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Updated: Feb 8, 2026
Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Commonly available hematological biomarkers are associated with the extent of coronary calcifications
Annemarie M den Harder1, Pim A de Jong1, Mark C H de Groot2
1Department of Radiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
Insights
This study found that red blood cell distribution width (RDW), immature reticulocyte fraction, neutrophil lobularity variation, and lymphocyte cell size are associated with coronary artery calcification (CAC) scores, offering new insights into subclinical coronary artery disease.
Area of Science:
- Cardiovascular Research
- Hematology
- Biomarker Discovery
Background:
- Coronary artery calcification (CAC) is a marker of subclinical coronary artery disease.
- Understanding the pathophysiology of CAC can be improved by identifying associated hematological biomarkers.
- Hematological parameters are readily available in routine clinical care.
Purpose of the Study:
- To investigate associations between common hematological biomarkers and CAC scores.
- To identify novel hematological markers related to coronary calcification.
- To enhance the understanding of subclinical coronary artery disease development.
Main Methods:
- A cross-sectional study utilizing the Utrecht Patient Oriented Database (UPOD).
- Inclusion of patients with suspected or known coronary artery disease who underwent CT CAC scoring and hematology analysis within 3 months.
- Linear regression analysis adjusted for confounders (age, sex, BMI, diabetes, GFR, HDL) to assess biomarker associations with CAC score.
Main Results:
- 1504 patients were included; 43% had a CAC score of 0.
- Red blood cell distribution width (RDW) showed a positive association with CAC score (β=0.20, p=0.007).
- Fraction of immature reticulocytes (β=0.97, p=0.004), coefficient of variation of neutrophil lobularity (β=0.13, p=0.040), and mean lymphocyte cell size (β=0.21, p=0.001) were also positively associated with CAC score.
Conclusions:
- Confirms the established link between RDW and CAC score.
- Identifies the fraction of immature reticulocytes, coefficient of variation of neutrophil lobularity, and mean lymphocyte cell size as novel markers associated with higher CAC scores.
- These findings contribute to understanding the hematological underpinnings of subclinical coronary artery disease.
Background And Aims:
We aimed to improve the understanding of potential associations between commonly available hematological biomarkers and the coronary artery calcification (CAC) score, which may help unravel the pathophysiology of coronary calcifications and subclinical coronary artery disease.
Methods:
A cross-sectional study was performed within the Utrecht Patient Oriented Database (UPOD). Patients with suspected or known coronary artery disease who underwent CT CAC scoring as well as standard hematology analysis that was part of routine clinical care (within 3 months of CT acquisition) were included. Complete hematology datasets were extracted from hematology analyzers. Linear regression adjusted for potential confounders was used to assess if hematological biomarkers were related to the CAC score.
Results:
In total, 1504 patients were included, of whom 43% (n = 647) had a CAC score of 0. Mean age (±SD) was 53 ± 13 years, and 34% of patients were women. Red blood cell distribution width (RDW, β = 0.20 [0.05-0.36], p=0.007), the fraction of immature reticulocytes (β = 0.97 [0.10-6.43], p=0.004), coefficient of variation of neutrophil lobularity (β = 0.13 [0.01-0.25], p=0.040) and mean lymphocyte cell size (β = 0.21 [0.08-0.34], p=0.001) were positively associated with the CAC score after adjustment for age, sex, body mass index (BMI), diabetes, glomerular filtration rate (GFR) and high-density lipoprotein (HDL).
Conclusions:
This study confirms the known association of RDW with the CAC score, and presents the fraction of immature reticulocytes, coefficient of variation of neutrophil lobularity, and mean lymphocyte cell size as new markers associated with a higher CAC score.
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