Coronary artery calcification: From crystal to plaque rupture

Epidemiological studies using coronary artery calcification measurement have linked calcification strongly with coronary events and mortality. Formerly considered as a passive age-related phenomenon, coronary artery calcification is now recognized as an active and regulated process. In fact, there is a local influence linked to the inflammation generated by the presence of oxidized lipids and, equally, a general influence from mineral metabolism factors, such as inorganic phosphate, calcium, pyrophosphate or fibroblast growth factor 23, which are regulators of cell differentiation and of phosphate and calcium deposition on the vascular layers. Despite active research in this field, no therapy is currently able to stop the progression of calcification. However, new data have provided a better understanding of atherosclerosis, enabling us to see calcification as a marker of the state of stability or instability of the atherosclerotic plaque, and opening new perspectives for atherosclerotic plaque imaging.