Interventions to Attenuate Cardiovascular Calcification Progression: A Systematic Review of Randomized Clinical
Shashank Murali1, Edward R Smith1,2, Mark K Tiong1,2
1Department of Nephrology The Royal Melbourne Hospital Parkville Victoria Australia.
Insights
Cardiovascular calcification interventions show limited success. Aged garlic extract appears promising for reducing arterial calcification, but more research is needed due to small study sizes.
Area of Science:
- Cardiovascular Medicine
- Medical Interventions
- Calcification Research
Background:
- Cardiovascular calcification, a key factor in heart disease, is prevalent in aging and diabetes.
- Current interventions to slow cardiovascular calcification progression lack definitive evidence.
Approach:
- Systematic review of 49 randomized controlled trials (9901 participants) assessing interventions for cardiovascular calcification.
- Evaluated interventions included aged garlic extract, statins, hormone therapy, vitamin K, and lifestyle changes.
- Cardiovascular calcification was measured using radiological methods; evidence quality assessed via Cochrane risk of bias and GRADE.
Key Points:
- Aged garlic extract consistently attenuated cardiovascular calcification across six studies.
- Statins, other lipid-lowering agents, hormone replacement therapy, vitamin K, lifestyle measures, and omega-3 fatty acids did not show consistent attenuation.
- Antiresorptive, antihypertensive, antithrombotic, and hypoglycemic agents yielded mixed results.
Conclusions:
- Insufficient or conflicting data exist for most interventions targeting cardiovascular calcification.
- Aged garlic extract shows potential but requires larger, longer studies.
- Further research is essential to identify effective strategies for mitigating cardiovascular calcification.
Background:
Cardiovascular calcification, characterized by deposition of calcium phosphate in the arterial wall and heart valves, is associated with cardiovascular morbidity and mortality and is commonly seen in aging, diabetes, and chronic kidney disease. Whether evidence-based interventions could significantly attenuate cardiovascular calcification progression remains uncertain.
Methods And Results:
We conducted a systematic review of randomized controlled trials involving interventions, compared with placebo, another comparator, or standard of care, to attenuate cardiovascular calcification. Included clinical trials involved participants without chronic kidney disease, and the outcome was cardiovascular calcification measured using radiological methods. Quality of evidence was determined by the Cochrane risk of bias and Grading of Recommendations, Assessment, Development, and Evaluations assessment. Forty-nine randomized controlled trials involving 9901 participants (median participants 104, median duration 12 months) were eligible for inclusion. Trials involving aged garlic extract (n=6 studies) consistently showed attenuation of cardiovascular calcification. Trials involving 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (n=14), other lipid-lowering agents (n=2), hormone replacement therapies (n=3), vitamin K (n=5), lifestyle measures (n=4), and omega-3 fatty acids (n=2) consistently showed no attenuation of cardiovascular calcification with these therapies. Trials involving antiresorptive (n=2), antihypertensive (n=2), antithrombotic (n=4), and hypoglycemic agents (n=3) showed mixed results. Singleton studies involving salsalate, folate with vitamin B6 and 12, and dalcetrapib showed no attenuation of cardiovascular calcification. Overall, Cochrane risk of bias was moderate, and the Grading of Recommendations, Assessment, Development, and Evaluations assessment for a majority of analyses was moderate certainty of evidence.
Conclusions:
Currently, there are insufficient or conflicting data for interventions evaluated in clinical trials for mitigation of cardiovascular calcification. Therapy involving aged garlic extract appears most promising, but evaluable studies were small and of short duration.
Related Concept Videos
01:25Antianginal Drugs: Calcium Channel Blockers and Ranolazine
CCBs, a diverse class that includes dihydropyridines (nifedipine) and diphenylalkylamines (verapamil and diltiazem), exert their effect by blocking calcium channels in cardiac and smooth muscle cells. This...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:18Antihypertensive Drugs: Action of Calcium Channel Blockers
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...