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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
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Coronary artery calcification in Takayasu's arteritis: clinical characteristics and risk factors
Shiyu Yang1, Nan Zhang2, Wenjing Zhao2
1Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Coronary artery calcification (CAC) affects over a quarter of Takayasu
Area of Science:
- Cardiovascular Medicine and Rheumatology
- Vascular Inflammation and Atherosclerosis
Background:
- Coronary artery calcification (CAC) is a common finding in patients with Takayasu's arteritis (TAK).
- Understanding the prevalence and risk factors for CAC in TAK is crucial for cardiovascular risk stratification.
Purpose of the Study:
- To determine the prevalence and severity of CAC in TAK patients.
- To evaluate the impact of traditional cardiovascular risk factors, glucocorticoid exposure, and disease activity on CAC development in TAK.
Main Methods:
- Retrospective analysis of 155 TAK patients.
- Coronary computed tomography angiography (CCTA) was used to measure the Agatston score for CAC assessment.
- Patients were categorized into groups with and without CAC for comparative analysis.
Main Results:
- CAC was present in 26.45% (41 out of 155) of TAK patients.
- Independent risk factors for CAC included older age of onset, longer disease duration, hypertension, hyperlipidaemia, Numano V classification, and glucocorticoid use.
- CAC extent positively correlated with the number of traditional cardiovascular risk factors but was not associated with disease activity.
Conclusions:
- CCTA screening is recommended for TAK patients classified under Numano V.
- Glucocorticoid use significantly increases the risk of CAC in TAK patients.
- Consideration of immunosuppressants to reduce glucocorticoid dosage in controlled TAK disease is advised to mitigate CAC risk.
Objectives:
Coronary artery calcification (CAC) is frequently observed in Takayasu's arteritis (TAK). Our objective is to calculate the prevalence and severity of CAC in TAK, while evaluating the influence of traditional cardiovascular risk factors, glucocorticoid exposure, and disease activity on CAC.
Methods:
This retrospective study involved 155 TAK patients. We measured the Agatston score by coronary computed tomography angiography (CCTA) and categorised all patients into groups with or without CAC (41 vs. 114) to compare clinical characteristics and ancillary findings between the two groups.
Results:
Among the TAK patients, a total of 41 TAK patients (26.45%) exhibited CAC. Age of onset, disease duration, history of hypertension, history of hyperlipidaemia, Numano V and glucocorticoid use emerged as the independent risk factors for developing CAC in TAK (OR [95% CI] 1.084[1.028-1.142], p=0.003; 1.005 [1.001-1.010], p=0.020; 4.792 [1.713-13.411], p=0.003; 4.199 [1.087-16.219], p=0.037; 3.287 [1.070-10.100], p=0.038; 3.558[1.269-9.977], p=0.016). Nonetheless, CAC was not associated with disease activity. Moreover, the extent of calcification score in TAK showed a positive correlation with the number of traditional cardiovascular risk factors.
Conclusions:
We recommend CCTA screening for Numano V classified TAK patients. Glucocorticoid usage significantly escalates the risk of CAC. Therefore, in cases of effectively controlled disease, the inclusion of immunosuppressants aimed at reducing glucocorticoid dosage is advisable.
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