoue, Kazunori; Kusunoki, Yasuo; Mori, Daisuke; Nakano, Chikako; Obi, Yoshitsugu; Fujii, Naohiko; Takabatake, Yoshitsugu; Nakano, Takayoshi; Tsubakihara, Yoshiharu; Rakugi, Hiromi

    2014-01-01

    Vascular calcification (VC) is a life-threatening complication of CKD. Severe protein restriction causes a shortage of essential amino acids, and exacerbates VC in rats. Therefore, we investigated the effects of dietary l-lysine, the first-limiting amino acid of cereal grains, on VC. Male Sprague-Dawley rats at age 13 weeks were divided randomly into four groups: low-protein (LP) diet (group LP), LP diet+adenine (group Ade), LP diet+adenine+glycine (group Gly) as a control amino acid group, and LP diet+adenine+l-lysine·HCl (group Lys). At age 18 weeks, group LP had no VC, whereas groups Ade and Gly had comparable levels of severe VC. l-Lysine supplementation almost completely ameliorated VC. Physical parameters and serum creatinine, urea nitrogen, and phosphate did not differ among groups Ade, Gly, and Lys. Notably, serum calcium in group Lys was slightly but significantly higher than in groups Ade and Gly. Dietary l-lysine strongly suppressed plasma intact parathyroid hormone in adenine rats and supported a proper bone-vascular axis. The conserved orientation of the femoral apatite in group Lys also evidenced the bone-protective effects of l-lysine. Dietary l-lysine elevated plasma alanine, proline, arginine, and homoarginine but not lysine. Analyses in vitro demonstrated that alanine and proline inhibit apoptosis of cultured vascular smooth muscle cells, and that arginine and homoarginine attenuate mineral precipitations in a supersaturated calcium/phosphate solution. In conclusion, dietary supplementation of l-lysine ameliorated VC by modifying key pathways that exacerbate VC. PMID:24652795

  20. Sex-related differences in calcific aortic stenosis: correlating clinical and echocardiographic characteristics and computed tomography aortic valve calcium score to excised aortic valve weight.

    PubMed

    Thaden, Jeremy J; Nkomo, Vuyisile T; Suri, Rakesh M; Maleszewski, Joseph J; Soderberg, Daniel J; Clavel, Marie-Annick; Pislaru, Sorin V; Malouf, Joseph F; Foley, Thomas A; Oh, Jae K; Miller, Jordan D; Edwards, William D; Enriquez-Sarano, Maurice

    2016-02-21

    Calcific aortic valve stenosis (AS) is purportedly associated with less calcium burden in women than in men. We sought to examine sex-related differences and correlates of surgically excised aortic valve weight (AVW) in pure AS. Clinical and echocardiographic characteristics of 888 consecutive patients who underwent aortic valve replacement for severe AS were correlated to AVW, and in 126 patients, AVW was also correlated to computed tomography aortic valve calcium (AVC) score. Women and men had similar indexed valve area (0.42 ± 0.09 vs. 0.42 ± 0.07 cm (2)/m(2), P = 0.95) and mean systolic gradient (53 ± 15 vs. 52 ± 13 mmHg, P = 0.11), but women had higher New York Heart Association class (2.63 ± 0.70 vs. 2.50 ± 0.70, P = 0.01) and less prevalent coronary artery disease (38 vs. 52%, P < 0.0001). Aortic valve weight was lower in women (1.94 ± 0.88 vs. 3.08 ± 1.32 g, P < 0.0001) even when indexed to body surface area (1.09 ± 0.48 vs. 1.48 ± 0.62 g/m(2), P < 0.0001) or left ventricular outflow tract (LVOT) area (0.54 ± 0.23 vs. 0.71 ± 0.29 g/cm(2), P < 0.0001). Using multivariate analysis, male sex (P < 0.0001), bicuspid valve (P < 0.0001), and larger LVOT area (P < 0.0001) were the major determinants of increased AVW, along with current cigarette smoking (P = 0.007). Diabetes (P = 0.004) and hypertension (P = 0.03) were independently associated with lower AVW. Aortic valve calcium correlated well with AVW (r = 0.81, P < 0.0001) and was lower in women than in men (2520 ± 1199 vs. 3606 ± 1632 arbitrary units, P < 0.0001). Despite the same degree of AS severity, women have less AVC and lower AVW compared with men, irrespective of valve morphology. Aortic valve calcium is correlated to excised AVW. Hypertension, diabetes, and current cigarette smoking were independently associated with AVW. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

  1. Increased risk of coronary artery calcification progression in subjects with high baseline Lp(a) levels: The Kangbuk Samsung Health Study.

    PubMed

    Cho, Jung Hwan; Lee, Da Young; Lee, Eun Seo; Kim, Jihyun; Park, Se Eun; Park, Cheol-Young; Lee, Won-Young; Oh, Ki-Won; Park, Sung-Woo; Rhee, Eun-Jung

    2016-11-01

    Results from previous studies support the association of lipoprotein(a) [Lp(a)] levels and coronary artery disease risk. In this study, we analyzed the association between baseline Lp(a) levels and future progression of coronary artery calcification (CAC) in apparently healthy Korean adults. A total of 2611 participants (mean age: 41years, 92% mend) who underwent a routine health check-up in 2010 and 2014 were enrolled. Coronary artery calcium score (CACS) were measured by multi-detector computed tomography. Baseline Lp(a) was measured by high-sensitivity immunoturbidimetric assay. Progression of CAC was defined as a change in CACS >0 over four years. Bivariate correlation analyses with baseline Lp(a) and other metabolic parameters revealed age, total cholesterol, HDL-C, LDL-C and CACS to have a significant positive correlation, while body weight, fasting glucose level, blood pressure and triglyceride level were negatively correlated with baseline Lp(a) level. After four years of follow-up, 635 subjects (24.3%) had CAC progression. The participants who had CAC progression were older, composed of more men, more obese, and had higher fasting glucose levels and worse baseline lipid profiles compared to those who did not have CAC progression. The mean serum Lp(a) level was significantly higher in subjects who had CAC progression compared to those who did not (32.5 vs. 28.9mg/dL, p<0.01). When the risk for CAC progression according to baseline Lp(a) was calculated, those with Lp(a) level≥50mg/dL had an odds ratio of 1.333 (95% CI 1.027-1.730) for CAC progression compared to those with Lp(a)<50mg/dL after adjusting for confounding factors. In this study, the subjects who had higher Lp(a) were at significantly higher risk for CAC progression after four years of follow-up, suggesting the role of high Lp(a) in CAC progression. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  2. Familial defective apolipoprotein B-100 and increased low-density lipoprotein cholesterol and coronary artery calcification in the old order amish.

    PubMed

    Shen, Haiqing; Damcott, Coleen M; Rampersaud, Evadnie; Pollin, Toni I; Horenstein, Richard B; McArdle, Patrick F; Peyser, Patricia A; Bielak, Lawrence F; Post, Wendy S; Chang, Yen-Pei C; Ryan, Kathleen A; Miller, Michael; Rumberger, John A; Sheedy, Patrick F; Shelton, John; O'Connell, Jeffrey R; Shuldiner, Alan R; Mitchell, Braxton D

    2010-11-08

    Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major cardiovascular disease risk factor. Genetic factors are an important determinant of LDL-C levels. To identify single nucleotide polymorphisms associated with LDL-C and subclinical coronary atherosclerosis, we performed a genome-wide association study of LDL-C in 841 asymptomatic Amish individuals aged 20 to 80 years, with replication in a second sample of 663 Amish individuals. We also performed scanning for coronary artery calcification (CAC) in 1018 of these individuals. From the initial genome-wide association study, a cluster of single nucleotide polymorphisms in the region of the apolipoprotein B-100 gene (APOB) was strongly associated with LDL-C levels (P < 10(-68)). Additional genotyping revealed the presence of R3500Q, the mutation responsible for familial defective apolipoprotein B-100, which was also strongly associated with LDL-C in the replication sample (P < 10(-36)). The R3500Q carrier frequency, previously reported to be 0.1% to 0.4% in white European individuals, was 12% in the combined sample of 1504 Amish participants, consistent with a founder effect. The mutation was also strongly associated with CAC in both samples (P < 10(-6) in both) and accounted for 26% and 7% of the variation in LDL-C levels and CAC, respectively. Compared with noncarriers, R3500Q carriers on average had LDL-C levels 58 mg/dL higher, a 4.41-fold higher odds (95% confidence interval, 2.69-7.21) of having detectable CAC, and a 9.28-fold higher odds (2.93-29.35) of having extensive CAC (CAC score ≥400). The R3500Q mutation in APOB is a major determinant of LDL-C levels and CAC in the Amish.

  3. Increased Risk of Progression of Coronary Artery Calcification in Male Subjects with High Baseline Waist-to-Height Ratio: The Kangbuk Samsung Health Study

    PubMed Central

    Oh, Hyung-Geun; Nallamshetty, Shriram

    2016-01-01

    Background The waist-to-height ratio (WHtR) is an easy and inexpensive adiposity index that reflects central obesity. In this study, we examined the association of baseline WHtR and progression of coronary artery calcification (CAC) over 4 years of follow-up in apparently healthy Korean men. Methods A total of 1,048 male participants (mean age, 40.9 years) in a health-screening program in Kangbuk Samsung Hospital, Seoul, Korea who repeated a medical check-up in 2010 and 2014 were recruited. Baseline WHtR was calculated using the value for the waist in 2010 divided by the value for height in 2010. The CAC score (CACS) of each subject was measured by multi-detector computed tomography in both 2010 and 2014. Progression of CAC was defined as a CACS change over 4 years greater than 0. Results During the follow-up period, progression of CAC occurred in 278 subjects (26.5%). The subjects with CAC progression had slightly higher but significant baseline WHtR compared to those who did not show CAC progression (0.51±0.04 vs. 0.50±0.04, P<0.01). The proportion of subjects with CAC progression significantly increased as the baseline WHtR increased from the 1st quartile to 4th quartile groups (18.3%, 18.7%, 28.8%, and 34.2%; P<0.01). The risk for CAC progression was elevated with an odds ratio of 1.602 in the 4th quartile group of baseline WHtR even after adjustment for confounding variables (95% confidence interval, 1.040 to 2.466). Conclusion Increased baseline WHtR was associated with increased risk for CAC progression. WHtR might be a useful screening tool to identify individuals at high risk for subclinical atherosclerosis. PMID:26912156

  4. Increased Risk of Progression of Coronary Artery Calcification in Male Subjects with High Baseline Waist-to-Height Ratio: The Kangbuk Samsung Health Study.

    PubMed

    Oh, Hyung Geun; Nallamshetty, Shriram; Rhee, Eun Jung

    2016-02-01

    The waist-to-height ratio (WHtR) is an easy and inexpensive adiposity index that reflects central obesity. In this study, we examined the association of baseline WHtR and progression of coronary artery calcification (CAC) over 4 years of follow-up in apparently healthy Korean men. A total of 1,048 male participants (mean age, 40.9 years) in a health-screening program in Kangbuk Samsung Hospital, Seoul, Korea who repeated a medical check-up in 2010 and 2014 were recruited. Baseline WHtR was calculated using the value for the waist in 2010 divided by the value for height in 2010. The CAC score (CACS) of each subject was measured by multi-detector computed tomography in both 2010 and 2014. Progression of CAC was defined as a CACS change over 4 years greater than 0. During the follow-up period, progression of CAC occurred in 278 subjects (26.5%). The subjects with CAC progression had slightly higher but significant baseline WHtR compared to those who did not show CAC progression (0.51±0.04 vs. 0.50±0.04, P<0.01). The proportion of subjects with CAC progression significantly increased as the baseline WHtR increased from the 1st quartile to 4th quartile groups (18.3%, 18.7%, 28.8%, and 34.2%; P<0.01). The risk for CAC progression was elevated with an odds ratio of 1.602 in the 4th quartile group of baseline WHtR even after adjustment for confounding variables (95% confidence interval, 1.040 to 2.466). Increased baseline WHtR was associated with increased risk for CAC progression. WHtR might be a useful screening tool to identify individuals at high risk for subclinical atherosclerosis.

  5. Relationship of Change in Traditional Cardiometabolic Risk Factors to Change in Coronary Artery Calcification Among Individuals with Detectable Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Arguelles, William; Llabre, Maria M.; Penedo, Frank J.; Daviglus, Martha L.; Sacco, Ralph L.; Liu, Kiang; Szklo, Moyses; Polak, Joseph F.; Eng, John; Burke, Gregory L.; Schneiderman, Neil

    2014-01-01

    Background/Objectives Data describing relationships between change in risk factors and coronary artery calcification (CAC) are lacking and could inform optimal cardiovascular disease prevention and treatment strategies. This study aimed to examine how change in traditional cardiometabolic risk factors related to change in CAC among individuals with detectable subclinical atherosclerosis. Methods Latent growth modeling was used to examine change in cardiometabolic risk factors (waist circumference, body mass index, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and glucose) related to change in CAC up to an average 4.9-year follow-up in a multi-ethnic cohort of 3,398 asymptomatic individuals (57.8% men) who had detectable CAC (score > 0) at baseline, adjusting for baseline risk factor levels and CAC values, age, gender, race/ethnicity, smoking, family history of CVD, income, and use of antihypertensive, lipid-lowering, and glucose-lowering medications. Results Greater declines in blood pressure (systolic and diastolic) and low-density lipoprotein cholesterol at follow-up were each associated with greater CAC progression. The observed inverse associations were attributable to greater CAC progression in participants taking antihypertensive and lipid-lowering drugs who, as expected, had declines in blood pressure and lipid levels, respectively. These inverse associations did not emerge in participants not taking these medications. Conclusions Among individuals with subclinical atherosclerosis, the unexpected inverse associations observed between change in blood pressure and lipid levels with CAC progression emphasize the importance of considering medication use, and, when feasible, the severity and duration of disease, in exploring associations between risk factors and CAC change. PMID:24698232

  6. Genetic Pathways of Vascular Calcification

    PubMed Central

    Bowman, Marion A. Hofmann; McNally, Elizabeth M.

    2012-01-01

    Vascular calcification is an independent risk factor for cardiovascular disease. Arterial calcification of the aorta, coronary, carotid and peripheral arteries becomes more prevalent with age. Genomewide association studies have identified regions of the genome linked to vascular calcification, and these same regions are linked to myocardial infarction risk. The 9p21 region linked to vascular disease and inflammation also associates with vascular calcification. In addition to these common variants, rare genetic defects can serve as primary triggers of accelerated and premature calcification. Infancy-associated calcific disorders are caused by loss of function mutations in ENPP1 an enzyme that produces extracellular pyrophosphate. Adult onset vascular calcification is linked to mutations NTE5, another enzyme that regulates extracellular phosphate metabolism. Common conditions that secondarily enhance vascular calcification include atherosclerosis, metabolic dysfunction, diabetes, and impaired renal clearance. Oxidative stress and vascular inflammation, along with biophysical properties, converge with these predisposing factors to promote soft tissue mineralization. Vascular calcification is accompanied by an osteogenic profile, and this osteogenic conversion is seen within the vascular smooth muscle itself as well as the matrix. Herein we will review the genetic causes of medial calcification in the smooth muscle layer, focusing on recent discoveries of gene mutations that regulate extracellular matrix phosphate production and the role of S100 proteins as promoters of vascular calcification. PMID:23040839

  7. ADVANCE: Study to Evaluate Cinacalcet Plus Low Dose Vitamin D on Vascular Calcification in Subjects With Chronic Kidney Disease Receiving Hemodialysis

    ClinicalTrials.gov

    2014-07-14

    Chronic Kidney Disease; End Stage Renal Disease; Coronary Artery Calcification; Vascular Calcification; Calcification; Cardiovascular Disease; Chronic Renal Failure; Hyperparathyroidism; Kidney Disease; Nephrology; Secondary Hyperparathyroidism

  8. Does a plain X-ray of the pelvis predict arterial complications in renal transplantation? A prospective study.

    PubMed

    Aalten, Jeroen; Dekker, Helena M; van der Vliet, J A Daan; Hoitsma, Andries J

    2011-06-01

    It is unknown whether if a plain X-ray of the iliac arteries (pelvic X-ray) is a reliable tool to detect calcifications and predict vascular complications. In a prospective study, a pelvic X-ray was performed before transplantation in patients without evidence of peripheral vascular disease (n = 109) and vascular calcifications were scored. Vascular calcifications in the iliac arteries and complications were scored by the transplant surgeon during the operation (gold standard). Vascular calcifications were found on the pelvic X-ray in 33 patients (30.2%). The transplant surgeon identified vascular calcifications in 35%. Sensitivity and specificity of the pelvic X-ray for vascular calcifications in the iliac arteries were 48 and 82%, respectively. Technical problems with the arterial anastomosis due to vascular calcifications were observed in five patients. The negative predictive value and positive predictive value of a pelvic X-ray for complications with the arterial anastomosis were 99 and 14%, respectively. A pelvic X-ray is not a reliable tool to detect vascular calcifications. Technical problems with the arterial anastomosis due to calcifications are infrequent in the absence of vascular calcifications on the pelvic X-ray.

  9. Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography.

    PubMed

    Engel, Leif-Christopher; Thai, Wai-Ee; Medina-Zuluaga, Hector; Karolyi, Mihaly; Sidhu, Manavjot S; Maurovich-Horvat, Pal; Margey, Ronan; Pomerantsev, Eugene; Abbara, Suhny; Ghoshhajra, Brian B; Hoffmann, Udo; Liew, Gary Y

    2017-05-01

    Background Heavy coronary artery calcification (CAC) impairs diagnostic accuracy of coronary computed tomography angiography (cCTA) and is considered to be a major limitation. Purpose To investigate the effect of non-evaluable CAC seen on cCTA on clinical decision-making by determining the degree of subsequent invasive testing and to assess the relationship between non-evaluable segments containing CAC and significant stenosis as seen in invasive coronary angiography (ICA). Material and Methods The study comprised of 356 patients who underwent cCTA and subsequent ICA within 2 months between 2005 and 2009. Clinical reports were reviewed to identify the indications for referral to ICA. In a subset of 68 patients where non-diagnostic CAC on cCTA and significant stenosis on ICA were present in the same segment, we correlated and analyzed the underlying stenosis severity of the lesion on ICA to the cCTA. Lesions with CAC were analyzed in a standardized fashion by application of reading rules. Results Non-diagnostic CAC on cCTA prompted ICA in 5.6% of patients. CAC occurred at the site of maximum stenosis in segments with stenosis <50% (95.9% [47/49]), 50-69% (82.4% [28/34]), 70-99% (64.5% [31/48]), and 100% (33.3% [1/3]). At the point of maximum calcium deposit, non-obstructive disease was present in 61.2%. Application of reading rules resulted in a 44% reduction in non-diagnostic cCTA reads. Conclusion Severe CAC may prompt further investigation with ICA. There is less CAC with increasing lesion severity at the point of maximum stenosis. Additional application of reading rules improved non-diagnostic cCTA reads.

  10. [ANALYSIS OF THE ASSOCIATION BETWEEN THR83ALA POLYMORPHISM OF MATRIX GLA-PROTEIN GENE AND LOWER EXTREMITY ARTERIAL CALCIFICATION].

    PubMed

    Ataman, Yu; Еrmolenko, Т; Grek, A; Zharkova, A; Ovechkin, D

    2016-03-01

    Lower extremity arterial calcification (AC) is a common pathological process that has independent significance in the pathogenesis of many cardiovascular diseases. There is evidence that development of AC associated with Thr83Ala polymorphism of matrix GLA-protein gene. The objective of this study was to examine the association between Thr83Ala polymorphism of matrix Cla protein (MGP) gene and AC in male and female subjects of the Ukrainian population. 40 AC and 40 healthy controls were recruited to the study. MGP exon 4 Thr83Ala polymorphism (rs 4236) was examined using the polymerase chain reaction with subsequent restriction fragment length polymorphism analysis. The obtained data show that the substitution of threonin by alanine at position 83 in a molecule of MGP can affect its functional characteristics and anticalcinogenic properties. The distribution of homozygous carriers of a major allelic variant, and heterozygous and homozygous minor allele variants of Thr83Ala polymorphism in patients with AC was 40,0%, 47,5%, and 12,5% respectively. The corresponding distribution of variants in the control group was 32,5%, 42,5% and 25,0% (p=0,352 by χ2 -test). In women who are carriers of Ala/Ala-variant, CA occurs more rarely than in men with the same genotype (p=0,036 by χ2 -test). The substitution of threonine by alanine due to MGP exon 4 Thr83Ala polymorphism is related to a decrease in the likelihood of CA in female persons in the Ukrainian population.

  11. Cortisol responses to mental stress and the progression of coronary artery calcification in healthy men and women.

    PubMed

    Hamer, Mark; Endrighi, Romano; Venuraju, Shreenidhi M; Lahiri, Avijit; Steptoe, Andrew

    2012-01-01

    Psychosocial stress is a risk factor for coronary heart disease (CHD). The mechanisms are incompletely understood, although dysfunction of the hypothalamic pituitary adrenal (HPA) axis might be involved. We examined the association between cortisol responses to laboratory-induced mental stress and the progression of coronary artery calcification (CAC). Participants were 466 healthy men and women (mean age = 62.7±5.6 yrs), without history or objective signs of CHD, drawn from the Whitehall II epidemiological cohort. At the baseline assessment salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task. CAC was measured at baseline and at 3 years follow up using electron beam computed tomography. CAC progression was defined as an increase >10 Agatston units between baseline and follow up. 38.2% of the sample demonstrated CAC progression over the 3 years follow up. There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/l. There was an association between cortisol stress reactivity (per SD) and CAC progression (odds ratio = 1.27, 95% CI, 1.02-1.60) after adjustments for age, sex, pre-stress cortisol, employment grade, smoking, resting systolic BP, fibrinogen, body mass index, and use of statins. There was no association between systolic blood pressure reactivity and CAC progression (odds ratio per SD increase = 1.03, 95% CI, 0.85-1.24). Other independent predictors of CAC progression included age, male sex, smoking, resting systolic blood pressure, and fibrinogen. Results demonstrate an association between heightened cortisol reactivity to stress and CAC progression. These data support the notion that cortisol reactivity, an index of HPA function, is one of the possible mechanisms through which psychosocial stress may influence the risk of CHD.

  12. Vitamin D deficiency is associated with coronary artery calcification in cardiovascularly asymptomatic African Americans with HIV infection.

    PubMed

    Lai, Shenghan; Fishman, Elliot K; Gerstenblith, Gary; Brinker, Jeffrey; Tai, Hong; Chen, Shaoguang; Li, Ji; Tong, Wenjing; Detrick, Barbara; Lai, Hong

    2013-01-01

    Patients with HIV infection are at increased risk for coronary artery disease (CAD), and growing evidence suggests a possible link between vitamin D deficiency and clinical/subclinical CAD. However, the relationship between vitamin D deficiency and coronary artery calcification (CAC), a sensitive marker for subclinical CAD, in those with HIV infection is not well investigated. CAC was quantified using a Siemens Cardiac 64 scanner, and vitamin D levels and the presence of traditional and novel risk factors for CAD were obtained in 846 HIV-infected African American (AA) participants aged 25 years or older in Baltimore, MD, USA without symptoms or clinical evidence of CAD. The prevalence of vitamin D deficiency (25-hydroxy vitamin D <10 ng/mL) was 18.7%. CAC was present in 238 (28.1%) of the 846 participants. Logistic regression analysis revealed that the following factors were independently associated with CAC: age (adjusted odds ratio [OR]: 1.11; 95% confidence interval [CI]: 1.08-1.14); male sex (adjusted OR: 1.71; 95% CI: 1.18-2.49); family history of CAD (adjusted OR: 1.53; 95% CI: 1.05-2.23); total cholesterol (adjusted OR: 1.006; 95% CI: 1.002-1.010); high-density lipoprotein cholesterol (adjusted OR: 0.989; 95% CI: 0.979-0.999); years of cocaine use (adjusted OR: 1.02; 95% CI: 1.001-1.04); duration of exposure to protease inhibitors (adjusted OR: 1.004; 95% CI: 1.001-1.007); and vitamin D deficiency (adjusted OR: 1.98; 95% CI: 1.31-3.00). Both vitamin D deficiency and CAC are prevalent in AAs with HIV infection. In order to reduce the risk for CAD in HIV-infected AAs, vitamin D levels should be closely monitored. These data also suggest that clinical trials should be conducted to examine whether vitamin D supplementations reduce the risk of CAD in this AA population.

  13. A propensity score-based comparison of flat panel digital detector fluoroscopy versus digital cinefluoroscopy for coronary artery calcium detection.

    PubMed

    Hahalis, George; Xanthopoulou, Ioanna; Davlouros, Periklis; Mylona, Panagiota; Tsigkas, Grigorios; Alexopoulos, Dimitrios

    2012-01-01

    Detection of coronary artery calcification (CAC) allows for a refined prediction of cardiovascular risk beyond global risk assessment algorithms. Newer-generation, high-resolution, flat-panel digital detector (FPDD) fluoroscopic systems may provide higher CAC detection rates compared with older fluoroscopic devices. We compared the CAC detection rates of two fluoroscopic techniques in two different cohorts of asymptomatic individuals, analyzed within a two-decade time interval. FPDD detected CAC more frequently than the older fluoroscopy device, in the more recent and the older patient cohort of individuals, respectively. After propensity score matching to account for differences in age and risk factor prevalence, the adjusted rates of CAC detection remained higher in favor of FPDD (37.7% vs. 23.7%, p=0.026). The ability of newer cine-fluoroscopic systems to identify CAC in a larger number of asymptomatic, intermediate-risk individuals may have implications for further risk stratification, management of risk factors and long-term prognosis.

  14. The Minimal Important Difference in Borg Dyspnea Score in Pulmonary Arterial Hypertension.

    PubMed

    Khair, Rubina M; Nwaneri, Chisom; Damico, Rachel L; Kolb, Todd; Hassoun, Paul M; Mathai, Stephen C

    2016-06-01

    Despite therapeutic advances, pulmonary arterial hypertension remains a disease without a cure. Focusing on symptoms, such as dyspnea, is an important part of assessing response to therapy. To determine the minimal important differences for the Borg dyspnea score and the Borg fatigue score in adult patients undergoing initial therapy for pulmonary arterial hypertension. We studied 129 patients enrolled between 2003 and 2013 in the Pulmonary Arterial Hypertension Program registry at Johns Hopkins University Hospital in Baltimore, Maryland. We analyzed baseline demographics, clinical characteristics, 6-minute-walk test distance, and Borg dyspnea and fatigue scores at baseline and at follow up 3 months after initiation of pulmonary arterial hypertension therapy. The minimal important differences for the Borg dyspnea and fatigue scores were determined using distributional and anchor-based methods, using 6-minute-walk test distance as the anchor. Most subjects were in New York Heart Association functional class II or III and had moderate to severe pulmonary arterial hypertension. The baseline Borg dyspnea score was 3.4 ± 1.9 units; the baseline Borg fatigue score was 2.8 ± 2.2 units. After therapy, the average change in the dyspnea score was -0.16 ± 1.9 units and the average change in the fatigue score was -0.21 ± 2.4 units. Using distributional methods, the minimum important difference for Borg dyspnea score ranged from 0.7 to 1.24 units and for Borg fatigue score ranged from 0.73 to 1.39 units. Using anchor-based methods, the minimum important difference for the Borg dyspnea scales was 0.36; this could not be calculated for the Borg fatigue score. Using distributional and anchor-based methods, we estimate the minimum important difference for Borg dyspnea scale in pulmonary arterial hypertension is approximately 0.9 units. Using distributional methods only, we estimate the minimum important difference for the Borg fatigue scale is around 1 unit

  15. A Comparison of Mortality Rates in a Large Population of Smokers and Non-smokers: based on the Presence or Absence of Coronary Artery Calcification

    PubMed Central

    McEvoy, John W; Blaha, Michael J; Rivera, Juan J; Budoff, Matthew J; Khan, Atif N; Shaw, Leslee J; Berman, Daniel S; Raggi, Paolo; Min, James K; Rumberger, John A; Callister, Tracy Q; Blumenthal, Roger S.; Nasir, Khurram

    2015-01-01

    Objectives To further study the interplay between smoking status, Coronary Artery Calcium (CAC) and all-cause mortality. Background Prior studies have not directly compared the relative prognostic impact of CAC in smokers versus non-smokers. In particular, while zero CAC is a known favorable prognostic-marker, whether smokers without CAC have as good a prognosis as non-smokers without CAC is unknown. Given computed tomography (CT) screening for lung cancer appears effective in smokers, the relative prognostic implications of visualizing any CAC versus no CAC on such screening also deserve study. Methods Our study cohort consisted of 44,042 asymptomatic individuals referred for non-contrast cardiac CT (age 54±11 years, 54% males). Subjects were followed for a mean of 5.6 years. The primary endpoint was all-cause mortality. Results Approximately 14% (n=6020) of subjects were active smokers at enrollment. There were 901 deaths (2.05%) overall, with increased mortality in smokers vs. non-smokers (4.3% vs. 1.7%, p<0.0001). Smoking remained a risk factor for mortality across increasing strata of CAC scores (1-100, 101-400, and >400). In multivariable analysis within these strata, we found mortality hazard ratios (HRs) of 3.8 (95% CI, 2.8-5.2), 3.5 (2.6-4.9), and 2.7 (2.1-3.5), respectively, in smokers compared to nonsmokers. At each stratum of elevated CAC score, mortality in smokers was consistently higher than mortality in non-smokers from the CAC stratum above. However, among the 19,898 individuals with CAC=0, the mortality HR for smokers without CAC was 3.6 (95% CI, 2.3-5.7), compared to non-smokers without CAC. Conclusion Smoking is a risk factor for death across the entire spectrum of subclinical coronary atherosclerosis. Smokers with any coronary calcification are at significantly increased future mortality risk than smokers without CAC. However, the absence of CAC may not be as useful a “negative risk factor” in active smokers; as this group has mortality

  16. Prognostic Value of Coronary Artery Calcium Score for Determination of Presence and Severity of Coronary Artery Disease

    PubMed Central

    Moradi, Maryam; Nouri, Shadi; Nourozi, Ali; Golbidi, Danial

    2017-01-01

    Summary Background There are controversies regarding the usefulness of coronary artery calcium score (CACS) for predicting coronary artery stenosis. The aim of this study was to determine the prognostic value of CACS for determining the presence and severity of coronary artery disease (CAD) in patients with sign and symptoms of the disease. Material/Methods In this cross-sectional study, 748 consecutive patients with suspected CAD, referred for coronary computed tomography angiography (CCTA), were enrolled. The mean CACS was compared between patients with different severities of coronary artery stenosis. The association between CACS and different CAD risk factors was determined as well. Different cutoff points of CACS for discriminating between different levels of coronary artery stenosis was determined using receiver operating characteristic (ROC) curves. Results The mean CACS was significantly different between different levels of coronary artery stenosis (P<0.001) and there was a significant positive association between the severity of CAD and CACS (P<0.001,r=0.781). ROC curve analysis indicated that the optimal cutoff point for discriminating between CAD (presence of stenosis) and the non-stenosis condition was 5.35 with 88.6% sensitivity and 86.2% specificity. Area under the curve for different levels of coronary artery stenosis did not have sufficient sensitivity and specificity for discriminating between different levels of CAD severity (<70%). Conclusions The study demonstrated that there is a significant association between CACS and the presence as well as the severity of CAD. CACS could have an appropriate prognostic value for the determination of coronary artery stenosis but not for discriminating between different severities of stenoses.

  17. Cortisol Responses to Mental Stress and the Progression of Coronary Artery Calcification in Healthy Men and Women

    PubMed Central

    Hamer, Mark; Endrighi, Romano; Venuraju, Shreenidhi M.; Lahiri, Avijit; Steptoe, Andrew

    2012-01-01

    Background Psychosocial stress is a risk factor for coronary heart disease (CHD). The mechanisms are incompletely understood, although dysfunction of the hypothalamic pituitary adrenal (HPA) axis might be involved. We examined the association between cortisol responses to laboratory-induced mental stress and the progression of coronary artery calcification (CAC). Methods and Results Participants were 466 healthy men and women (mean age = 62.7±5.6 yrs), without history or objective signs of CHD, drawn from the Whitehall II epidemiological cohort. At the baseline assessment salivary cortisol was measured in response to mental stressors, consisting of a 5-min Stroop task and a 5-min mirror tracing task. CAC was measured at baseline and at 3 years follow up using electron beam computed tomography. CAC progression was defined as an increase >10 Agatston units between baseline and follow up. 38.2% of the sample demonstrated CAC progression over the 3 years follow up. There was considerable variation in the cortisol stress response, with approximately 40% of the sample responding to the stress tasks with an increase in cortisol of at least 1 mmol/l. There was an association between cortisol stress reactivity (per SD) and CAC progression (odds ratio = 1.27, 95% CI, 1.02–1.60) after adjustments for age, sex, pre-stress cortisol, employment grade, smoking, resting systolic BP, fibrinogen, body mass index, and use of statins. There was no association between systolic blood pressure reactivity and CAC progression (odds ratio per SD increase = 1.03, 95% CI, 0.85–1.24). Other independent predictors of CAC progression included age, male sex, smoking, resting systolic blood pressure, and fibrinogen. Conclusion Results demonstrate an association between heightened cortisol reactivity to stress and CAC progression. These data support the notion that cortisol reactivity, an index of HPA function, is one of the possible mechanisms through which psychosocial stress may

  18. Progression of coronary artery calcification seems to be inevitable, but predictable - results of the Heinz Nixdorf Recall (HNR) study†

    PubMed Central

    Erbel, Raimund; Lehmann, Nils; Churzidse, Sofia; Rauwolf, Michael; Mahabadi, Amir A.; Möhlenkamp, Stefan; Moebus, Susanne; Bauer, Marcus; Kälsch, Hagen; Budde, Thomas; Montag, Michael; Schmermund, Axel; Stang, Andreas; Führer-Sakel, Dagmar; Weimar, Christian; Roggenbuck, Ulla; Dragano, Nico; Jöckel, Karl-Heinz

    2014-01-01

    Aim Coronary artery calcification (CAC), as a sign of atherosclerosis, can be detected and progression quantified using computed tomography (CT). We develop a tool for predicting CAC progression. Methods and results In 3481 participants (45–74 years, 53.1% women) CAC percentiles at baseline (CACb) and after five years (CAC5y) were evaluated, demonstrating progression along gender-specific percentiles, which showed exponentially shaped age-dependence. Using quantile regression on the log-scale (log(CACb+1)) we developed a tool to individually predict CAC5y, and compared to observed CAC5y. The difference between observed and predicted CAC5y (log-scale, mean±SD) was 0.08±1.11 and 0.06±1.29 in men and women. Agreement reached a kappa-value of 0.746 (95% confidence interval: 0.732–0.760) and concordance correlation (log-scale) of 0.886 (0.879–0.893). Explained variance of observed by predicted log(CAC5y+1) was 80.1% and 72.0% in men and women, and 81.0 and 73.6% including baseline risk factors. Evaluating the tool in 1940 individuals with CACb>0 and CACb<400 at baseline, of whom 242 (12.5%) developed CAC5y>400, yielded a sensitivity of 59.5%, specificity 96.1%, (+) and (−) predictive values of 68.3% and 94.3%. A pre-defined acceptance range around predicted CAC5y contained 68.1% of observed CAC5y; only 20% were expected by chance. Age, blood pressure, lipid-lowering medication, diabetes, and smoking contributed to progression above the acceptance range in men and, excepting age, in women. Conclusion CAC nearly inevitably progresses with limited influence of cardiovascular risk factors. This allowed the development of a mathematical tool for prediction of individual CAC progression, enabling anticipation of the age when CAC thresholds of high risk are reached. PMID:25062951

  19. The atherosclerosis burden score (ABS): a convenient ultrasound-based score of peripheral atherosclerosis for coronary artery disease prediction.

    PubMed

    Yerly, Patrick; Marquès-Vidal, Pedro; Owlya, Reza; Eeckhout, Eric; Kappenberger, Lukas; Darioli, Roger; Depairon, Michèle

    2015-03-01

    Ultrasonographic detection of subclinical atherosclerosis improves cardiovascular risk stratification, but uncertainty persists about the most discriminative method to apply. In this study, we found that the "atherosclerosis burden score (ABS)", a novel straightforward ultrasonographic score that sums the number of carotid and femoral arterial bifurcations with plaques, significantly outperformed common carotid intima-media thickness, carotid mean/maximal thickness, and carotid/femoral plaque scores for the detection of coronary artery disease (CAD) (receiver operating characteristic (ROC) curve area under the curve (AUC) = 0.79; P = 0.027 to <0.001 with the other five US endpoints) in 203 patients undergoing coronary angiography. ABS was also more correlated with CAD extension (R = 0.55; P < 0.001). Furthermore, in a second group of 1128 patients without cardiovascular disease, ABS was weakly correlated with the European Society of Cardiology chart risk categories (R(2) = 0.21), indicating that ABS provided information beyond usual cardiovascular risk factor-based risk stratification. Pending prospective studies on hard cardiovascular endpoints, ABS appears as a promising tool in primary prevention.

  20. Genome-wide association study of coronary and aortic calcification in lung cancer screening CT

    NASA Astrophysics Data System (ADS)

    de Vos, Bob D.; van Setten, Jessica; de Jong, Pim A.; Mali, Willem P.; Oudkerk, Matthijs; Viergever, Max A.; Išgum, Ivana

    2016-03-01

    Arterial calcification has been related to cardiovascular disease (CVD) and osteoporosis. However, little is known about the role of genetics and exact pathways leading to arterial calcification and its relation to bone density changes indicating osteoporosis. In this study, we conducted a genome-wide association study of arterial calcification burden, followed by a look-up of known single nucleotide polymorphisms (SNPs) for coronary artery disease (CAD) and myocardial infarction (MI), and bone mineral density (BMD) to test for a shared genetic basis between the traits. The study included a subcohort of the Dutch-Belgian lung cancer screening trial comprised of 2,561 participants. Participants underwent baseline CT screening in one of two hospitals participating in the trial. Low-dose chest CT images were acquired without contrast enhancement and without ECG-synchronization. In these images coronary and aortic calcifications were identified automatically. Subsequently, the detected calcifications were quantified using coronary artery calcium Agatston and volume scores. Genotype data was available for these participants. A genome-wide association study was conducted on 10,220,814 SNPs using a linear regression model. To reduce multiple testing burden, known CAD/MI and BMD SNPs were specifically tested (45 SNPs from the CARDIoGRAMplusC4D consortium and 60 SNPS from the GEFOS consortium). No novel significant SNPs were found. Significant enrichment for CAD/MI SNPs was observed in testing Agatston and coronary artery calcium volume scores. Moreover, a significant enrichment of BMD SNPs was shown in aortic calcium volume scores. This may indicate genetic relation of BMD SNPs and arterial calcification burden.

  1. Assessment and validation of a novel angiographic scoring system for peripheral artery disease.

    PubMed

    Morris, D R; Singh, T P; Moxon, J V; Smith, A; Stewart, F; Jones, R E; Golledge, J

    2017-04-01

    Angiography is used routinely in the assessment of lower-limb arteries, but there are few well validated angiographic scoring systems. The aim of this study was to develop and validate a novel angiographic scoring system for peripheral artery disease. An angiographic scoring system (the ANGIO score) was developed and applied to a sample of patients from a single vascular surgical department who underwent CT angiography of the lower limbs. The reproducibility of the ANGIO score was compared with those of the Bollinger and Trans-Atlantic inter-Society Consensus (TASC) IIb systems in a series of randomly selected patients. Associations between the ANGIO score and lower-limb ischaemia, as measured by the ankle : brachial pressure index (ABPI), and outcome events (major lower-limb amputations and cardiovascular events - myocardial infarction, stroke and cardiovascular death) were assessed. Some 256 patients undergoing CT angiography were included. The interobserver reproducibility of the ANGIO score was better than that of the other scoring systems examined (κ = 0·90, P = 0·002). There was a negative correlation between the ANGIO score and ABPI (ρ = -0·33, P = 0·008). A higher ANGIO score was associated with an increased risk of major lower-limb amputation (hazard ratio (HR) for highest versus lowest tertile 9·30, 95 per cent c.i. 1·95 to 44·38; P = 0·005) and cardiovascular events (HR 2·73, 1·31 to 5·70; P = 0·007) following adjustment for established risk factors. The ANGIO score provided a reproducible and valid assessment of the severity of lower-limb ischaemia and risk of major amputation and cardiovascular events in these patients with peripheral artery disease. © 2017 BJS Society Ltd Published by John Wiley & Sons Ltd.

  2. Association of aortic valve calcification to the presence, extent, and composition of coronary artery plaque burden: from the Rule Out Myocardial Infarction using Computer Assisted Tomography (ROMICAT) trial.

    PubMed

    Mahabadi, Amir A; Bamberg, Fabian; Toepker, Michael; Schlett, Christopher L; Rogers, Ian S; Nagurney, John T; Brady, Thomas J; Hoffmann, Udo; Truong, Quynh A

    2009-10-01

    Aortic valve calcification (AVC) is associated with cardiovascular risk factors and coronary artery calcification. We sought to determine whether AVC is associated with the presence and extent of overall plaque burden, as well as to plaque composition (calcified, mixed, and noncalcified). We examined 357 subjects (mean age 53 +/- 12 years, 61% male) who underwent contrast-enhanced electrocardiogram-gated 64-slice multidetector computed tomography from the ROMICAT trial for the assessment of presence and extent of coronary plaque burden according to the 17-coronary segment model and presence of AVC. Patients with AVC (n = 37, 10%) were more likely than those without AVC (n = 320, 90%) to have coexisting presence of any coronary plaque (89% vs 46%, P < .001) and had a greater extent of coronary plaque burden (6.4 vs 1.8 segments, P < .001). Those with AVC had >3-fold increase odds of having any plaque (adjusted odds ratio [OR] 3.6, P = .047) and an increase of 2.5 segments of plaque (P < .001) as compared to those without AVC. When stratified by plaque composition, AVC was associated most with calcified plaque (OR 5.2, P = .004), then mixed plaque (OR 3.2, P = .02), but not with noncalcified plaque (P = .96). Aortic valve calcification is associated with the presence and greater extent of coronary artery plaque burden and may be part of the later stages of the atherosclerosis process, as its relation is strongest with calcified plaque, less with mixed plaque, and nonsignificant with noncalcified plaque. If AVC is present, consideration for aggressive medical therapy may be warranted.

  3. Pineal calcification.

    PubMed

    Bhatti, I H; Khan, A

    1977-04-01

    The incidence of pineal calcification was studied by reviewing skull radiographs of 1400 patients admitted to a major neurosurgical centre at Karachi over an eight year period. The total frequency as well as age and sex distribution of pineal calcification were worked out and compared with frequency and age distribution of calcification reported in Western and Eastern races by different workers.

  4. Renal osteodystrophy and vascular calcification.

    PubMed

    Arcidiacono, T; Paloschi, V; Rainone, F; Terranegra, A; Dogliotti, E; Aloia, A; Soldati, L; Vezzoli, G

    2009-01-01

    Chronic kidney disease (CKD) is characterized by phosphate retention and reduced synthesis of 1.25(OH)2-vitamin D stimulating parathyroid hyperplasia. These changes cause a complex osteopathy, defined as renal osteodystrophy, and vascular calcification. Renal osteodystrophy increases the risk of fracture and causes deformities and disability. Vascular calcification occurs in a large proportion of hemodialysis patients and is a marker of arteriopathy. Calcifying arteriopathy induces arterial stiffness and contributes to the high cardiovascular mortality and morbidity among CKD patients. Vascular calcification results from a process of local bone formation induced by osteoblast-like cells developing in the vascular wall from resident cells. Osteoblast differentiation of resident vascular cells may be mediated by metabolic factors and may be induced by high concentrations of phosphate. Therefore, phosphate retention appears as the most detrimental factor affecting arteries in CKD patients. There is no specific therapy to revert soft tissue calcification, but calcification must be prevented in the early stages of CKD.

  5. Technetium-99m and rhenium-188 complexes with one and two pendant bisphosphonate groups for imaging arterial calcification.

    PubMed

    Bordoloi, Jayanta Kumar; Berry, David; Khan, Irfan Ullah; Sunassee, Kavitha; de Rosales, Rafael Torres Martin; Shanahan, Catherine; Blower, Philip J

    2015-03-21

    The first (99m)Tc and (188)Re complexes containing two pendant bisphosphonate groups have been synthesised, based on the mononuclear M(v) nitride core with two dithiocarbamate ligands each with a pendant bisphosphonate. The structural identity of the (99)Tc and stable rhenium analogues as uncharged, mononuclear nitridobis(dithiocarbamate) complexes was determined by electrospray mass spectrometry. The (99m)Tc complex showed greater affinity for synthetic and biological hydroxyapatite, and greater stability in biological media, than the well-known but poorly-characterised and inhomogeneous bone imaging agent (99m)Tc-MDP. It gave excellent SPECT images of both bone calcification (mice and rats) and vascular calcification (rat model), but the improved stability and the availability of two pendant bisphosphonate groups conferred no dramatic advantage in imaging over the conventional (99m)Tc-MDP agent in which the bisphosphonate group is bound directly to Tc. The (188)Re complex also showed preferential uptake in bone. These tracers and the biological model of vascular calcification offer the opportunity to study the biological interpretation and clinical potential of radionuclide imaging of vascular calcification and to deliver radionuclide therapy to bone metastases.

  6. Role of Coronary Artery Calcium Scoring in Detection of Coronary Artery Disease according to Framingham Risk Score in Populations with Low to Intermediate Risks.

    PubMed

    Kim, Won-Jang; Kwon, Chang Hee; Han, Seungbong; Lee, Woo Seok; Kang, Joon Won; Ahn, Jung-Min; Lee, Jong-Young; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Seung-Jung

    2016-06-01

    Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P < 0.01). The total CAD prevalence was 6.1%. The occult CAD prevalence in the FRS ≤ 5%, 6%-10%, 11%-20%, and > 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P < 0.001). In multivariate logistic regression analysis adjusting, not only the intermediate and high risk groups but also the low risk (FRS 6%-10%) group had significantly increased odds ratio for occult CAD compared to the very low-risk (FRS ≤ 5%) group (1.89 [95% confidence interval, CI, 1.09-3.29] in FRS 6%-10%; 2.48 [95% CI, 1.47-4.20] in FRS 11%-20%; and 3.10 [95% CI, 1.75-5.47] in FRS > 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.

  7. [Bilateral Internal Mammary Artery Versus Single Internal Mammary Artery in Myocardial Revascularization Surgery. Propensity Score - Adjusted Survival Analysis].

    PubMed

    Saraiva, Francisca; Vilas Boas, Noélia; Amorim, Mário Jorge; Cidade Silva, Pedro; B Azevedo, Tânia; J Cerqueira, Rui; C Pinho-Gomes, Ana; P Lourenço, André; Pinho, Paulo; Leite-Moreira, Adelino

    2015-01-01

    Although arterial grafts are superior to venous grafts in terms of long-term patency, single internal mammary artery (SIMA) is still the preferred strategy in most cardiac surgical centres. Our main aim was to compare long- -term survival between BIMA and SIMA at our own tertiary care centre. Retrospective cohort including patients referred to Centro Hospitalar São João (CHSJ), from 2004 to 2011, who underwent isolated CABG and received two or more bypass with at least 1 IMA graft. Kaplan-Meier, Cox regression and propensity score matching 2:1 were used to compare long-term survival between BIMA and SIMA. BIMA was performed in 696 (29.3%) out of 2329 eligible procedures. Mean follow-up time was 5.1 years (2-9.9 years). All-cause mortality was superior in patients with only one internal mammary artery - cumulative survival of 75% for SIMA vs 88% for BIMA. Because of discrepancy between groups regarding preoperative and surgical characteristics, we ran a propensity score matching which revealed BIMA as an independent predictor of survival (n=1510, 40.3% BIMA, HR: 0.648, 95% CI: 0.452-0.927). BIMA is associated with significantly better long-term survival than SIMA in CABG. A higher sample size might clarify BIMA advantages, discriminating specific groups that might profit the most with this approach.

  8. Calcification of the internal pudendal artery and development of erectile dysfunction in adenine-induced chronic kidney disease: a sentinel of systemic vascular changes.

    PubMed

    Maio, M Tina; McCabe, Kristin M; Pruss, Cynthia M; Pang, Judith J; Laverty, Kimberly; Holden, Rachel M; Adams, Michael A

    2014-10-01

    Chronic kidney disease (CKD), erectile dysfunction (ED), and cardiovascular disease share common vascular etiologies and risk factors. Using a rat model, this is the first study to characterize the consequences of CKD in the onset and development of ED associated with differential regional vascular calcification and circulatory changes. Stable CKD was generated at 3 weeks in male Sprague-Dawley rats given dietary adenine and progressed until 7 weeks. Mineral content and morphometry were assessed in the internal pudendal arteries (IPAs), thoracic aorta, and carotid artery. Endothelial function was determined via changes in serum von Willebrand factor (VWF) and endothelium-dependent relaxation of the thoracic aorta. In severe CKD rats, calcium and phosphate content in all arteries increased, and pulse wave velocity was elevated. Distal IPA segments, in particular, were the first to calcify, but penile tissue per se did not. CKD rats had endothelial dysfunction, as indicated by a decrease in acetylcholine-mediated relaxation (∼40%) and an increase in serum VWF (∼40%), as well as increased lumen diameter (20%) of the distal IPA. Erectile function, assessed using a centrally acting dopaminergic agent, was significantly impaired by 7 weeks (∼40%). In CKD, the distal IPA appears to be more susceptible to vascular dysfunction and calcification. Additionally, the onset of ED may be an important sentinel of impending systemic vascular disease. To confirm this concept, future experimental and clinical studies will need to examine a range of vessel types and the use of supplementary methods to assess erectile function. © 2014 International Society for Sexual Medicine.

  9. Is arterial stiffness predicted by continuous metabolic syndrome score in obese children?

    PubMed

    Prochotska, Katarina; Kovacs, Laszlo; Vitariusova, Eva; Feber, Janusz

    2016-01-01

    The aim of the article was to evaluate arterial stiffness, an early marker of increased cardiovascular risk, in relation to obesity. The continuous metabolic syndrome (cMetS) score was calculated as sum of Z score of mean arterial pressure, body mass index, serum glucose, triglyceride, and high-density lipoprotein cholesterol in 144 obese patients and 66 nonobese controls. Ambulatory arterial stiffness index (AASI) was calculated as 1 minus regression slope of diastolic on systolic blood pressure from ambulatory blood pressure measurements. The mean AASI increased progressively with severity of obesity. The receiver operator curve analysis of body mass index and AASI showed area under the curve of 0.64 ± 0.06; cMetS area under the curve was 0.72 ± 0.05 suggesting a better predictive power of the cMetS for an increased AASI (>0.3). Patients with obesity have significantly higher arterial stiffness. A composite score such as cMetS seems to be better predictor of an increased stiffness than individual risk factors.

  10. Vascular calcification in Mexican hemodialysis patients.

    PubMed

    Rojas-Campos, Enrique; Herrera-Llamas, Rebeca; Montañez-Fernández, José L; Martínez-Martínez, Petra; Andrade-Sierra, Jorge; Avila-Baray, Angel A; Cueto-Manzano, Alfonso M

    2013-11-01

    Vascular calcification (VC) is a predictor of poor survival and cardiovascular outcome in end-stage renal disease (ESRD) patients; however, there is scarce information of VC in Latin America, and virtually no data in our setting. We undertook this study to evaluate the prevalence and characteristics of VC in a hemodialysis (HD) population from western Mexico and to determine possible associated factors. This was a cross-sectional study performed in 52 patients. VC was evaluated using plain X-ray films (Adragao's score) of hands and pelvis; clinical and biochemical variables were also collected. Statistical analysis was carried out with Student t and χ(2) tests performed as appropriate and logistic regression to determine predictors of VC. Mean age was 43 years, 48% were female, 23% had diabetes mellitus (DM), and median time on dialysis was 46 months. Percentage prevalence was 52% with a mean calcification score of 2.0 ± 2.6; 23% of patients had severe calcification. VC was present in about 23-37% among the different vascular territories evaluated (radial, digital, femoral and iliac). Patients with calcification were significantly older, had a higher frequency of DM, higher alkaline phosphatase and lower HDL lipoproteins than those without VC. In the multivariate analysis, VC in these patients was significantly predicted only by an older age (OR [95% CI]: 1.15 [1.01-1.31], p = 0.04); lower HDL-cholesterol and higher alkaline phosphatase were marginal predictors. Half of our HD patients had VC. Territories of radial, iliac, femoral and digital arteries were roughly equally affected, and 25% of patients had a calcification considered as severe. Older age was the only significant predicting variable for VC, with low HDL-cholesterol and high alkaline phosphatase as marginal predictors. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

  11. Non-invasive half millimetre 32 detector row computed tomography angiography accurately excludes significant stenoses in patients with advanced coronary artery disease and high calcium scores.

    PubMed

    Cordeiro, M A S; Miller, J M; Schmidt, A; Lardo, A C; Rosen, B D; Bush, D E; Brinker, J A; Bluemke, D A; Shapiro, E P; Lima, J A C

    2006-05-01

    To show an overall diagnostic accuracy > or = 90% for detection of > or = 50% stenoses by coronary half millimetre 32 detector row computed tomography angiography (32 x 0.5-MDCTA) in patients with advanced coronary artery disease (CAD) and a high likelihood of raised calcium scores. ECG gated 32 x 0.5-MDCTA (32 x 0.5 mm cross sections, 0.35 x 0.35 x 0.35 mm3 isotropic voxels, 400 ms rotation) was performed after injection of iodixanol (120 ml, 320 mg/ml) in 30 consecutive patients (25 men, mean (SD) age 59 (13) years, body mass index 26.2 (4.9) kg/m2). Native arteries, including > or = 1.5 mm branches, and bypass grafts were screened for > or = 50% stenoses. Stents were excluded. Conventional coronary angiography (performed 18 (12) days before 32 x 0.5-MDCTA) was analysed by quantitative coronary angiography. Median Agatston calcium score was 510 (range 3-5066). Sensitivity, specificity, and positive and negative predictive values for detection of > or = 50% stenoses in native arteries were 76% (29 of 38), 94% (190 of 202), 71% (29 of 41), and 96% (190 of 199), respectively. Overall diagnostic accuracy was 91% (219 of 240). Due to the following artefacts 20% (69 of 352) of the vessels were excluded: motion, noise, and low contrast enhancement isolated or in combination (45 of 69 (65%)); image distortion by implantable cardioverter-defibrillator or pacemaker leads (18 of 69 (26%)); and blooming secondary to severe calcification (6 of 69 (9%)). Coronary 32 x 0.5-MDCTA accurately excludes > or = 50% stenoses in patients with advanced CAD and high calcium scores with an overall diagnostic accuracy of 91%.

  12. 15-Year Prognostic Utility of Coronary Artery Calcium Scoring for All-Cause Mortality in the Elderly

    PubMed Central

    Hartaigh, Bríain ó; Valenti, Valentina; Cho, Iksung; Schulman-Marcus, Joshua; Gransar, Heidi; Knapper, Joseph; Kelkar, Anita A.; Xie, Joseph X.; Chang, Hyuk-Jae; Shaw, Leslee J.; Callister, Tracy Q.; Min, James K.

    2016-01-01

    Introduction Prior studies have demonstrated a decline in the predictive ability of conventional risk factors (RF) with advancing age, emphasizing the need for novel tools to improve risk stratification in the elderly. Coronary artery calcification (CAC) is a robust predictor of adverse cardiovascular events, but its long-term prognostic utility beyond RFs in elderly persons is unknown. Methods A consecutive series of 9,715 individuals underwent CAC scoring and were followed for a mean of 14.6±1.1 years. Multivariable Cox proportional hazards regression (HR) with 95% confidence intervals (95% CI) was employed to assess the independent relationship of CAC and RFs with all-cause death. The incremental value of CAC, stratified by age, was examined by using an area under the receiver operator characteristic curve (AUC) and category-free net reclassification improvement (NRI). Results Of the overall study sample, 728 (7.5%) adults (mean age 74.2±4.2 years; 55.6% female) were 70 years or older, of which 157 (21.6%) died. The presence of any CAC was associated with a >4-fold (95% CI = 2.84–6.59) adjusted risk of death for those over the age of 70, which was higher compared with younger study counterparts, or other measured RFs. For individuals 70 years or older, the discriminatory ability of CAC improved upon that of RFs alone (C statistics 0.764 vs. 0.675, P <0.001). CAC also enabled improved reclassification (category-free NRI = 84%, P <0.001) when added to RFs. Conclusion In a large-scale observational cohort registry, CAC improves prediction, discrimination, and reclassification of elderly individuals at risk for future death. PMID:26841073

  13. Divergent determinants of 18F-NaF uptake and visible calcium deposition in large arteries: relationship with Framingham risk score.

    PubMed

    Morbelli, Silvia; Fiz, Francesco; Piccardo, Arnoldo; Picori, Lorena; Massollo, Michela; Pestarino, Emanuela; Marini, Cecilia; Cabria, Manlio; Democrito, Alessia; Cittadini, Giuseppe; Villavecchia, Giampiero; Bruzzi, Paolo; Alavi, Abass; Sambuceti, Gianmario

    2014-02-01

    To compare regional vascular distribution and biological determinants of visible calcium load, as assessed by computed tomography, as well as of molecular calcium deposition as assessed by (18)F-NaF positron emission tomography. Eighty oncologic patients undergoing (18)F-NaF PET/CT scan were included in the study. Cardiovascular-risk stratification was performed according to a simplified version of the Framingham model [including age, diabetes, smoking, systolic blood pressure and body mass index (BMI)]. Arterial (18)F-NaF uptake was measured by drawing regions of interest comprising the arteries on each slice of the transaxial PET/CT and normalized to blood (18)F-NaF activity to obtain the arterial target-to-background ratio (TBR). The degree of arterial calcification (AC) was measured using a software program providing Agatston-like scores. Differences in mean values and regression analysis were tested. Predictors of AC and TBR were evaluated by univariate and multivariate analysis. p value of 0.05 was considered statistically significant. No correlation was documented between regional calcium load and regional TBR in any of the studied arterial segments. Visible calcium deposition was found to be dependent upon age while it was not influenced by all the remaining determinants of cardiovascular risk. By contrast, (18)F-NaF uptake was significantly correlated with all descriptors of cardiovascular risk, with the exception of BMI. Vascular (18)F-NaF uptake displays a different regional distribution, as well as different biological predictors, when compared to macroscopic AC. The tight dependency of tracer retention upon ongoing biological determinants of vascular damage suggests that this tool might provide an unexplored window on plaque pathophysiology.

  14. Insulin Resistance, Defective Insulin-Mediated Fatty Acid Suppression, and Coronary Artery Calcification in Subjects With and Without Type 1 Diabetes

    PubMed Central

    Schauer, Irene E.; Snell-Bergeon, Janet K.; Bergman, Bryan C.; Maahs, David M.; Kretowski, Adam; Eckel, Robert H.; Rewers, Marian

    2011-01-01

    OBJECTIVE To assess insulin action on peripheral glucose utilization and nonesterified fatty acid (NEFA) suppression as a predictor of coronary artery calcification (CAC) in patients with type 1 diabetes and nondiabetic controls. RESEARCH DESIGN AND METHODS Insulin action was measured by a three-stage hyperinsulinemic-euglycemic clamp (4, 8, and 40 mU/m2/min) in 87 subjects from the Coronary Artery Calcification in Type 1 Diabetes cohort (40 diabetic, 47 nondiabetic; mean age 45 ± 8 years; 55% female). RESULTS Peripheral glucose utilization was lower in subjects with type 1 diabetes compared with nondiabetic controls: glucose infusion rate (mg/kg FFM/min) = 6.19 ± 0.72 vs. 12.71 ± 0.66, mean ± SE, P < 0.0001, after adjustment for age, sex, BMI, fasting glucose, and final clamp glucose and insulin. Insulin-induced NEFA suppression was also lower in type 1 diabetic compared with nondiabetic subjects: NEFA levels (μM) during 8 mU/m2/min insulin infusion = 370 ± 27 vs. 185 ± 25, P < 0.0001, after adjustment for age, sex, BMI, fasting glucose, and time point insulin. Lower glucose utilization and higher NEFA levels, correlated with CAC volume (r = −0.42, P < 0.0001 and r = 0.41, P < 0.0001, respectively) and predicted the presence of CAC (odds ratio [OR] = 0.45, 95% CI = 0.22–0.93, P = 0.03; OR = 2.4, 95% CI = 1.08–5.32, P = 0.032, respectively). Insulin resistance did not correlate with GHb or continuous glucose monitoring parameters. CONCLUSIONS Type 1 diabetic patients are insulin resistant compared with nondiabetic subjects, and the degree of resistance is not related to current glycemic control. Insulin resistance predicts the extent of coronary artery calcification and may contribute to the increased risk of cardiovascular disease in patients with type 1 diabetes as well as subjects without diabetes. PMID:20978091

  15. Associations of Inflammatory Markers with Coronary Artery Calcification: Results from the Multi-Ethnic Study of Atherosclerosis

    PubMed Central

    Jenny, Nancy Swords; Brown, Elizabeth R.; Detrano, Robert; Folsom, Aaron R.; Saad, Mohammed F.; Shea, Steven; Szklo, Moyses; Herrington, David M.; Jacobs, David R.

    2009-01-01

    Objective Inflammatory markers predict coronary heart disease (CHD). However, associations with coronary artery calcium (CAC), a marker of subclinical CHD, are not established. Methods We examined cross-sectional associations of C-reactive protein (CRP), interleukin-6 (IL-6) and fibrinogen with CAC presence (Agatston score > 0 by computed tomography) in 6,783 Multi-Ethnic Study of Atherosclerosis (MESA) participants. Results In all participants, those in the highest, compared to lowest, quartile of CRP had a relative risk (RR, 95% confidence interval) of 1.13 (1.06-1.19; p<0.01) for CAC in age, sex and ethnicity adjusted models. For highest versus lowest quartiles, relative risks were 1.22 (1.15-1.30; p<0.01) for IL-6 and 1.18 (1.11-1.24; p<0.01) for fibrinogen. Adjusting for CHD risk factors (smoking, diabetes, blood pressure, obesity and dyslipidemia) attenuated RRs. RRs for CAC were 1.05 (0.99-1.12; p=0.63) for CRP, 1.12 (1.06-1.20; p<0.01) for IL-6 and 1.09 (1.02-1.16; p=0.01) for fibrinogen in multivariable adjusted models. Results were similar for men and women and across ethnic groups. Conclusion Inflammatory markers were weakly associated with CAC presence and burden in MESA. Our data support the hypothesis that inflammatory biomarkers and CAC reflect distinct pathophysiology. PMID:19766217

  16. Inhibition of neo-intimal hyperplasia in porcine coronary arteries utilizing a novel paclitaxel-coated scoring balloon catheter.

    PubMed

    Cremers, Bodo; Schmitmeier, Stephanie; Clever, Yvonne P; Gershony, Gary; Speck, Ulrich; Scheller, Bruno

    2014-12-01

    Scoring balloons are particularly useful in the acute treatment of fibro-calcific, bifurcation and in-stent restenosis lesions but have not been shown to affect the restenosis rate. Conventional balloons coated with paclitaxel have recently been shown to reduce restenosis rates in certain lesion subsets, but are associated with suboptimal acute results. A novel paclitaxel-coated scoring balloon was developed to overcome these limitations. AngioSculpt(®) scoring balloons (SB) were coated with paclitaxel admixed with a specific excipient. Four in vitro and in vivo studies were performed: (a) loss of the drug during passage to the lesion, (b) transfer of the drug to the vessel wall; (c) inhibition of neo-intimal proliferation in porcine coronary arteries as compared to uncoated SB and the Paccocath™, and (d) evaluation of the dose-response to 1.5-12 μg of paclitaxel/mm(2) . Drug loss during delivery to the lesion was 17% ± 8%, and transfer to the vessel wall was 9% ± 4% of dose on unused balloons. The paclitaxel-coated SB resulted in a lower late lumen loss of 0.27 ± 0.24 mm compared to 1.4 ± 0.7 mm with the uncoated SB (P = 0.001). Histomorphometry revealed larger luminal areas of 6.8 ± 1.6 mm(2) (paclitaxel-coated SB) and 5.8 ± 1.7 mm(2) (Paccocath) as compared to the uncoated SB (2.3 ± 1.5 mm(2) ; P = 0.001). No coating related adverse effects were observed on follow-up angiography or histologic examination at the treatment site or downstream myocardium. A novel paclitaxel-coated SB leads to a significant inhibition of neointimal proliferation in the porcine coronary model. © 2013 Wiley Periodicals, Inc.

  17. SPECT myocardial perfusion imaging as an adjunct to coronary calcium score for the detection of hemodynamically significant coronary artery stenosis

    PubMed Central

    2012-01-01

    Background Coronary artery calcifications (CAC) are markers of coronary atherosclerosis, but do not correlate well with stenosis severity. This study intended to evaluate clinical situations where a combined approach of coronary calcium scoring (CS) and nuclear stress test (SPECT-MPI) is useful for the detection of relevant CAD. Methods Patients with clinical indication for invasive coronary angiography (ICA) were included into our study during 08/2005-09/2008. At first all patients underwent CS procedure as part of the study protocol performed by either using a multidetector computed tomography (CT) scanner or a dual-source CT imager. CAC were automatically defined by dedicated software and the Agatston score was semi-automatically calculated. A stress-rest SPECT-MPI study was performed afterwards and scintigraphic images were evaluated quantitatively. Then all patients underwent ICA. Thereby significant CAD was defined as luminal stenosis ≥75% in quantitative coronary analysis (QCA) in ≥1 epicardial vessel. To compare data lacking Gaussian distribution an unpaired Wilcoxon-Test (Mann–Whitney) was used. Otherwise a Students t-test for unpaired samples was applied. Calculations were considered to be significant at a p-value of <0.05. Results We consecutively included 351 symptomatic patients (mean age: 61.2±12.3 years; range: 18–94 years; male: n=240) with a mean Agatston score of 258.5±512.2 (range: 0–4214). ICA verified exclusion of significant CAD in 66/67 (98.5%) patients without CAC. CAC was detected in remaining 284 patients. In 132/284 patients (46.5%) with CS>0 significant CAD was confirmed by ICA, and excluded in 152/284 (53.5%) patients. Sensitivity for CAD detection by CS alone was calculated as 99.2%, specificity was 30.3%, and negative predictive value was 98.5%. An additional SPECT in patients with CS>0 increased specificity to 80.9% while reducing sensitivity to 87.9%. Diagnostic accuracy was 84.2%. Conclusions In patients without CS=0

  18. Diabetes and Hypertension Consistently Predict the Presence and Extent of Coronary Artery Calcification in Symptomatic Patients: A Systematic Review and Meta-Analysis

    PubMed Central

    Nicoll, Rachel; Zhao, Ying; Ibrahimi, Pranvera; Olivecrona, Gunilla; Henein, Michael

    2016-01-01

    Background: The relationship of conventional cardiovascular risk factors (age, gender, ethnicity, diabetes, dyslipidaemia, hypertension, obesity, exercise, and the number of risk factors) to coronary artery calcification (CAC) presence and extent has never before been assessed in a systematic review and meta-analysis. Methods: We included only English language studies that assessed at least three conventional risk factors apart from age, gender, and ethnicity, but excluded studies in which all patients had another confirmed condition such as renal disease. Results: In total, 10 studies, comprising 15,769 patients, were investigated in the systematic review and seven studies, comprising 12,682 patients, were included in the meta-analysis, which demonstrated the importance of diabetes and hypertension as predictors of CAC presence and extent, with age also predicting CAC presence. Male gender, dyslipidaemia, family history of coronary artery disease, obesity, and smoking were overall not predictive of either CAC presence or extent, despite dyslipidaemia being a key risk factor for coronary artery disease (CAD). Conclusion: Diabetes and hypertension consistently predict the presence and extent of CAC in symptomatic patients. PMID:27608015

  19. AN ARTERIAL BASED COMPLEXITY (ABC) SCORING SYSTEM TO ASSESS THE MORBIDITY PROFILE OF PARTIAL NEPHRECTOMY

    PubMed Central

    Spaliviero, Massimiliano; Poon, Bing Ying; Karlo, Christoph A.; Guglielmetti, Giuliano B.; Di Paolo, Pier Luigi; Corradi, Renato Beluco; Martin-Malburet, Alexandre G.; Campos-Juanatey, Felix; Escudero-Fontano, Eva; Sjoberg, Daniel D.; Russo, Paul; Coleman, Jonathan A.; Akin, Oguz; Touijer, Karim A.

    2016-01-01

    Background Tumor characteristics affect surgical complexity and outcomes of partial nephrectomy (PN). Objective To develop an Arterial Based Complexity (ABC) scoring system to predict morbidity of PN. Design, Setting, and Participants Four readers independently scored contrast-enhanced computed tomography images of 179 patients who underwent PN. Intervention Renal cortical masses were categorized by the order of vessels needed to be transected/dissected during PN. Scores of 1, 2, 3S, or 3H were assigned to tumors requiring transection of interlobular and arcuate arteries, interlobar arteries, segmental arteries, or in close proximity of the renal hilum, respectively during PN. Outcome Measurements and Statistical Analysis Interobserver variability was assessed with kappa values and percentage of exact matches between each pairwise combination of readers. Linear regression was used to evaluate the association between reference scores and ischemia time, estimated blood loss, and estimated glomerular filtration rates (eGFR) at 6 wk and 6 mo after surgery adjusted for baseline eGFR. Fisher’s exact test was used to test for differences in risk of urinary fistula formation by reference category assignment. Results and Limitations Pairwise comparisons of readers’ score assignments were significantly correlated (all p <0.0001); average kappa = 0.545 across all reader pairs. The average proportion of exact matches was 69%. Linear regression between the complexity score system and surgical outcomes showed significant associations between reference category assignments and ischemia time (p <0.0001) and estimated blood loss (p = 0.049). Fisher’s exact test showed a significant difference in risk of urinary fistula formation with higher reference category assignments (p = 0.028). Limitations include use of a single institutional cohort to evaluate our system. Conclusions The ABC scoring system for PN is intuitive, easy to use, and demonstrated good correlation with

  20. Senile Cardiac Calcification Syndrome: A Rare Case of Extensive Calcification of Left Ventricular Papillary Muscle

    PubMed Central

    Kim, Eun Jin; Song, Bong Gun; Sohn, Hyung Rae; Hong, Su-Min; Park, Dong Won; Heo, Seung Hye; Kim, Kye Yeon; Cho, Wook-Hyun; Choi, Suk-Koo

    2011-01-01

    Extensive papillary muscle calcification is uncommon and only scarce literature about causes and the clinical significance is available, whereas small calcific deposits are common findings in elderly people and are located most commonly at the apex. Papillary muscle calcification has been associated with coronary artery disease, dilated cardiomyopathy, mitral valve disease, hypercalcemia, and increased calcium phosphate product in end stage renal disease. We reported a rare case of extensive calcification of anterolateral papillary muscle diagnosed by echocardiography and multidetector computed tomography.

  1. Plaque Vulnerability as Assessed by Radiofrequency Intravascular Ultrasound in Patients with Valvular Calcification

    PubMed Central

    Senguttuvan, Nagendra Boopathy; Kumar, Sharath; Mishra, Sundeep; Cho, Jun Hwan; Kwon, Jee Eun; Hyeon, Seong Hyeop; Jeong, Yun Sang; Won, Hoyoun; Shin, Seung Yong; Lee, Kwang Je; Kim, Tae Ho; Kim, Chee Jeong; Kim, Sang-Wook

    2016-01-01

    Background Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability. Methods Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score–matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive. Results Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification. Conclusions There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA). PMID

  2. Automatic detection and quantification of the Agatston coronary artery calcium score on contrast computed tomography angiography.

    PubMed

    Ahmed, Wehab; de Graaf, Michiel A; Broersen, Alexander; Kitslaar, Pieter H; Oost, Elco; Dijkstra, Jouke; Bax, Jeroen J; Reiber, Johan H C; Scholte, Arthur J

    2015-01-01

    Potentially, Agatston coronary artery calcium (CAC) score could be calculated on contrast computed tomography coronary angiography (CTA). This will make a separate non-contrast CT scan superfluous. This study aims to assess the performance of a novel fully automatic algorithm to detect and quantify the Agatston CAC score in contrast CTA images. From a clinical registry, 20 patients were randomly selected for each CAC category (i.e. 0, 1-99, 100-399, 400-999, ≥1,000). The Agatston CAC score on non-contrast CT was calculated manually, while the novel algorithm was used to automatically detect and quantify Agatston CAC score in contrast CTA images. The resulting Agatston CAC scores were validated against the non-contrast images. A total of 100 patients (60 ± 11 years, 63 men) were included. The median CAC score on non-contrast CT was 145 (IQR 5-760), whereas the contrast CTA CAC score was 170 (IQR 23-594) (P = 0.004). The automatically computed CAC score showed a high correlation (R = 0.949; P < 0.001) and intra-class correlation (R = 0.863; P < 0.001) with non-contrast CT CAC score. Moreover, agreement within CAC categories was good (κ 0.588). Fully automatic detection of Agatston CAC score on contrast CTA is feasible and showed high correlation with non-contrast CT CAC score. This could imply a radiation dose reduction and time saving by omitting the non-contrast scan.

  3. Grading of carotid artery stenosis in the presence of extensive calcifications: dual-energy CT angiography in comparison with contrast-enhanced MR angiography.

    PubMed

    Korn, A; Bender, B; Brodoefel, H; Hauser, T-K; Danz, S; Ernemann, U; Thomas, C

    2015-03-01

    We investigated the agreement of dual-energy computed tomography angiography (DE-CTA) and contrast-enhanced magnetic resonance angiography (CE-MRA)in the quantitative measurement of stenoses of the internal carotid artery in comparison with digital subtraction angiography (DSA). A total of 21 patients with stenoses of the external carotid artery were investigated with a DE-CTA and CE-MRA before undergoing carotid angioplasty. The grade of the stenoses was assessed in axial multiplanar reformations (MPR) before and multi-intensity projections (MIP) after plaque subtraction (PS) and compared with results from CE-MRA and DSA according to the North American Symptomatic Carotid Endarterectomy Trial. Average grades of stenoses were 80.7 ± 16.1 % (DSA), 81.4 ± 15.3 % (MRA), 80.0 ± 16.7 % (DE-CTA-MPR), and 85.2 ± 14.7 % (DE-CTA-PS-MIP). Of 21 stenoses, 6 were filiform (stenosis grade, 99 %) in the DSA examination. Five of these cases were identified as pseudo-occlusions in MRA, while four were considered as occlusions in DE-CTA-PS-MIP. Another four cases were identified as pseudo-occlusion in DE-CTA-PS-MIP, which were identified as 90 % stenosis in the DSA examination. In comparison with the gold standard DSA, DE-CTA-MPR had a slightly better agreement in measuring the degree of stenosis of the internal carotid arteries than CE-MRA. In DE-CTA-PS-MIP images, a systematic overestimation has to be taken into account due to partial extinction of the lumen by the PS algorithm. Nevertheless, DE-CTA should be preferred in imaging patients with carotid artery stenosis in the presence of extensive calcifications.

  4. The Effect of Intensive Glycemic Treatment on Coronary Artery Calcification in Type 1 Diabetic Participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

    PubMed Central

    Cleary, Patricia A.; Orchard, Trevor J.; Genuth, Saul; Wong, Nathan D.; Detrano, Robert; Backlund, Jye-Yu C.; Zinman, Bernard; Jacobson, Alan; Sun, Wanjie; Lachin, John M.; Nathan, David M.

    2008-01-01

    The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an observational follow-up of the Diabetes Control and Complications Trial (DCCT) type 1 diabetes cohort, measured coronary artery calcification (CAC), an index of atherosclerosis, with computed tomography (CT) in 1,205 EDIC patients at ~7–9 years after the end of the DCCT. We examined the influence of the 6.5 years of prior conventional versus intensive diabetes treatment during the DCCT, as well as the effects of cardiovascular disease risk factors, on CAC. The prevalences of CAC >0 and >200 Agatston units were 31.0 and 8.5%, respectively. Compared with the conventional treatment group, the intensive group had significantly lower geometric mean CAC scores and a lower prevalence of CAC >0 in the primary retinopathy prevention cohort, but not in the secondary intervention cohort, and a lower prevalence of CAC >200 in the combined cohorts. Waist-to-hip ratio, smoking, hypertension, and hypercholesterolemia, before or at the time of CT, were significantly associated with CAC in univariate and multivariate analyses. CAC was associated with mean HbA1c (A1C) levels before enrollment, during the DCCT, and during the EDIC study. Prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced levels of A1C during the DCCT. PMID:17130504

  5. The effect of intensive glycemic treatment on coronary artery calcification in type 1 diabetic participants of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study.

    PubMed

    Cleary, Patricia A; Orchard, Trevor J; Genuth, Saul; Wong, Nathan D; Detrano, Robert; Backlund, Jye-Yu C; Zinman, Bernard; Jacobson, Alan; Sun, Wanjie; Lachin, John M; Nathan, David M

    2006-12-01

    The Epidemiology of Diabetes Interventions and Complications (EDIC) study, an observational follow-up of the Diabetes Control and Complications Trial (DCCT) type 1 diabetes cohort, measured coronary artery calcification (CAC), an index of atherosclerosis, with computed tomography (CT) in 1,205 EDIC patients at approximately 7-9 years after the end of the DCCT. We examined the influence of the 6.5 years of prior conventional versus intensive diabetes treatment during the DCCT, as well as the effects of cardiovascular disease risk factors, on CAC. The prevalences of CAC >0 and >200 Agatston units were 31.0 and 8.5%, respectively. Compared with the conventional treatment group, the intensive group had significantly lower geometric mean CAC scores and a lower prevalence of CAC >0 in the primary retinopathy prevention cohort, but not in the secondary intervention cohort, and a lower prevalence of CAC >200 in the combined cohorts. Waist-to-hip ratio, smoking, hypertension, and hypercholesterolemia, before or at the time of CT, were significantly associated with CAC in univariate and multivariate analyses. CAC was associated with mean HbA(1c) (A1C) levels before enrollment, during the DCCT, and during the EDIC study. Prior intensive diabetes treatment during the DCCT was associated with less atherosclerosis, largely because of reduced levels of A1C during the DCCT.

  6. Visualizing novel concepts of cardiovascular calcification.

    PubMed

    Hjortnaes, Jesper; New, Sophie E P; Aikawa, Elena

    2013-04-01

    Cardiovascular calcification is currently viewed as an active disease process similar to embryonic bone formation. Cardiovascular calcification mainly affects the aortic valve and arteries and is associated with increased mortality risk. Aortic valve and arterial calcification share similar risk factors, including age, gender, diabetes, chronic renal disease, and smoking. However, the exact cellular and molecular mechanism of cardiovascular calcification is unknown. Late-stage cardiovascular calcification can be visualized with conventional imaging modalities such as echocardiography and computed tomography. However, these modalities are limited in their ability to detect the development of early calcification and the progression of calcification until advanced tissue mineralization is apparent. Due to the subsequent late diagnosis of cardiovascular calcification, treatment is usually comprised of invasive interventions such as surgery. The need to understand the process of calcification is therefore warranted and requires new imaging modalities which are able to visualize early cardiovascular calcification. This review focuses on the use of new imaging techniques to visualize novel concepts of cardiovascular calcification. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Food quality score and the risk of coronary artery disease: a prospective analysis in 3 cohorts.

    PubMed

    Fung, Teresa T; Pan, An; Hou, Tao; Mozaffarian, Dariush; Rexrode, Kathryn M; Willett, Walter C; Hu, Frank B

    2016-07-01

    Currently, there are few diet quality assessment tools that are predictive of coronary artery disease (CAD) risk that do not require nutrient analysis and substantial time to administer in clinical settings. To inform the development of such a tool, we prospectively examined the association between a food-based diet quality score and risk of CAD in 3 separate large US cohort studies. Between 1984 and 2012, 71,415 women (aged 43-63 y in 1984), 42,945 men (aged 40-75 y in 1986), and 93,131 younger women (aged 27-44 y in 1991) without a history of cardiovascular disease were followed up to 28 y. Diet was assessed ≤7 times by using repeated food-frequency questionnaires. We computed the Food Quality Score (FQS) for each individual based on food groups previously associated with less weight gain. A higher score represented a healthier diet. The FQS and CAD association was modeled with the Cox proportional hazard model, controlling for potential confounders. We also compared the magnitude of association with CAD for the FQS and other diet quality scores. We ascertained 6817 incident total CAD events, with 4588 cases of nonfatal myocardial infarction and 2131 fatal CAD events. Comparing top to bottom deciles, pooled RRs of the FQS were 0.61 (95% CI: 0.54, 0.69; P-trend < 0.001) for total CAD. These associations were independent of established cardiovascular disease risk factors including body weight, physical activity, and smoking. The magnitude of the RR for 1 SD of the FQS and CAD was generally similar to established diet scores that require detailed nutrient analysis, including the Alternate Healthy Eating Index-2010, the Dietary Approaches to Stop Hypertension score, and the alternate Mediterranean diet score. A higher food-based diet quality score was associated with lower risk of CAD and was comparable with established diet scores. © 2016 American Society for Nutrition.

  8. Arterial reconstruction after mangled extremity: injury severity scoring systems are not predictive of limb salvage.

    PubMed

    Elsharawy, Mohamed Amin

    2005-01-01

    The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.

  9. Coronary Artery Calcium Score and Bone Metabolism: A Pilot Study in Postmenopausal Women

    PubMed Central

    Keshtkar, Abbasali; Shirani, Shapour; Mounesan, Leila

    2017-01-01

    Background Since 1991 many studies evaluated the link between cardiovascular diseases and osteoporosis, two age-related conditions, but the main common pathologic pathway has not been determined yet. The histological similarity between arterial calcified plaque and bone matrix and involvement of similar cells and mediators provide a special field of research. Therefore in the present study, we aimed to evaluate the relationship between coronary artery calcium score (CACS) as a surrogate marker of atherosclerosis and bone mediators and parameters in postmenopausal women. Methods Eleven postmenopausal women who had CACS higher than 80 were enrolled into the study and underwent bone densitometry. In addition, their serum and urine samples were taken for measuring osteoprotegerin, osteocalcin, and β cross laps. Patients' 10-year probability of fracture was calculated by the World Health Organization fracture-risk assessment tool (FRAX). Results The regression analysis of our results showed the association between CACS and OC (std β=0.66, 95% confidence interval [CI] 5.47-72.27, P=0.027), femoral bone density (std β=−0.6, 95% CI -6864.34-14.27, P=0.05) and T-score (std β=−0.6, 95% CI −773.08-1.28, P=0.05) which remained significant after adjustment for age, weight, years since menopause and body mass index. No association was found between CACS and osteoprotegerin, spinal bone density and FRAX score. Conclusions In conclusion, this pilot study with small sample size showed the potential association between CACS and osteocalcin, femoral bone density and T-score. However, the relationship between CACS and osteoprotegerin, receptor activator of nuclear factor-kappa B ligand, FRAX score and other bone parameters remain to be clarified in larger sample size studies. PMID:28326297

  10. Association of coronary artery calcium score and vascular dysfunction in long-term hemodialysis patients.

    PubMed

    Zeb, Irfan; Ahmadi, Naser; Molnar, Miklos Z; Li, Dong; Shantouf, Ronney; Hatamizadeh, Parta; Choi, Taeyoung; Kalantar-Zadeh, Kamyar; Budoff, Matthew J

    2013-04-01

    Long-term hemodialysis patients are prone to an exceptionally high burden of cardiovascular disease and mortality. The novel temperature-based technology of digital thermal monitoring (DTM) of vascular reactivity appears associated with the severity of coronary artery disease in asymptomatic population. We hypothesized that in hemodialysis patients, the DTM and coronary artery calcium (CAC) score have a gradient association that follows that of subjects without kidney disease. We examined the cross-sectional DTM-CAC associations in a group of long-term hemodialysis patients, and their 1:1 matched normal counterpart. Area under the curve for temperature (TMP-AUC), the surrogate of the DTM index of vascular function, was assessed after a 5-minute arm-cuff reactive hyperemia test. Coronary calcium score was measured via electron beam computed tomography or multidetector computed tomography scan. We studied 105 randomly recruited hemodialysis patients (age: 58 ± 13 years, 47% men) and 105 age- and gender-matched controls. In hemodialysis patients vs. controls, TMP-AUC was significantly worse (114 ± 72 vs. 143 ± 80, P = 0.001) and CAC score was higher (525 ± 425 vs. 240 ± 332, P < 0.001). Hemodialysis patients were 14 times more likely to have CAC score >1000 as compared with controls. After adjustment for known confounders, the relative risk for case vs. control for each standard deviation decrease in TMP-AUC was 1.46 (95% confidence interval: 1.12-1.93, P = 0.007). Vascular reactivity measured via the novel DTM technology is incrementally worse across CAC scores in hemodialysis patients, in whom both measures are even worse than their age- and gender-matched controls. The DTM technology may offer a convenient and radiation-free approach to risk-stratify hemodialysis patients.

  11. Breast Calcifications

    MedlinePlus

    ... remain unchanged. References What mammograms show: Calcifications, cysts, fibroadenomas. Breastcancer.org. http://www.breastcancer.org/symptoms/testing/types/mammograms/mamm_show. Accessed Dec. 9, 2015. Mammograms and other breast imaging tests. American Cancer Society. http://www.cancer. ...

  12. Automatic coronary calcium scoring using noncontrast and contrast CT images

    SciTech Connect

    Yang, Guanyu Chen, Yang; Shu, Huazhong; Ning, Xiufang; Sun, Qiaoyu; Coatrieux, Jean-Louis

    2016-05-15

    Purpose: Calcium scoring is widely used to assess the risk of coronary heart disease (CHD). Accurate coronary artery calcification detection in noncontrast CT image is a prerequisite step for coronary calcium scoring. Currently, calcified lesions in the coronary arteries are manually identified by radiologists in clinical practice. Thus, in this paper, a fully automatic calcium scoring method was developed to alleviate the work load of the radiologists or cardiologists. Methods: The challenge of automatic coronary calcification detection is to discriminate the calcification in the coronary arteries from the calcification in the other tissues. Since the anatomy of coronary arteries is difficult to be observed in the noncontrast CT images, the contrast CT image of the same patient is used to extract the regions of the aorta, heart, and coronary arteries. Then, a patient-specific region-of-interest (ROI) is generated in the noncontrast CT image according to the segmentation results in the contrast CT image. This patient-specific ROI focuses on the regions in the neighborhood of coronary arteries for calcification detection, which can eliminate the calcifications in the surrounding tissues. A support vector machine classifier is applied finally to refine the results by removing possible image noise. Furthermore, the calcified lesions in the noncontrast images belonging to the different main coronary arteries are identified automatically using the labeling results of the extracted coronary arteries. Results: Forty datasets from four different CT machine vendors were used to evaluate their algorithm, which were provided by the MICCAI 2014 Coronary Calcium Scoring (orCaScore) Challenge. The sensitivity and positive predictive value for the volume of detected calcifications are 0.989 and 0.948. Only one patient out of 40 patients had been assigned to the wrong risk category defined according to Agatston scores (0, 1–100, 101–300, >300) by comparing with the ground

  13. Is SYNTAX Score Predictive of Atrial Fibrillation after On-Pump Coronary Artery Bypass Graft Surgery?

    PubMed Central

    Duygu, Hamza; Gulsen, Kamil; Kemal, Hatice S; Ozcem, Barcın; Balcioglu, Ozlem; Gunsel, Aziz; Tosun, Ozgur; Emren, Volkan

    2016-01-01

    Background and Objectives The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (≥22.25) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion The SYNTAX score level was independently associated with the development of AF after CABG. PMID:27826338

  14. Vascular calcification in chronic kidney disease.

    PubMed

    Jono, Shuichi; Shioi, Atsushi; Ikari, Yuji; Nishizawa, Yoshiki

    2006-01-01

    Vascular calcification is often encountered in advanced atherosclerotic lesions and is a common consequence of aging. Calcification of the coronary arteries has been positively correlated with coronary atherosclerotic plaque burden, increased risk of myocardial infarction, and plaque instability. Chronic kidney disease (CKD) patients have two to five times more coronary artery calcification than healthy age-matched individuals. Vascular calcification is a strong prognostic marker of cardiovascular disease mortality in CKD patients. Vascular calcification has long been considered to be a passive, degenerative, and end-stage process of atherosclerosis and inflammation. However, recent evidence indicates that bone matrix proteins such as osteopontin, matrix Gla protein (MGP), and osteocalcin are expressed in calcified atherosclerotic lesions, and that calcium-regulating hormones such as vitamin D3 and parathyroid hormone-related protein regulate vascular calcification in in vitro vascular calcification models based on cultured aortic smooth muscle cells. These findings suggest that vascular calcification is an actively regulated process similar to osteogenesis, and that bone-associated proteins may be involved in the development of vascular calcification. The pathogenesis of vascular calcification in CKD is not well understood and is almost multifactorial. In CKD patients, several studies have found associations of both traditional risk factors, such as hypertension, hyperlipidemia, and diabetes, and uremic-specific risk factors with vascular calcification. Most patients with progressive CKD develop hyperphosphatemia. An elevated phosphate level is an important risk factor for the development of calcification and cardiovascular mortality in CKD patients. Thus, it is hypothesized that an important regulator of vascular calcification is the level of inorganic phosphate. In order to test this hypothesis, we characterized the response of human smooth muscle cell (HSMC

  15. Associations between Carotid Artery Plaque Score, Carotid Hemodynamics and Coronary Heart Disease

    PubMed Central

    Zhang, Huiping; Liu, Mengxue; Ren, Tiantian; Wang, Xiangqian; Liu, Dandan; Xu, Mingliang; Han, LingFei; Wu, Zewei; Li, Haibo; Zhu, Yu; Wen, Yufeng; Sun, Wenjie

    2015-01-01

    Background: The carotid artery plaque score (PS) is an independent predictor of Coronary Heart Disease (CHD). This study aims to evaluate the combination of PS and carotid hemodynamics to predict CHD. Methods: A total of 476 patients who underwent carotid ultrasonography and coronary angiography were divided into two groups depending on the presence of CHD. PS, carotid intima-media thickness, and carotid blood flow were measured. Receiver operating characteristic curve analysis was performed to establish the best prediction model for CHD presence. Results: Age, sex, carotid intima-media thickness of internal carotid artery and carotid bifurcation, PS, peak systolic velocity (PSA) of right internal carotid artery (RICA), and most resistance index data were significantly related with the presence of CHD. The area under the curve for a collective model, which included factors of the PS, carotid hemodynamics and age, was significantly higher than the other model. Age, PS, and PSA of RICA were significant contributors for predicting CHD presence. Conclusions: The model of PS and PSA of RICA has greater predictive value for CHD than PS alone. Adding age to PS and PSA of RICA further improves predictive value over PS alone. PMID:26569275

  16. Ultrastructural Analysis of Vascular Calcifications in Uremia

    PubMed Central

    Aretz, Anke; Verberckmoes, Steven C.; Krüger, Thilo; Behets, Geert J.; Ghadimi, Reza; Weirich, Thomas E.; Rohrmann, Dorothea; Langer, Stephan; Tordoir, Jan H.; Amann, Kerstin; Westenfeld, Ralf; Brandenburg, Vincent M.; D'Haese, Patrick C.; Mayer, Joachim; Ketteler, Markus; McKee, Marc D.; Floege, Jürgen

    2010-01-01

    Accelerated intimal and medial calcification and sclerosis accompany the increased cardiovascular mortality of dialysis patients, but the pathomechanisms initiating microcalcifications of the media are largely unknown. In this study, we systematically investigated the ultrastructural properties of medial calcifications from patients with uremia. We collected iliac artery segments from 30 dialysis patients before kidney transplantation and studied them by radiography, microcomputed tomography, light microscopy, and transmission electron microscopy including electron energy loss spectrometry, energy dispersive spectroscopy, and electron diffraction. In addition, we performed synchrotron x-ray analyses and immunogold labeling to detect inhibitors of calcification. Von Kossa staining revealed calcification of 53% of the arteries. The diameter of these microcalcifications ranged from 20 to 500 nm, with a core-shell structure consisting of up to three layers (subshells). Many of the calcifications consisted of 2- to 10-nm nanocrystals and showed a hydroxyapatite and whitlockite crystalline structure and mineral phase. Immunogold labeling of calcification foci revealed the calcification inhibitors fetuin-A, osteopontin, and matrix gla protein. These observations suggest that uremic microcalcifications originate from nanocrystals, are chemically diverse, and intimately associate with proteinaceous inhibitors of calcification. Furthermore, considering the core-shell structure of the calcifications, apoptotic bodies or matrix vesicles may serve as a calcification nidus. PMID:20203159

  17. Coronary Artery Aneurysm Measurement and Z Score Variability in Kawasaki Disease.

    PubMed

    Ronai, Christina; Hamaoka-Okamoto, Akiko; Baker, Annette L; de Ferranti, Sarah D; Colan, Steven D; Newburger, Jane W; Friedman, Kevin G

    2016-02-01

    Coronary artery (CA) Z scores are commonly used for clinical decisions in Kawasaki disease, including treatment, anticoagulation, and duration and frequency of follow-up. The aim of this study was to evaluate CA measurement reproducibility, Z score calculation variability, and the impact of variability on management. Twenty-one patients with Kawasaki disease with right CA (RCA) or left anterior descending CA (LAD) Z scores of 1.5 to 3 (group 1) were randomly selected, and all patients with Kawasaki disease with Z scores of 7 to 14 for either the RCA or LAD (n = 20; group 2) were included from March 2008 to May 2014. Two echocardiographers measured left main CA, LAD, and RCA dimensions. The inter- and intraobserver reliability of absolute measurements was calculated, and the CA Z scores derived from three commonly used formulas were compared. Median age at echocardiography was 1.2 years (range, 0.2-11.5 years), and 68% of subjects (n = 28) were male. Interobserver reliability was high for the LAD (intraclass correlation coefficient [ICC], 96.79%) and RCA (ICC, 93.31%) and lower for the left main CA (ICC, 73.54%). Intraobserver reliability was also high for the LAD and RCA (ICC, 99.08% and 97.74%) and lower for the left main CA (ICC, 80.88%). Calculated Z scores were similar among the three formulas for group 1 but varied markedly in group 2. Calculated Z scores using the same CA measurement in each of the three formulas resulted in different clinical management in up to seven of 21 group 1 patients (22%) and in up to 10 of 20 group 2 patients (50%). Although CA measurements have high inter- and intraobserver agreement, CA Z scores vary dramatically on the basis of the Z score formula at larger CA dimensions. Discrepancies in CA Z score calculators may affect clinical decision making. Copyright © 2016 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.

  18. The impact of gender on cardiovascular system calcification in very elderly patients with severe aortic stenosis.

    PubMed

    Liyanage, Luckmini; Lee, Nam Ju; Cook, Tessa; Herrmann, Howard C; Jagasia, Dinesh; Litt, Harold; Han, Yuchi

    2016-01-01

    There is an established sex difference in cardiovascular disease among pre-menopausal women and age-matched men, with men having greater susceptibility to cardiovascular and coronary artery disease. Cardiovascular calcification may be linked to the atherosclerotic process and resulting disease, but the sex difference regarding coronary artery disease susceptibility and calcification is incompletely understood. We thought to measure calcium volume in different chest vascular beds in very elderly men and women with severe aortic stenosis (AS). Computed tomography scans of 94 patients with severe AS were calcium volume scored on Aquarius iNtuition Terarecon (Terarecon Inc., CA, USA) work stations. Coronary beds, aortic valve, mitral valve apparatus, and the thoracic aorta were examined. A significant sex difference in the mean total calcium volume of the coronary arteries was found in elderly (p = 0.001), with men having greater levels of calcification. There is also a significant sex difference in the amount of aortic valve calcium (p = 0.003). Furthermore, aortic and coronary calcification was independently correlated with sex. This study demonstrates a significant sex impact on calcification in the coronary beds and aortic valve in elderly patients with severe AS.

  19. Progression of coronary artery calcification in black and white women: do the stresses and rewards of multiple roles matter?

    PubMed

    Janssen, Imke; Powell, Lynda H; Jasielec, Mateusz S; Matthews, Karen A; Hollenberg, Steven M; Sutton-Tyrrell, Kim; Everson-Rose, Susan A

    2012-02-01

    Black women experience higher rates of cardiovascular disease (CVD) than white women, though evidence for racial differences in subclinical CVD is mixed. Few studies have examined multiple roles (number, perceived stress, and/or reward) in relation to subclinical CVD, or whether those effects differ by race. The aim of this study was to investigate the effects of multiple roles on 2-year progression of coronary artery calcium. Subjects were 104 black and 232 white women (mean age 50.8 years). Stress and reward from four roles (spouse, parent, employee, caregiver) were assessed on five-point scales. Coronary artery calcium progression was defined as an increase of ≥10 Agatston units. White women reported higher rewards from their multiple roles than black women, yet black women showed cardiovascular benefits from role rewards. Among black women only, higher role rewards were related significantly to lower progression of coronary artery calcium, adjusting for body mass index, blood pressure, and other known CVD risk factors. Blacks reported fewer roles but similar role stress as whites; role number and stress were unrelated to coronary artery calcium progression. Rewarding roles may be a novel protective psychosocial factor for progression of coronary calcium among black women.

  20. Predicting arterial injuries after penetrating brain trauma based on scoring signs from emergency CT studies.

    PubMed

    Bodanapally, Uttam K; Krejza, Jaroslaw; Saksobhavivat, Nitima; Jaffray, Paul M; Sliker, Clint W; Miller, Lisa A; Shanmuganathan, Kathirkamanathan; Dreizin, David

    2014-04-01

    The objective of this study was to determine the accuracy of individual radiologists in detection of vascular injury in patients after penetrating brain injury (PBI) based on head CT findings at admission. We retrospectively evaluated 54 PBI patients who underwent admission head CT and digital subtraction angiography (DSA), used here as a reference standard. Two readers reviewed the CT images to determine the presence or absence of the 29 CT variables of injury profile and quantified selected variables. Four experienced trauma radiologists and one neuroradiologist assigned their own specific scores for each CT variable, a high score indicative of a high probability of artery injury. A sixth set consisted of the average score obtained from the five sets, generated by five experts. Receiver operating characteristic (ROC) curves were constructed for each set to assess the diagnostic performance of an individual radiologist in predicting an underlying vascular injury. The area under ROC curve (AUC) was higher for CT scores obtained from the sixth set (average of five sets of scores) of variable rank score 0.75 (95% CI 0.62-0.88) and for the rest of the data sets, the value ranged from 0.70 (95% CI 0.56-0.84) to 0.74 (95% CI 0.6-0.88). In conclusion, radiologists may be able to recommend DSA with a fair accuracy rate in selected patients, deemed 'high-risk' for developing intracranial vascular injuries after PBI based on admission CT studies. A better approach needs to be developed to reduce the false positive rate to avoid unnecessary emergency DSA.

  1. The effect of different amounts of calcium intake on bone metabolism and arterial calcification in ovariectomized rats.

    PubMed

    Agata, Umon; Park, Jong-Hoon; Hattori, Satoshi; Iimura, Yuki; Ezawa, Ikuko; Akimoto, Takayuki; Omi, Naomi

    2013-01-01

    Low calcium (Ca) intake is the one of risk factors for both bone loss and medial elastocalcinosis in an estrogen deficiency state. To examine the effect of different amounts of Ca intake on the relationship between bone mass alteration and medial elastocalcinosis, 6-wk-old female SD rats were randomized into ovariectomized (OVX) control or OVX treated with vitamin D(3) plus nicotine injection (VDN) groups. The OVX treated with VDN group was then divided into 5 groups depending on the different Ca content in their diet, 0.01%, 0.1%, 0.6%, 1.2%, and 2.4% Ca intakes. After 8 wk of experimentation, the low Ca intake groups of 0.01% and 0.1% showed a low bone mineral density (BMD) and bone properties significantly different from those of the other groups, whereas the high Ca intake groups of 1.2% and 2.4% showed no difference compared with the OVX control. Only in the 0.01% Ca intake group, a significantly higher Ca content in the thoracic artery was found compared with that of the OVX control. Arterial tissues of the 0.01% Ca intake group showed an increase of bone-specific alkaline phosphatase (BAP) activity, a marker of bone mineralization, associated with arterial Ca content. However, the high Ca intake did not affect arterial Ca content nor arterial BAP activity. These results suggested that a low Ca intake during periods of rapid bone loss caused by estrogen deficiency might be one possible cause for the complication of both bone loss and medial elastocalcinosis.

  2. Coronary artery calcium scoring is a better predictor of cardiac risk in subclinical hypothyroidism patients with low-risk Framingham score

    PubMed Central

    Verma, Rajesh; Verma, Ashish; Gupta, Piyush; Agrawal, N. K.

    2016-01-01

    Context: Overt hypothyroidism accelerates the cardiovascular disease. Subclinical hypothyroidism (SCH), being considered as a preclinical state, impacts on cardiovascular status is not clear. Aims: This study was aimed at assessing cardiac risk stratification by Framingham risk scoring (FRS) and coronary coronary artery calcium score (CACS) by noncontrast cardiac computed tomography in SCH. Study Design: Observational study. Subjects and Methods: We enrolled thirty treatment-naive SCH patients (aged 30–60 years with no serious concurrent medical conditions), thirty euthyroid (age, sex, and body mass index-matched) controls, and ten healthy controls. All cases were evaluated for coronary artery calcium scoring and Framingham risk score. Statistical Analysis: Qualitative data were analyzed using the Chi-square test. In addition, demographics and CACS are summarized graphically or in a table. Results: SCH cases had higher thyroglobulin, while there was a trend toward an increase in total cholesterol, low-density lipoprotein (LDL), very LDL, and decrease in HDL levels. All participants had low-risk FRS (10-year FRS < 10%). The mean CACS in SCH was significantly higher than simple obese and healthy controls (47.17 vs. 2.67 vs. 0.00). Conclusion: This study suggests that SCH is an independent risk factor for coronary artery disease in apparently healthy controls. The risk of occult coronary artery disease is increased in SCH cases. PMID:27867875

  3. Rectus Femoris Tendon Calcification

    PubMed Central

    Zini, Raul; Panascì, Manlio; Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Denaro, Vincenzo

    2014-01-01

    Background: Since it was developed, hip arthroscopy has become the favored treatment for femoroacetabular impingement. Due to recent considerable improvements, the indications for this technique have been widely extended. Injuries of the rectus femoris tendon origin, after an acute phase, could result in a chronic tendinopathy with calcium hydroxyapatite crystal deposition, leading to pain and loss of function. Traditionally, this condition is addressed by local injection of anesthetic and corticosteroids or, when conservative measures fail, by open excision of the calcific lesion by an anterior approach. Purpose: To assess whether arthroscopic excision of calcification of the proximal rectus is a safe and effective treatment. Study Design: Case series; Level of evidence, 4. Methods: Outcomes were studied from 6 top amateur athletes (age range, 30-43 years; mean, 32.6 years) affected by calcification of the proximal rectus who underwent arthroscopic excision of the calcification. Patients were preoperatively assessed radiographically, and diagnosis was confirmed by a 3-dimensional computed tomography scan. To evaluate the outcome, standardized hip rating scores were used pre- and postoperatively (at 6 and 12 months): the Hip disability and Osteoarthritis Outcome Score, Oxford Hip Score, and Modified Harris Hip Score. Moreover, visual analog scales (VAS) for pain, sport activity level (SAL), and activities of daily living (ADL) were also used. Results: One year after surgery, all patients reported satisfactory outcomes, with 3 of 6 rating their return-to-sport level as high as preinjury level, and the remaining 3 with a percentage higher than 80%. Five patients ranked their ability to carry on daily activities at 100%. Statistical analysis showed significant improvement of the Oxford Hip Score, the Modified Harris Hip Score, and all 3 VAS subscales (pain, SAL, and ADL) from pre- to latest postoperative assessment (P < .05). Conclusion: Arthroscopic excision of

  4. Estimation of cardiovascular risk on routine chest CT: Ordinal coronary artery calcium scoring as an accurate predictor of Agatston score ranges.

    PubMed

    Azour, Lea; Kadoch, Michael A; Ward, Thomas J; Eber, Corey D; Jacobi, Adam H

    Coronary artery calcium (CAC) is often identified on routine chest computed tomography (CT). The purpose of our study was to evaluate whether ordinal scoring of CAC on non-gated, routine chest CT is an accurate predictor of Agatston score ranges in a community-based population, and in particular to determine the accuracy of an ordinal score of zero on routine chest CT. Two thoracic radiologists reviewed consecutive same-day ECG-gated and routine non-gated chest CT scans of 222 individuals. CAC was quantified using the Agatston scoring on the ECG-gated scans, and using an ordinal method on routine scans, with a score from 0 to 12. The pattern and distribution of CAC was assessed. The correlation between routine exam ordinal scores and Agatston scores in ECG-gated exams, as well as the accuracy of assigning a zero calcium score on routine chest CT was determined. CAC was most prevalent in the left anterior descending coronary artery in both single and multi-vessel coronary artery disease. There was a strong correlation between the non-gated ordinal and ECG-gated Agatston scores (r = 0.811, p < 0.01). Excellent inter-reader agreement (k = 0.95) was shown for the presence (total ordinal score ≥1) or absence (total ordinal score = 0) of CAC on routine chest CT. The negative predictive value for a total ordinal score of zero on routine CT was 91.6% (95% CI, 85.1-95.9). Total ordinal scores of 0, 1-3, 4-5, and ≥6 corresponded to average Agatston scores of 0.52 (0.3-0.8), 98.7 (78.2-117.1), 350.6 (264.9-436.3) and 1925.4 (1526.9-2323.9). Visual assessment of CAC on non-gated routine chest CT accurately predicts Agatston score ranges, including the zero score, in ECG-gated CT. Inclusion of this information in radiology reports may be useful to convey important information on cardiovascular risk, particularly premature atherosclerosis in younger patients. Copyright © 2016 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights

  5. Efficacy of hyperphosphatemia control in the progression of chronic renal failure and the prevalence of cardiovascular calcification.

    PubMed

    Lezaic, V; Tirmenstajn-Jankovic, B; Bukvic, D; Vujisic, B; Perovic, M; Novakovic, N; Dopsaj, V; Maric, I; Djukanovic, Lj

    2009-01-01

    Chronic kidney disease mineral- and bone disorder (CKD-MBD) has been studied more often in dialysis than in predialysis CKD patients. The association between efficacy of hyperphosphatemia control and chronic renal failure (CRF) progression, prevalence of bone disease and cardiovascular calcification was the objective of the present investigation. 42 patients with CKD in Stage 5, regularly monitored for 5 years, were divided into Group 1 of 20 patients with normal serum phosphate (sPO4) levels and Group 2 of 22 patients with hyperphosphatemia registered at the majority of checks. Serum urea, creatinine, calcium (sCa) and sPO4 levels were regularly determined in the retrospective 5-year period. At the end of this period iPTH, bone alkaline phosphatase-BAP and inflammation markers (CRP, fetuin-A) were measured, valvular and arterial calcifications were detected by B mode echocardiogram and soft-tissue native radiograms of the pelvis and the wrist. Progression of CRF (1/sCr over time) was faster in Group 2 than in Group 1 (b = -0.0577 vs. -0.0288, p = 0.003) during the study period. Average BAP and iPTH values were similar in both groups and 23/42 patients had PTH > 300 pg/ml. Arterial and valvular calcifications were found in 5/23 patients from Group 1 and 14/22 patients from Group 2 (p = 0.011). Linear regression analysis revealed sPO4 as a predictor for total calcification number, inflammatory diseases as a predictor for valvular calcifications, while sPO4 and iPTH were predictors for arterial calcifications. More than half the patients with Stage 5 CKD not yet on dialysis exhibited elevated PTH. Faster CRF progression and frequent arterial and valvular calcifications were seen in patients with poor phosphate control and sPO4 was selected as an independent predictor of total calcification score.

  6. Vascular calcification in maintenance hemodialysis patients.

    PubMed

    Wang, Mi; Wang, Mei; Gan, Liang-Ying; Li, Si-Jun; Hong, Nan; Zhang, Meng

    2009-01-01

    The objective was to investigate the status of vascular calcification, and to explore factors influencing vascular calcification in maintenance hemodialysis patients. Vascular calcification was quantitatively evaluated using radiographic films of the abdomen, pelvis and hands. Plasma fetuin-A and other parameters related to calcification were examined. 33/50 cases of vascular calcification were identified by radiographic film. Calcifications of the abdominal aorta and peripheral muscular arteries were seen in 90.9 and 36.4%. Patients with moderate to severe calcification were older, more likely to be male, had lower diastolic blood pressure and fetuin-A levels, and a higher incidence of diabetes than those with mild calcification. Logistic regression analysis showed that diabetes and plasma fetuin-A were independent risk factors for vascular calcification. Vascular calcification was present in a large proportion of maintenance hemodialysis patients, most frequently in the abdominal aorta. Diabetes and plasma fetuin-A levels were independent risk factors for vascular calcification in maintenance hemodialysis patients. (c) 2009 S. Karger AG, Basel.

  7. Indices of socioeconomic position across the life course as predictors of coronary calcification in black and white men and women: coronary artery risk development in young adults study.

    PubMed

    Matthews, Karen A; Schwartz, Joseph E; Cohen, Sheldon

    2011-09-01

    Few studies have investigated the association of socioeconomic status (SES) and coronary artery calcification (CAC) and only one study has examined African Americans separately from Caucasians, despite empirical evidence suggesting that blacks have equivalent or lower CAC, relative to whites. We tested the hypotheses that lower childhood SES and lower average education, occupation, and income and change in SES (slope) in adulthood are related to risk of CAC in blacks and whites in the US CARDIA study. Parental education and occupation were measured at study entry (Year 0 in 1985-1986) and participant education, occupation, and household income were evaluated multiple times throughout a 20 year follow-up period at four sites in the United States. CAC was measured at Year 20 in 3138 (45% black) participants in CARDIA; 19% had CAC. Latent growth models and multivariate logistic regression analyses adjusted for the major risk factors for CAC. Multivariate models showed that lower paternal education in blacks and lower maternal occupational status in the full sample and in whites were related to higher risk of any CAC, independent of adult SES. Lower average adult education, occupation, and income were related to higher risk of any CAC, with the effects primarily in blacks. Our results are the first to show that SES, measured retrospectively and prospectively in multiple ways, is related to CAC, and the first to document the effects primarily in blacks.

  8. Elastin Degradation and Vascular Smooth Muscle Cell Phenotype Change Precede Cell Loss and Arterial Medial Calcification in a Uremic Mouse Model of Chronic Kidney Disease

    PubMed Central

    Pai, Ashwini; Leaf, Elizabeth M.; El-Abbadi, Mohga; Giachelli, Cecilia M.

    2011-01-01

    Arterial medial calcification (AMC), a hallmark of vascular disease in uremic patients, is highly correlated with serum phosphate levels and cardiovascular mortality. To determine the mechanisms of AMC, mice were made uremic by partial right-side renal ablation (week 0), followed by left-side nephrectomy at week 2. At 3 weeks, mice were switched to a high-phosphate diet, and various parameters of disease progression were examined over time. Serum phosphate, calcium, and fibroblast growth factor 23 (FGF-23) were up-regulated as early as week 4. Whereas serum phosphate and calcium levels declined to normal by 10 weeks, FGF-23 levels remained elevated through 16 weeks, consistent with an increased phosphate load. Elastin turnover and vascular smooth muscle cell (VSMC) phenotype change were early events, detected by week 4 and before AMC. Both AMC and VSMC loss were significantly elevated by week 8. Matrix metalloprotease 2 (MMP-2) and cathepsin S were present at baseline and were significantly elevated at weeks 8 and 12. In contrast, MMP-9 was not up-regulated until week 12. These findings over time suggest that VSMC phenotype change and VSMC loss (early phosphate-dependent events) may be necessary and sufficient to promote AMC in uremic mice fed a high-phosphate diet, whereas elastin degradation might be necessary but is not sufficient to induce AMC (because elastin degradation occurred also in uremic mice on a normal-phosphate diet, but they did not develop AMC). PMID:21281809

  9. Radiographic assessment of vascular calcification, aortic pulse wave velocity, ankle-brachial index and fibroblast growth factor-23 in chronic hemodialysis patients.

    PubMed

    Breznik, Silv