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Published on: May 31, 2016
Intimal and medial calcification in relation to cardiovascular risk factors
Sabine R Zwakenberg1, Pim A de Jong2, Eva J Hendriks1
1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Intimal arterial calcification (IAC) and medial arterial calcification (MAC) in lower extremities share some risk factors but differ significantly. Understanding these differences is key for targeted prevention and treatment strategies in vascular disease.
Area of Science:
- Vascular Biology
- Arterial Calcification
- Cardiovascular Disease Risk Factors
Background:
- Arterial calcification, including intimal arterial calcification (IAC) and medial arterial calcification (MAC), is a significant contributor to cardiovascular morbidity and mortality.
- Distinct risk factor profiles and biomarkers may underlie IAC and MAC, necessitating targeted research for effective management.
Purpose of the Study:
- To investigate the specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC) in the lower extremities.
- To differentiate the etiological pathways of IAC and MAC based on clinical and biochemical markers.
Main Methods:
- A cross-sectional study involving patients with or at risk of vascular disease (SMART study and DCS cohort).
- Non-contrast computed tomography of lower extremities to score femoral and crural artery calcification (absent, IAC, MAC, indistinguishable).
- Multinomial regression models and biomarker analysis (inflammation, calcification, vitamin K status) in subsets of patients.
Main Results:
- Femoral calcification was prevalent (77%), with IAC (38%) and MAC (28%) being common patterns.
- Age, male sex, statin use, and coronary artery disease history were linked to both IAC and MAC.
- Smoking and low ankle-brachial index (ABI) correlated with IAC, while high ABI was associated with less IAC.
- MAC was more frequent in patients with diabetes, high ABI, and fewer smokers, unlike IAC.
- Inactive Matrix-Gla Protein was linked to increased MAC, and osteonectin to decreased MAC risk.
Conclusions:
- Intimal arterial calcification (IAC) and medial arterial calcification (MAC) are distinct entities within the lower extremities, each with unique associated risk factor profiles.
- The findings highlight the importance of differentiating between IAC and MAC for a more precise understanding of arterial calcification pathogenesis and for developing tailored therapeutic strategies.
Purpose:
To assess specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC).
Methods:
We conducted a cross-sectional study in patients with or at risk of vascular disease from the SMART study(n = 520) and the DCS cohort(n = 198). Non-contrast computed tomography scanning of the lower extremities was performed and calcification in the femoral and crural arteries was scored as absent, predominant IAC, predominant MAC or indistinguishable. Multinomial regression models were used to assess the associations between cardiovascular risk factors and calcification patterns. Biomarkers for inflammation, calcification and vitamin K status were measured in a subset of patients with IAC(n = 151) and MAC(n = 151).
Results:
Femoral calcification was found in 77% of the participants, of whom 38% had IAC, 28% had MAC and 11% were scored as indistinguishable. The absolute agreement between the femoral and crural arteries was high(69%). Higher age, male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC compared to absence of calcification. Smoking and low ankle-brachial-index (ABI) were associated with higher prevalence of IAC and high ABI was associated with less IAC. Compared to patients with IAC, patients with MAC more often had diabetes, have a high ABI and were less often smokers. Inactive Matrix-Gla Protein was associated with increased MAC prevalence, while osteonectin was associated with decreased risk of MAC, compared to IAC.
Conclusions:
When femoral calcification is present, the majority of the patients have IAC or MAC throughout the lower extremity, which have different associated risk factor profiles.
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