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Updated: May 29, 2026
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Progression of coronary artery calcification and thoracic aorta calcification in kidney transplant recipients
Céline Maréchal1, Emmanuel Coche, Eric Goffin
1Division of Nephrology, Cliniques Universitaires Saint-Luc, Université catholique de Louvain Medical School, Brussels, Belgium.
Insights
Vascular calcification significantly progresses in kidney transplant recipients within 4 years. Modifiable cardiovascular risk factors, including statin use and vitamin D levels, influence this progression.
Area of Science:
- Nephrology
- Cardiology
- Radiology
Background:
- Vascular calcification is a major predictor of cardiovascular disease mortality in kidney transplant recipients (KTRs).
- Existing longitudinal studies on vascular calcification in KTRs are limited in size and follow-up duration.
- This study investigates the progression of coronary artery calcification (CAC) and thoracic aorta calcification in a cohort of prevalent KTRs.
Purpose of the Study:
- To assess the longitudinal changes in coronary artery and thoracic aorta calcification in prevalent kidney transplant recipients.
- To identify the determinants of vascular calcification progression in this patient population.
Main Methods:
- A longitudinal study involving 281 prevalent kidney transplant recipients.
- Coronary artery calcification (CAC) and thoracic aorta calcification were quantified using the Agatston score via 16-slice spiral computed tomography.
- Measurements were repeated after a median follow-up of 4.40 years, with simultaneous recording of demographic, clinical, and biochemical parameters.
Main Results:
- Repeat CT scans were available for 197 KTRs (70% follow-up rate).
- Significant progression of CAC (median 11% per year) and aorta calcification (median 4% per year) was observed.
- Independent predictors of CAC progression included higher baseline CAC, prior cardiovascular events, statin use, and lower 25-hydroxyvitamin D(3) levels.
- Determinants of aorta calcification progression included higher baseline aorta calcification, pulse pressure, statin use, older age, higher serum phosphate, aspirin use, and male sex.
Conclusions:
- Vascular calcification progresses substantially within 4 years in prevalent KTRs, contrary to previous findings.
- Progression is linked to both traditional and non-traditional cardiovascular risk factors, some of which are modifiable.
- The study highlights the need for managing cardiovascular risk factors in KTRs, but generalizability may be limited due to potential survival bias and underrepresentation of certain demographics.
Background:
Vascular calcification independently predicts cardiovascular disease, the major cause of death in kidney transplant recipients (KTRs). Longitudinal studies of vascular calcification in KTRs are few and small and have short follow-up. We assessed the evolution of coronary artery (CAC) and thoracic aorta calcification and their determinants in a cohort of prevalent KTRs.
Study Design:
Longitudinal.
Setting & Participants:
The Agatston score of coronary arteries and thoracic aorta was measured by 16-slice spiral computed tomography in 281 KTRs.
Predictors:
Demographic, clinical, and biochemical parameters were recorded simultaneously.
Outcomes & Measurements:
The Agatston score was measured again 3.5 or more years later.
Results:
Repeated analyzable computed tomographic scans were available for 197 (70%) KTRs after 4.40 ± 0.28 years; they were not available for the rest of patients because of death (n = 40), atrial fibrillation (n = 1), other arrhythmias (n = 4), refusal (n = 35), or technical problems precluding confident calcium scoring (n = 4). CAC and aorta calcification scores increased significantly (by a median of 11% and 4% per year, respectively) during follow-up. By multivariable linear regression, higher baseline CAC score, history of cardiovascular event, use of a statin, and lower 25-hydroxyvitamin D(3) level were independent determinants of CAC progression. Independent determinants of aorta calcification progression were higher baseline aorta calcification score, higher pulse pressure, use of a statin, older age, higher serum phosphate level, use of aspirin, and male sex. Significant regression of CAC or aorta calcification was not observed in this cohort.
Limitations:
Cohort of prevalent KTRs with potential survival bias; few patients with diabetes and nonwhites, limiting the generalizability of results.
Conclusion:
In contrast to previous small short-term studies, we show that vascular calcification progression is substantial within 4 years in prevalent KTRs and is associated with several traditional and nontraditional cardiovascular risk factors, some of which are modifiable.
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