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Multifocal cardiovascular calcification in patients with established cardiovascular disease; prevalence, risk
Cilie C van 't Klooster1, Hendrik M Nathoe2, J Hjortnaes3,4
1Department of Vascular Medicine, University Medical Center Utrecht (UMCU), Utrecht University, the Netherlands.
Insights
Cardiovascular calcification is common and often multifocal in patients with established cardiovascular disease (CVD). Coronary artery calcification (CAC) is the strongest predictor of recurrent CVD or vascular interventions.
Area of Science:
- Cardiology
- Radiology
- Preventive Medicine
Background:
- Cardiovascular calcification is a hallmark of atherosclerosis and a predictor of cardiovascular events.
- Understanding the prevalence, risk factors, and clinical implications of multifocal calcification is crucial for managing patients with established cardiovascular disease (CVD).
Purpose of the Study:
- To investigate the prevalence, risk factors, and association with recurrent CVD or vascular interventions of multifocal cardiovascular calcification.
- Specific calcification sites studied include coronary arteries (CAC), thoracic aorta (TAC), mitral annulus (MAC), and aortic valve (AVC).
Main Methods:
- The ORACLE cohort included 568 patients with established CVD.
- Computed tomography was used to assess the prevalence of site-specific and multifocal calcification.
- Ordinal and Cox regression analyses were employed to determine associations between risk factors, calcification, and clinical outcomes.
Main Results:
- Calcification was multifocal in 76% of patients.
- Age, diabetes mellitus, systolic blood pressure, and male sex were associated with calcification at various locations.
- Both TAC and CAC were related to recurrent CVD or vascular interventions, but only CAC remained significant in a multivariable model.
Conclusions:
- Cardiovascular calcification is typically multifocal in patients with established CVD, with distinct risk factor associations for different anatomical locations.
- Coronary artery calcification (CAC) is the most significant predictor of recurrent CVD or vascular interventions, independent of traditional risk factors and other calcification sites.
Aims:
The aim is to investigate (multifocal) cardiovascular calcification in patients with established cardiovascular disease (CVD), regarding prevalence, risk factors, and relation with recurrent CVD or vascular interventions. Coronary artery calcification (CAC), thoracic aortic calcification (TAC) (including ascending aorta, aortic arch, descending aorta), mitral annular calcification (MAC), and aortic valve calcification (AVC) are studied.
Methods:
The study concerned 568 patients with established CVD enrolled in the ORACLE cohort. All patients underwent computed tomography. Prevalence of site-specific and multifocal calcification was determined. Ordinal regression analyses were performed to quantify associations of risk factors with cardiovascular calcification, and Cox regression analyses to determine the relation between calcium scores and recurrent CVD or vascular interventions.
Results:
Calcification was multifocal in 76% (N = 380) of patients with calcification. Age (per SD) was associated with calcification at all locations (lowest OR 2.17; 99%CI 1.54-3.11 for ascending aorta calcification). Diabetes mellitus and systolic blood pressure were associated with TAC, whereas male sex was a determinant of CAC. TAC and CAC were related to the combined endpoint CVD or vascular intervention (N = 68). In a model with all calcium scores combined, only CAC was related to the combined outcome (HR 1.39; 95%CI 1.15-1.68).
Conclusion:
Cardiovascular calcification is generally multifocal in patients with established CVD. Differences in associations between risk factors and calcification at various anatomical locations stress the divergence in pathophysiological pathways. CAC is most strongly related to recurrent CVD or vascular interventions independent of traditional risk factors, and independent of heart valve and thoracic aorta calcification.
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