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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Presence of valvular calcification predicts the response to cinacalcet: data from the ADVANCE study
Antonio Bellasi1, Maureen Reiner, Frank Pétavy
1Division of Nephrology, Sant' Anna Hospital, Como, Italy.
Insights
Cardiac valve calcification (CVC) predicts coronary artery calcification (CAC) progression in dialysis patients. Combined cinacalcet and low-dose vitamin D therapy slowed CAC progression more effectively than higher vitamin D doses.
Area of Science:
- Nephrology
- Cardiology
- Vascular Biology
Background:
- Cardiac valve calcification (CVC) and coronary artery calcification (CAC) share pathogenic links and portend poor prognosis in chronic kidney disease on dialysis (CKD-5D).
- Factors influencing CVC and CAC progression remain poorly understood.
- CVC and CAC are significant contributors to cardiovascular morbidity and mortality in CKD-5D patients.
Purpose of the Study:
- To investigate the association between CVC and CAC progression.
- To determine if CVC predicts response to secondary hyperparathyroidism treatments.
- To evaluate the impact of different therapeutic regimens on CAC progression in patients with CVC.
Main Methods:
- Post-hoc analysis of the ADVANCE study data.
- Randomized patients to cinacalcet with low-dose vitamin D analogs or higher, variable doses of vitamin D.
- Assessed CVC and CAC at baseline and monitored CAC progression.
Main Results:
- Cardiac valve calcification (CVC) was present in 46-50% of subjects, with 29% having both aortic and mitral valve calcification.
- CVC was significantly associated with baseline CAC and CAC progression (p < 0.05).
- Patients with aortic valve calcification treated with cinacalcet and low-dose vitamin D showed significantly less CAC progression (adjusted OR: 0.26; 95% CI: 0.10, 0.64) compared to those on higher vitamin D doses, particularly those with higher baseline CAC.
Conclusions:
- Cardiac valve calcification (CVC) is a predictor of coronary artery calcification (CAC) progression and increased cardiovascular risk in CKD-5D patients.
- Combination therapy with cinacalcet and low-dose vitamin D effectively slowed CAC progression.
- This suggests a potential therapeutic strategy to mitigate cardiovascular complications in this high-risk population.
Background And Aim Of The Study:
Cardiac valve calcification (CVC) and coronary artery calcification (CAC) appear to be linked pathogenetically, and both are associated with a poor prognosis among patients with chronic kidney disease on dialysis (CKD-5D). Little is known, however, about factors that affect the progression of CVC and CAC.
Methods:
A post-hoc analysis was performed of the ADVANCE study to assess whether patients with CVC are more prone to CAC progression, and whether CVC predicts the response to different treatments for secondary hyperparathyroidism.
Results:
Subjects were randomized to treatment with either cinacalcet and low doses of vitamin D analogs or larger, varying doses of vitamin D. Among 235 subjects, aortic valve or mitral valve calcification was detected in 108 (46%) and 118 (50%), respectively; 69 subjects (29%) had calcification of both valves. CVC was associated both with baseline CAC and CAC progression (p < 0.05). Subjects with aortic valve calcification who were treated with cinacalcet and low doses of vitamin D experienced less progression of CAC than subjects given larger, varying doses of vitamin D (adjusted OR: 0.26; 95% CI: 0.10, 0.64). This effect was greater in subjects with larger CAC burden at baseline.
Conclusion:
The study findings suggest that CVC is a predictor of CAC progression and, potentially, of greater cardiovascular vulnerability. Treatment with cinacalcet combined with low doses of vitamin D slowed the progression of CAC compared to therapy using larger, varying doses of vitamin D.
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