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Published on: June 2, 2022
Prevalence and Correlates of Cardiovascular Calcification and Its Prognostic Effects Among Patients With Chronic
Lan Wang1,2, Hong Cheng2, Xinrong Zou2
1The First Clinical College, Hubei University of Chinese Medicine, Wuhan, China.
Insights
Cardiovascular calcification, particularly abdominal aortic calcification (AAC), is common in chronic kidney disease (CKD) and linked to higher mortality. Early assessment of vascular calcification in CKD patients is crucial for timely intervention.
Area of Science:
- Nephrology and Cardiovascular Medicine
- Chronic Kidney Disease (CKD) Pathophysiology
- Vascular Calcification Epidemiology
Background:
- Cardiovascular calcification is a significant complication in patients with chronic kidney disease (CKD).
- Understanding the risk factors and prognostic implications of calcification in early-stage CKD is essential for patient management.
Purpose of the Study:
- To identify characteristics and risk factors associated with cardiovascular calcification in CKD stages 1-4.
- To investigate the relationship between abdominal aortic calcification (AAC) and cardiac valvular calcification (CVC) with prognosis, including cardiovascular events and all-cause mortality.
Main Methods:
- Cross-sectional analysis of 2,235 patients for AAC (abdominal radiography) and 2,756 for CVC (echocardiogram) within the C-STRIDE study.
- Logistic regression models identified factors associated with calcification prevalence.
- Cox proportional hazards regression assessed the association between AAC/CVC and clinical outcomes.
Main Results:
- Prevalence of AAC was 9.22% and CVC was 5.91%.
- Demographic factors (age, gender) and traditional cardiovascular risk factors (hypertension, diabetes, smoking, dyslipidemia) were associated with AAC and CVC.
- Both AAC and CVC were significantly associated with increased cardiovascular events and all-cause mortality. AAC predicted all-cause mortality, while CVC predicted cardiovascular events in patients with preserved eGFR (≥45 ml/min/1.73m²).
Conclusions:
- Demographic and traditional cardiovascular risk factors are strongly linked to cardiovascular calcification in CKD.
- Abdominal aortic calcification (AAC) may indicate increased mortality risk across all CKD severities.
- Cardiac valvular calcification (CVC) may be a risk factor for cardiovascular events specifically in mild to moderate CKD, highlighting the need for early vascular calcification assessment and intervention.
Abstract:
Background and Aims: The purpose of this study was to identify the characteristics and risk factors for cardiovascular calcification, and its relationship to prognosis, in patients with chronic kidney disease (CKD) stages 1-4. Methods: Cardiovascular calcification was evaluated at baseline by lateral abdominal radiography to detect abdominal aortic calcifications (AAC), and by echocardiogram to detect cardiac valvular calcifications (CVC), respectively. Demographic and laboratory data were collected and analyzed. Univariate and multivariable logistic regression model was used to explore the factors associated with the indicators of cardiovascular calcification, while Cox proportional hazards regression was used to examine the association between AAC/CVC and incidence of cardiovascular events and all-cause mortality. Results: A subgroup of 2,235 patients with measurement of AAC in the C-STRIDE study and a subgroup of 2,756 patients with CVC were included in the analysis. AAC was present in 206 patients (9.22%) and CVC was present in 163 patients (5.91%). Age, gender, history of cardiovascular diseases, smoking, hypertension, diabetes, levels of hemoglobin, low-density lipoprotein cholesterol, and uric acid were associated with prevalence of AAC, while only age, history of cardiovascular diseases, levels of serum albumin and low-density lipoprotein cholesterol were associated with prevalence of CVC (all p < 0.05).Survival analyses showed that cardiovascular events and all-cause mortality were significantly greater in patients with AACor with CVC (all p-values for log-rank tests <0.05). After adjustment for age, sex and estimated glomerular filtration rate (eGFR), AAC was associated with increased risk of all-cause mortality (hazard ratio = 1.67[95% confidence interval: 0.99, 2.79]), while CVC associated with that of cardiovascular events only among patients with comparatively normal eGFR (≥45 ml/min/1.73m2) (hazard ratio = 1.99 [0.98, 4.03]). Conclusion: Demographic and traditional cardiovascular risk factors were associated with cardiovascular calcification, especially AAC. AAC may be associated with risk of death for patients CKD of any severity, while CVC as a possible risk factor for cardiovascular disease only among those with mild to moderate CKD. Assessments of vascular calcification are need to be advanced to patients in the early and middle stages of chronic kidney disease and to initiate appropriate preventive measures earlier.
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