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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Ankle-brachial index (ABI), abdominal aortic calcification (AAC), and coronary artery calcification (CAC): the
Bobby W Tullos1, Jung Hye Sung, Jae Eun Lee
1University of Mississippi Medical Center, Jackson, MS, USA.
Insights
Lower ankle-brachial index (ABI) is linked to increased coronary artery calcification (CAC) and aortic arch calcification (AAC). ABI is a valuable, radiation-free tool for assessing vascular health and cardiovascular risk.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Peripheral atherosclerosis, indicated by a low ankle-brachial index (ABI), is a marker of systemic vascular disease.
- Coronary artery calcification (CAC) and aortic arch calcification (AAC) are indicators of atherosclerosis and cardiovascular risk.
- The relationship between baseline ABI and the extent of AAC and CAC requires further investigation.
Purpose of the Study:
- To examine the association between peripheral atherosclerosis, assessed by ABI, and the extent of AAC and CAC.
- To determine if ABI is a predictor of coronary and aortic calcification in the Jackson Heart Study cohort.
Main Methods:
- Analysis of 2,398 participants from the Jackson Heart Study cohort.
- ABI categorized into four groups: <0.90, 0.90-0.99, 1.00-1.39 (normal), and >1.40.
- AAC and CAC assessed by MDCT, with significant calcification defined as scores above the 75th percentile.
- Multivariable log-binomial models used to estimate prevalence ratios, adjusted for various cardiovascular risk factors.
Main Results:
- Lower ABI (<0.90 and 0.90-0.99) was significantly associated with a higher prevalence of both AAC and CAC compared to normal ABI.
- Prevalence of significant AAC was 1.7 times higher for ABI < 0.90 and 1.57 times higher for ABI 0.90-0.99.
- Prevalence of significant CAC was 1.55 times higher for ABI < 0.90 and 1.60 times higher for ABI 0.90-0.99.
- No significant difference in AAC or CAC prevalence was observed for ABI > 1.40 compared to normal ABI.
Conclusions:
- A lower ankle-brachial index is significantly associated with the extent of both aortic arch calcification and coronary artery calcification.
- ABI serves as an inexpensive, non-invasive tool for clinicians to assess vascular health and cardiovascular risk.
- Findings suggest ABI can aid in identifying individuals at higher risk for atherosclerosis without the need for ionizing radiation.
Abstract:
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.
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