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Voorhies K, Young K, Hsu FC, Palmer ND, McDonald MLN, Lee S, Hahn G, Hecker J, Prokopenko D, Wu AC, Regan EA, DeMeo D, Kinney GL, Crapo JD, Cho MH, Silverman EK, Lange C, Budoff MJ, Hokanson JE, Lutz SM. Association of PHACTR1 with Coronary Artery Calcium Differs by Sex and Cigarette Smoking. J Cardiovasc Dev Dis 2024; 11:194. [PMID: 39057616 PMCID: PMC11276683 DOI: 10.3390/jcdd11070194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Coronary artery calcium (CAC) is a marker of subclinical atherosclerosis and is a complex heritable trait with both genetic and environmental risk factors, including sex and smoking. Methods: We performed genome-wide association (GWA) analyses for CAC among all participants and stratified by sex in the COPDGene study (n = 6144 participants of European ancestry and n = 2589 participants of African ancestry) with replication in the Diabetes Heart Study (DHS). We adjusted for age, sex, current smoking status, BMI, diabetes, self-reported high blood pressure, self-reported high cholesterol, and genetic ancestry (as summarized by principal components computed within each racial group). For the significant signals from the GWA analyses, we examined the single nucleotide polymorphism (SNP) by sex interactions, stratified by smoking status (current vs. former), and tested for a SNP by smoking status interaction on CAC. Results: We identified genome-wide significant associations for CAC in the chromosome 9p21 region [CDKN2B-AS1] among all COPDGene participants (p = 7.1 × 10-14) and among males (p = 1.0 × 10-9), but the signal was not genome-wide significant among females (p = 6.4 × 10-6). For the sex stratified GWA analyses among females, the chromosome 6p24 region [PHACTR1] had a genome-wide significant association (p = 4.4 × 10-8) with CAC, but this signal was not genome-wide significant among all COPDGene participants (p = 1.7 × 10-7) or males (p = 0.03). There was a significant interaction for the SNP rs9349379 in PHACTR1 with sex (p = 0.02), but the interaction was not significant for the SNP rs10757272 in CDKN2B-AS1 with sex (p = 0.21). In addition, PHACTR1 had a stronger association with CAC among current smokers (p = 6.2 × 10-7) than former smokers (p = 7.5 × 10-3) and the SNP by smoking status interaction was marginally significant (p = 0.03). CDKN2B-AS1 had a strong association with CAC among both former (p = 7.7 × 10-8) and current smokers (p = 1.7 × 10-7) and the SNP by smoking status interaction was not significant (p = 0.40). Conclusions: Among current and former smokers of European ancestry in the COPDGene study, we identified a genome-wide significant association in the chromosome 6p24 region [PHACTR1] with CAC among females, but not among males. This region had a significant SNP by sex and SNP by smoking interaction on CAC.
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Affiliation(s)
- Kirsten Voorhies
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA
| | - Kendra Young
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Fang-Chi Hsu
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Nicholette D. Palmer
- Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Merry-Lynn N. McDonald
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35212, USA
- Department of Genetics, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Sanghun Lee
- Division of Medicine, Department of Medical Consilience, Graduate School, Dankook University, Yongin 16890, Republic of Korea
| | - Georg Hahn
- Brigham and Women’s Hospital, Division of Pharmacoepidemiology and Pharmacoeconomics, and Department of Medicine, Harvard Medical School, Boston, MA 02120, USA
| | - Julian Hecker
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
| | - Dmitry Prokopenko
- Genetics and Aging Research Unit and the McCance Center for Brain Health, Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ann Chen Wu
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA
| | | | - Dawn DeMeo
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Greg L. Kinney
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - James D. Crapo
- Department of Medicine, National Jewish Health, Denver, CO 80206, USA
| | - Michael H. Cho
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Edwin K. Silverman
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
- Division of Pulmonary and Critical Care Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Christoph Lange
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Matthew J. Budoff
- Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - John E. Hokanson
- Department of Epidemiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Sharon M. Lutz
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Nyvad J, Christensen KL, Andersen G, Reinhard M, Maeng M, Nielsen S, Thomsen MB, Jensen JM, Nørgaard BL, Buus NH. Aortic Calcification is Associated With the Difference Between Invasive Central and Cuff-Measured Brachial Blood Pressure in Chronic Kidney Disease. Am J Hypertens 2024; 37:455-464. [PMID: 38477704 DOI: 10.1093/ajh/hpae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with accelerated vascular calcification and increased central systolic blood pressure when measured invasively (invCSBP) relative to cuff-based brachial systolic blood pressure (cuffSBP). The contribution of aortic wall calcification to this phenomenon has not been clarified. We, therefore, examined the effects of aortic calcification on cuffSBP and invCSBP in a cohort of patients representing all stages of CKD. METHODS During elective coronary angiography, invCSBP was measured in the ascending aorta with a fluid-filled catheter with simultaneous recording of cuffSBP using an oscillometric device. Furthermore, participants underwent a non-contrast computed tomography scan of the entire aorta with observer-blinded calcification scoring of the aortic wall ad modum Agatston. RESULTS We included 168 patients (mean age 67.0 ± 10.5, 38 females) of whom 38 had normal kidney function, while 30, 40, 28, and 32 had CKD stages 3a, 3b, 4, and 5, respectively. Agatston scores adjusted for body surface area ranged from 48 to 40,165. We found that invCSBP increased 3.6 (95% confidence interval 1.4-5.7) mm Hg relative to cuffSBP for every 10,000-increment in aortic Agatston score. This association remained significant after adjustment for age, diabetes, antihypertensive treatment, smoking, eGFR, and BP level. No such association was found for diastolic BP. CONCLUSIONS Patients with advanced aortic calcification have relatively higher invCSBP for the same cuffSBP as compared to patients with less calcification. Advanced aortic calcification in CKD may therefore result in hidden central hypertension despite apparently well-controlled cuffSBP. ClinicalTrials.gov identifier: NCT04114695.
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Affiliation(s)
- Jakob Nyvad
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Gratien Andersen
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Mark Reinhard
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sebastian Nielsen
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Niels Henrik Buus
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
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Mszar R, Katz ME, Grandhi GR, Osei AD, Gallo A, Blaha MJ. Subclinical Atherosclerosis to Guide Treatment in Dyslipidemia and Diabetes Mellitus. Curr Atheroscler Rep 2024; 26:217-230. [PMID: 38662272 DOI: 10.1007/s11883-024-01202-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Dyslipidemia and type 2 diabetes mellitus are two common conditions that are associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD). In this review, we aimed to provide an in-depth and contemporary review of non-invasive approaches to assess subclinical atherosclerotic burden, predict cardiovascular risk, and guide appropriate treatment strategies. We focused this paper on two main imaging modalities: coronary artery calcium (CAC) score and computed tomography coronary angiography. RECENT FINDINGS Recent longitudinal studies have provided stronger evidence on the relationship between increased CAC, thoracic aorta calcification, and risk of cardiovascular events among those with primary hypercholesterolemia, highlighting the beneficial role of statin therapy. Interestingly, resilient profiles of individuals not exhibiting atherosclerosis despite dyslipidemia have been described. Non-conventional markers of dyslipidemia have also been associated with increased subclinical atherosclerosis presence and burden, highlighting the contribution of apolipoprotein B-100 (apoB)-rich lipoprotein particles, such as remnant cholesterol and lipoprotein(a), to the residual risk of individuals on-target for low-density lipoprotein cholesterol (LDL-C) goals. Regarding type 2 diabetes mellitus, variability in atherosclerotic burden has also been found, and CAC testing has shown significant predictive value in stratifying cardiovascular risk. Non-invasive assessment of subclinical atherosclerosis can help reveal the continuum of ASCVD risk in those with dyslipidemia and diabetes mellitus and can inform personalized strategies for cardiovascular disease prevention in the primary prevention setting.
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Affiliation(s)
- Reed Mszar
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Miriam E Katz
- School of Medicine, New York Medical College, Valhalla, NY, USA
| | - Gowtham R Grandhi
- Virginia Commonwealth University Health Pauley Heart Center, Richmond, VA, USA
| | - Albert D Osei
- Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Antonio Gallo
- Department of Nutrition, Lipidology and Cardiovascular Prevention Unit, APHP, INSERM UMR1166, Hôpital Pitié-Salpètriêre, Sorbonne Université, Paris, France
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA.
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4
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Cheng Y, Meng X, Gao H, Yang C, Li P, Li H, Chatterjee S, Rezende PC, Bonnet M, Li H, Zhang Z, Ji F, Zhang W. Long-term all-cause death prediction by coronary, aortic, and valvular calcification in patients with acute ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2024; 24:117. [PMID: 38373881 PMCID: PMC10877850 DOI: 10.1186/s12872-024-03758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/01/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND To determine the prognostic value of cumulative calcification score of coronary artery calcification (CAC), thoracic aortic calcification (TAC) and aortic valve calcification (AVC) in acute ST segment elevation myocardial infarction (STEMI) patients. METHODS This was a retrospective, single-center cohort study. A total of 332 STEMI patients who received primary percutaneous coronary intervention (PPCI) were enrolled in this study between January 2010 to October 2018. We assessed the calcification in the left anterior descending branch (LAD), left circumflex branch (LCX), right coronary artery (RCA), thoracic aorta, and aortic valve. Calcification of each part was counted as 1 point, and the cumulative calcification score was calculated as the sum of all points. The primary endpoint was all-cause mortality. Multivariate Cox proportional hazards models were used to determine association of cumulative calcification score with end points. The performance of the score was evaluated by receiver operating characteristic (ROC) curve analysis and absolute net reclassification improvement (NRI), compared with the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS The overall population's calcification score was 2.0 ± 1.6. During a mean follow-up time of 69.8 ± 29.3 months, the all-cause mortality rate was 12.1%. Kaplan-Meier curve showed that the score was significantly associated with mortality (log-rank p < 0.001). The multivariable Cox proportional hazard analyses showed that a calcification score of 4-5 was independently associated with all-cause death in STEMI patients [hazard ratio (HR) = 2.32, 95% confidence interval (CI): 1.01-5.31, p = 0.046]. The area under the ROC curve (AUC) of the calcification score was 0.67 (95% CI: 0.61-0.72), and the AUC of the GRACE score was 0.80 (95% CI: 0.75-0.84). There was no statistical difference in the predictive value between both scores for 3-year mortality in STEMI patients after PPCI (p = 0.06). Based on the NRI analysis, the calcification score showed better risk classification compared with the GRACE score (absolute NRI = 6.63%, P = 0.027). CONCLUSION The cumulative calcification score is independently associated with the long-term prognosis of STEMI patients after PPCI.
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Affiliation(s)
- Yalin Cheng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xuyang Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haiyang Gao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Peng Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Hongfei Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Saurav Chatterjee
- Clinical Assistant Professor of Medicine, Northwell Health, Zucker School of Medicine, Hempstead, NY, USA
| | - Paulo Cury Rezende
- Instituto do Coração (InCor), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marc Bonnet
- Cardiology Department, Hospital of Annecy, Annecy, France
| | - Huimin Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zunlei Zhang
- Department of Cardiology, People's Hospital of Weishan County, Jining, Shandong, 277600, China
| | - Fusui Ji
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Wenduo Zhang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Ejiri K, Ding N, Kim E, Honda Y, Cainzos‐Achirica M, Tanaka H, Howard‐Claudio CM, Butler KR, Hughes TM, Van't Hof JR, Meyer ML, Blaha MJ, Matsushita K. Association of Segment-Specific Pulse Wave Velocity With Vascular Calcification: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc 2024; 13:e031778. [PMID: 38214278 PMCID: PMC10926832 DOI: 10.1161/jaha.123.031778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Pulse wave velocity (PWV) is a noninvasive measure of arterial stiffness and predictor of cardiovascular disease. However, the association between PWV and vascular calcification across different vascular beds has not been fully investigated. This study aimed to quantify the association between PWV and multiterritory calcification and to explore whether PWV can identify individuals with vascular calcification beyond traditional risk factors. METHODS AND RESULTS Among 1351 older adults (mean age, 79.2 years [SD, 4.1]) from the ARIC (Atherosclerosis Risk in Communities) study, we measured segment-specific PWVs: heart-carotid, heart-femoral, carotid-femoral, heart-ankle, brachial-ankle, and femoral-ankle. Dependent variables were high calcium score (≥75th percentile of Agatston score) across different vascular beds: coronary arteries, aortic valve ring, aortic valve, mitral valve, ascending aorta, and descending aorta. Quartiles of carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV were significantly associated with coronary artery calcium (eg, adjusted odds ratio [OR] for the highest versus lowest quartile of carotid-femoral PWV, 1.84 [95% CI, 1.24-2.74]). Overall, PWVs were most strongly associated with descending aorta calcification, with significant results for carotid-femoral, heart-femoral, heart-ankle, and brachial-ankle PWV (eg, adjusted OR for the highest versus lowest quartile of carotid-femoral PWV, 3.99 [95% CI, 2.61-6.17]). In contrast, femoral-ankle PWV was inversely associated with descending aorta calcification. Some PWVs improved the discrimination of coronary artery calcium and descending aorta calcification beyond traditional risk factors. CONCLUSIONS The associations of PWV with vascular calcification varied substantially across segments, with descending aorta calcification most closely linked to PWVs. Our study suggests that some PWVs, especially carotid-femoral PWV, are helpful to identify individuals with coronary artery calcium and descending aorta calcification.
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Affiliation(s)
- Kentaro Ejiri
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Ning Ding
- Yale New Haven Health Bridgeport HospitalNew HavenCT
| | | | - Yasuyuki Honda
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Hirofumi Tanaka
- University of Texas at Austin, Kinesiology and Health EducationAustinTX
| | | | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Timothy M. Hughes
- Department of Internal MedicineWake Forest University School of MedicineWinston‐SalemNC
| | | | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Kunihiro Matsushita
- Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreMD
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Brodov Y, Massalha E, Shemesh J, Chodick G, Shalev V, Guindy M, Goitein O. Calcium score of the entire thoracic aorta is an independent predictor of all-cause mortality in patients referred to chest computed tomography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:177-183. [PMID: 37812261 DOI: 10.1007/s10554-023-02971-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Thoracic arterial calcifications (TAC) are not routinely reported or quantified in chest CT scans. We aimed to evaluate the association between TAC of the entire thoracic aorta and all-cause mortality (ACM) in patients referred to standard chest CT. METHODS A retrospective analysis of consecutive standard chest CT scans (non-gated, non-contrast) for the quantification of TAC, CAC and aortic valve calcification. TAC was divided into 4 sample-derived categories (TAC 1 = 0, TAC 2 = 1-65, TAC 3 = 66-439 and TAC 4 ≥ 440). Data regarding ACM was retrieved from the health care provider database. Multivariate Cox proportional regression models were used to assess associations between the TAC categories and ACM. RESULTS The study cohort included 415 patients (mean age 67 years, 52% male); 107 ACM events were recorded during a median follow-up of 9 years (inter-quartile range: 7.4-10.4). The rate of ACM was 13%, 25%, 32%, 41% according to TAC category (p < 0.001). The highest TAC category (≥ 440) was a strong and independent predictor of ACM [HR = 1.69 (1.13-2.52; 0.01)] in multivariate analysis. Other independent predictors of ACM included age [HR = 1.07 (1.04-1.10; p < 0.001)], male sex [HR = 2.27 (1.49-3.46; 0.001)] and malignancy [HR = 2.21 (1.49-3.23; < 0.001)]. CONCLUSIONS Severe TAC (≥ 440) was found to be an independent predictor of ACM. Thus, we suggest that documenting and quantifying TAC should be routinely incorporated into standard chest CT reports.
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Affiliation(s)
- Yafim Brodov
- Assuta Medical Center, Tel Aviv, affiliated with Ben Gurion University of Negev, Faculty of Medicine, Beer Sheva, Israel.
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel.
- Heart Center and Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| | - Eias Massalha
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel
- Heart Center and Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Joseph Shemesh
- Assuta Medical Center, Tel Aviv, affiliated with Ben Gurion University of Negev, Faculty of Medicine, Beer Sheva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel
| | - Gabriel Chodick
- Maccabi Healthcare Services, Maccabitech, Maccabi institute for research and innovation, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel
| | - Varda Shalev
- Maccabi Healthcare Services, Maccabitech, Maccabi institute for research and innovation, Tel Aviv, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel
| | - Michal Guindy
- Assuta Medical Center, Tel Aviv, affiliated with Ben Gurion University of Negev, Faculty of Medicine, Beer Sheva, Israel
| | - Orly Goitein
- Assuta Medical Center, Tel Aviv, affiliated with Ben Gurion University of Negev, Faculty of Medicine, Beer Sheva, Israel
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Tel Hashomer, 52621, Israel
- Heart Center and Diagnostic Radiology, Chaim Sheba Medical Center, Tel Hashomer, Israel
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7
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Razavi AC, Kim C, van Assen M, De Cecco CN, Berman DS, Budoff MJ, Quyyumi AA, Vaccarino V, Miedema MD, Nasir K, Rozanski A, Fernandez C, Rumberger JA, Shaw LJ, Mortensen MB, Wong ND, Blumenthal RS, Sperling LS, Whelton SP, Blaha MJ, Dzaye O. Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women. Circ Cardiovasc Imaging 2023; 16:e015690. [PMID: 38054290 PMCID: PMC10841590 DOI: 10.1161/circimaging.123.015690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/08/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND The development of thoracic aortic calcium (TAC) temporally precedes coronary artery calcium more often in women versus men. Whether TAC density and area confer sex-specific differences in atherosclerotic cardiovascular disease (ASCVD) risk is unknown. METHODS We studied 5317 primary prevention patients who underwent coronary artery calcium scoring on noncontrast cardiac gated computed tomography with TAC >0. The Agatston TAC score (Agatston units), density (Hounsfield units), and area (mm2) were compared between men and women. Cox proportional hazards regression calculated adjusted hazard ratios for TAC density-area groups with ASCVD mortality, adjusting for traditional risk factors, coronary artery calcium, and TAC. Multinomial logistic regression calculated adjusted odds ratios for the association between traditional risk factors and TAC density-area groups. RESULTS The mean age was 60.7 years, 38% were women, and 163 ASCVD deaths occurred over a median of 11.7-year follow-up. Women had higher median TAC scores (97 versus 84 Agatston units; P=0.004), density (223 versus 210 Hounsfield units; P<0.001), and area (37 versus 32 mm2; P=0.006) compared with men. There was a stepwise higher incidence of ASCVD deaths across increasing TAC density-area groups in men though women with low TAC density relative to TAC area (3.6 per 1000 person-years) had survival probability commensurate with the high-density-high-area group (4.8 per 1000 person-years). Compared with low TAC density-area, low TAC density/high TAC area conferred a 3.75-fold higher risk of ASCVD mortality in women (adjusted hazard ratio, 3.75 [95% CI, 1.13-12.44]) but not in men (adjusted hazard ratio, 1.16 [95% CI, 0.48-2.84]). Risk factors most strongly associated with low TAC density/high TAC area differed in women (diabetes: adjusted odds ratio, 2.61 [95% CI, 1.34-5.07]) versus men (hypertension: adjusted odds ratio, 1.45 [95% CI, 1.11-1.90]). CONCLUSIONS TAC density-area phenotypes do not consistently associate with ASCVD mortality though low TAC density relative to area may be a marker of increased ASCVD risk in women.
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Affiliation(s)
- Alexander C. Razavi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Cherry Kim
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
- Department of Radiology, Korea University College of Medicine, Ansan Hospital, 123, Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, South Korea
| | - Marly van Assen
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Carlo N. De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, United States
| | - Daniel S. Berman
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Matthew J. Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, United States
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Michael D. Miedema
- Minneapolis Heart Institute and Foundation, Minneapolis, MN, United States
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, United States
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai, St Luke’s Hospital, New York, NY, United States
| | - Camilo Fernandez
- Department of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | | | - Leslee J. Shaw
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | | | - Nathan D. Wong
- Heart Disease Prevention Program, University of California Irvine, Irvine, CA, United States
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, United States
| | - Seamus P. Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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He J, Wang Y, Zhan J, Li S, Ni Y, Huang W, Long L, Tan P, Wang Y, Liu Y. Icariin attenuates the calcification of vascular smooth muscle cells through ERα - p38MAPK pathway. Aging Med (Milton) 2023; 6:379-385. [PMID: 38239714 PMCID: PMC10792338 DOI: 10.1002/agm2.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 01/22/2024] Open
Abstract
Objective To investigate the relationship between icariin and the osteoblastic differentiation of vascular smooth muscle cells (VSMCs) and the signal pathway involved. Methods We applied a universally accepted calcification model of VSMCs induced by β glycerophosphate. Then the VSMCs calcification was observed by treatment with icariin and/or inhibitors of estrogen receptors (ERs) and p38-mitogen-activated protein kinase (MAPK) signaling. Results Icariin inhibited osteoblastic differentiation and mineralization of VSMCs due to decreased ALP activity and Runx2 expression. Further study demonstrated that icariin exerted this suppression effect through activating p38-MAPK but not extracellular-regulated kinase, JNK or Akt. An inhibitor of p38-MAPK partially reversed the inhibitory effects of icariin on osteoblastic differentiation. Interestingly, treatment of VSMCs with an ER antagonist ICI182780 and a selective ERα receptor antagonist PPT attenuated icariin-mediated inhibition effect of VSMCs calcification, associated with suppression of p38-MAPK phosphorylation. Conclusions Icariin inhibited the osteoblastic differentiation of VSMCs, and that the inhibitory effects were mediated by p38-MAPK pathways through ERα.
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Affiliation(s)
- Jieyu He
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yanjiao Wang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Junkun Zhan
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Shuang Li
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yuqing Ni
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Wu Huang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Limin Long
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Pan Tan
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Yi Wang
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
| | - Youshuo Liu
- Department of Geriatrics, The Second Xiangya HospitalCentral South UniversityChangshaChina
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9
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Zuo P, Xu R, Hu L, Hu W, Tong S. Association between monocyte lymphocyte ratio and abdominal aortic calcification in US adults: A cross-sectional study. Clinics (Sao Paulo) 2023; 78:100232. [PMID: 37364352 DOI: 10.1016/j.clinsp.2023.100232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 05/09/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND This study aimed to evaluate the association between Monocyte Lymphocyte Ratio (MLR) and Abdominal Aortic Calcification (AAC) in adults over 40 years of age in the United States. METHODS Data were collected from the 2013-2014 National Health and Nutrition Examination Survey (NHANES). AAC was quantified by the Kauppila score system based on dual-energy X-Ray absorptiometry. Severe AAC was defined as a total AAC score > 6. The lymphocyte count and monocyte count can be directly obtained from laboratory data files. Multivariable logistic regression models were used to determine the association between MLR and the AAC score and severe AAC. RESULTS A total of 3,045 participants were included in the present study. After adjusting for multiple covariates, MLR was positively associated with higher AAC score (β = 0.21, 95% CI 0.07, 0.34, p = 0.0032) and the odds of severe AAC increased by 14% per 0.1 unit increase in the MLR (OR = 1.14, 95% CI 1.00, 1.31, p = 0.0541). The Odds Ratio (OR) (95% CI) of severe AAC for participants in MLR tertile 3 was 1.88 (1.02, 3.47) compared with those in tertile 1 (p for trend = 0.0341). Subgroup analyses showed that a stronger association was detected in the elderly compared with non-elderly (p for interaction = 0.0346) and diabetes compared with non-diabetes (borderline significant p for interaction = 0.0578). CONCLUSION In adults in the United States, MLR was associated with higher AAC scores and a higher probability of severe AAC. MLR may become a promising tool to predict the risk of AAC.
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Affiliation(s)
- Peiyuan Zuo
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ranran Xu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liya Hu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Hu
- Department of Pediatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Song Tong
- Department of Thoracic Surgery, Union Hospital Tongji Medical College Huazhong University of Science and Technology, China.
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10
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Wallace RL, Ogunmoroti O, Zhao D, Vaidya D, Heravi A, Guallar E, Ndumele CE, Lima JA, Ouyang P, Budoff MJ, Allison M, Thomas I, Fashanu OE, Hoogeveen R, Post WS, Michos ED. Associations of urinary isoprostanes with measures of subclinical atherosclerosis: The Multi-Ethnic Study of Atherosclerosis (MESA). ATHEROSCLEROSIS PLUS 2022; 51:13-21. [PMID: 36969704 PMCID: PMC10037087 DOI: 10.1016/j.athplu.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022]
Abstract
Background Urinary isoprostanes are markers of systemic oxidative stress, which is implicated in the pathogenesis of atherosclerotic cardiovascular disease (ASCVD). Coronary artery calcium (CAC), thoracic aortic calcium (TAC) and carotid plaque are measure subclinical atherosclerosis and prognosticate ASCVD risk. We examined the associations between urinary isoprostane levels and measures of plaque prevalence, burden, incidence and progression across three vascular beds in a cohort from the Multi-Ethnic Study of Atherosclerosis. Methods Urinary levels of 8-isoprostane and 2,3-dinor-8-F2-isoprostane were measured in 1089 participants (mean ± SD 62 ± 8 years, 48% women) at baseline. Participants underwent computed tomography for CAC and TAC, and duplex ultrasound for carotid plaque. TAC and CAC were reassessed at 2.4 and 10 years, respectively. Regression models were adjusted for CVD risk factors. Results In adjusted models, there were no significant associations between isoprostane levels with CAC prevalence or progression. Highest versus lowest tertile of 8-isoprostane was associated with 28% lower prevalence of descending TAC at baseline [prevalence ratio (PR) 0.72 95% CI (0.56, 0.94)], while 1-SD higher 2,3-dinor-8-F2-isoprostane was associated with 96% higher incident ascending TAC at follow-up [Relative Risk 1.96 (1.24, 3.09)]. Highest versus lowest tertile of isoprostane measures were associated with 22% higher prevalence of carotid plaque [(PR 1.22 (1.04, 1.45)] and 14% difference [3,26] in greater extent of carotid plaque at baseline. Conclusions Higher urinary isoprostanes were inconsistently associated with some measures of subclinical atherosclerosis by imaging. This suggests a limited role of urinary isoprostane levels as a prognostic marker for the development of ASCVD. Trial registration The MESA cohort design is registered at clinicaltrials.gov as follows: https://clinicaltrials.gov/ct2/show/NCT00005487.
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11
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Extra-coronary Calcification and Cardiovascular Events: What Do We Know and Where Are We Heading? Curr Atheroscler Rep 2022; 24:755-766. [PMID: 36040566 DOI: 10.1007/s11883-022-01051-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW The coronary artery calcium score is a guideline-endorsed aid for further risk stratification in the primary prevention of atherosclerotic cardiovascular disease. The non-contrast scan performed for detection of coronary artery calcium also gives an opportunity to visualize calcifications in the thoracic aorta and in the heart valves, at no additional cost or radiation exposure. The purpose of this review was to discuss the potential clinical value of measuring thoracic aortic calcification, aortic valve calcification, and mitral annulus calcification. RECENT FINDINGS After two decades of active research, all three calcifications have been extensively evaluated, across various cohorts. We discuss classic and recent studies, current knowledge gaps, and future directions in this space. The added value of these measurements has traditionally been considered modest at best, and they are not currently discussed in relevant primary prevention guidelines in North America and Europe. However, recent studies evaluating high thoracic calcification thresholds and younger populations have further enriched this space. Specifically, some studies suggest that detection of severe thoracic aortic calcification may be helpful in further risk assessment and that detection of aortic valve calcifications may have important prognostic implications in younger individuals. Although more research is needed, particularly in larger young-to-middle-aged cohorts, future guidelines might consider including these features as risk-enhancing factors.
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12
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Obisesan OH, Kou M, Wang FM, Boakye E, Honda Y, Uddin SMI, Dzaye O, Osei AD, Orimoloye OA, Howard‐Claudio CM, Coresh J, Blumenthal RS, Hoogeveen RC, Budoff MJ, Matsushita K, Ballantyne CM, Blaha MJ. Lipoprotein(a) and Subclinical Vascular and Valvular Calcification on Cardiac Computed Tomography: The Atherosclerosis Risk in Communities Study. J Am Heart Assoc 2022; 11:e024870. [PMID: 35656990 PMCID: PMC9238743 DOI: 10.1161/jaha.121.024870] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Lipoprotein(a) (Lp(a)) is a potent causal risk factor for cardiovascular events and mortality. However, its relationship with subclinical atherosclerosis, as defined by arterial calcification, remains unclear. This study uses the ARIC (Atherosclerosis Risk in Communities Study) to evaluate the relationship between Lp(a) in middle age and measures of vascular and valvular calcification in older age. Methods and Results Lp(a) was measured at ARIC visit 4 (1996-1998), and coronary artery calcium (CAC), together with extracoronary calcification (including aortic valve calcium, aortic valve ring calcium, mitral valve calcification, and thoracic aortic calcification), was measured at visit 7 (2018-2019). Lp(a) was defined as elevated if >50 mg/dL and CAC/extracoronary calcification were defined as elevated if >100. Logistic and linear regression models were used to evaluate the association between Lp(a) and CAC/extracoronary calcification, with further stratification by race. The mean age of participants at visit 4 was 59.2 (SD 4.3) years, with 62.2% women. In multivariable adjusted analyses, elevated Lp(a) was associated with higher odds of elevated aortic valve calcium (adjusted odds ratio [aOR], 1.82; 95% CI, 1.34-2.47), CAC (aOR, 1.40; 95% CI, 1.08-1.81), aortic valve ring calcium (aOR, 1.36; 95% CI, 1.07-1.73), mitral valve calcification (aOR, 1.37; 95% CI, 1.06-1.78), and thoracic aortic calcification (aOR, 1.36; 95% CI, 1.05-1.77). Similar results were obtained when Lp(a) and CAC/extracoronary calcification were examined on continuous logarithmic scales. There was no significant difference in the association between Lp(a) and each measure of calcification by race or sex. Conclusions Elevated Lp(a) at middle age is significantly associated with vascular and valvular calcification in older age, represented by elevated CAC, aortic valve calcium, aortic valve ring calcium, mitral valve calcification, thoracic aortic calcification. Our findings encourage assessing Lp(a) levels in individuals with increased cardiovascular disease risk, with subsequent comprehensive vascular and valvular assessment where elevated.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Medstar Union Memorial HospitalBaltimoreMD
| | - Minghao Kou
- Tulane University School of Public Health and Tropical MedicineNew OrleansLA
| | | | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | - Yasuyuki Honda
- Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | | | | | - Josef Coresh
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
| | | | - Matthew J. Budoff
- Los Angeles Biomedical Research Institute at Harbor‐UCLA Medical CenterLos AngelesCA
| | - Kunihiro Matsushita
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD,Johns Hopkins Bloomberg School of Public HealthBaltimoreMD
| | | | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular DiseaseBaltimoreMD
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13
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Santos RD. Coronary Artery and Thoracic Aorta Calcification and Cardiovascular Events in Severe Hypercholesterolemia: More Wood for the Cardiovascular Disease Risk Heterogeneity Bonfire! Circ Cardiovasc Imaging 2022; 15:e014402. [PMID: 35727877 DOI: 10.1161/circimaging.122.014402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Raul D Santos
- Heart Institute (InCor) University of Sao Paulo Medical School Hospital, São Paulo, Brazil. Academic Research Organization Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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14
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Castagna F, Miles J, Arce J, Leiderman E, Neshiwat P, Ippolito P, Friedmann P, Schenone A, Zhang L, Rodriguez CJ, Blaha MJ, Levsky JM, Garcia MJ, Slipczuk L. Visual Coronary and Aortic Calcium Scoring on Chest Computed Tomography Predict Mortality in Patients With Low-Density Lipoprotein-Cholesterol ≥190 mg/dL. Circ Cardiovasc Imaging 2022; 15:e014135. [PMID: 35727870 PMCID: PMC9302708 DOI: 10.1161/circimaging.122.014135] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/09/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Current guidelines recommend coronary artery calcium (CAC) scoring for stratification of atherosclerotic cardiovascular disease risk only in patients with borderline to intermediate risk score by the pooled cohort equation with low-density lipoprotein-cholesterol (LDL-C) of 70 to 190 mg/dL. It remains unknown if CAC or thoracic aorta calcification (TAC), detected on routine chest computed tomography, can provide further risk stratification in patients with LDL-C≥190 mg/dL. METHODS From a multisite medical center, we retrospectively identified all patients from March 2005 to June 2021 age ≥40 years, without established atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL who had non-gated non-contrast chest computed tomography within 3 years of LDL-C measurement. Ordinal CAC and TAC scores were measured by visual inspection. Kaplan-Meier curves and multivariable Cox-regression models were built to ascertain the association of CAC and TAC scores with all-cause mortality. RESULTS We included 811 patients with median age 59 (53-68) years, 262 (32.3%) were male, and LDL-C median level was 203 (194-217) mg/dL. Patients were followed for 6.2 (3.29-9.81) years, and 109 (13.4%) died. Overall, 376 (46.4%) of patients had CAC=0 and 226 (27.9%) had TAC=0. All-cause mortality increased with any CAC and moderate to severe TAC. In a multivariate model, patients with CAC had a significantly higher mortality compared with those without CAC: mild hazard ratio (HR), 1.71 (1.03-2.83), moderate HR, 2.12 (1.14-3.94), and severe HR, 3.49 (1.94-6.27). Patients with moderate TAC (HR, 2.34 [1.19-4.59]) and those with severe TAC (HR, 3.02 [1.36-6.74]) had higher mortality than those without TAC. CONCLUSIONS In patients without history of atherosclerotic cardiovascular disease and LDL-C≥190 mg/dL, the presence and severity of CAC and TAC are independently associated with all-cause mortality.
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Affiliation(s)
- Francesco Castagna
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
| | - Jeremy Miles
- Cardiology Division, Montefiore Medical Center, Bronx, NY
| | - Javier Arce
- Cardiology Division, Montefiore Medical Center, Bronx, NY
| | | | | | - Paul Ippolito
- Cardiology Division, Montefiore Medical Center, Bronx, NY
| | - Patricia Friedmann
- Departments of Surgery and Cardiothoracic and Vascular Surgery, Albert Einstein College of Medicine. Bronx, NY
| | - Aldo Schenone
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
| | - Lili Zhang
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
| | - Carlos J Rodriguez
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. Baltimore, MD
| | - Jeffrey M Levsky
- Albert Einstein College of Medicine. Bronx, NY
- Radiology Department, Montefiore Medical Center, Bronx, NY
| | - Mario J Garcia
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
- Radiology Department, Montefiore Medical Center, Bronx, NY
| | - Leandro Slipczuk
- Cardiology Division, Montefiore Medical Center, Bronx, NY
- Albert Einstein College of Medicine. Bronx, NY
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15
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Harlianto NI, Westerink J, Hol ME, Wittenberg R, Foppen W, van der Veen PH, van Ginneken B, Verlaan JJ, de Jong PA, Mohamed Hoesein FAA, Asselbergs FW, Nathoe HM, de Borst GJ, Bots ML, Geerlings MI, Emmelot MH, de Jong PA, Leiner T, Lely AT, van der Kaaij NP, Kappelle LJ, Ruigrok YM, Verhaar MC, Visseren FLJ, Westerink J. Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications. Rheumatol Adv Pract 2022; 6:rkac060. [PMID: 35993014 PMCID: PMC9382268 DOI: 10.1093/rap/rkac060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022] Open
Abstract
Objectives. DISH has been associated with increased coronary artery calcifications and incident ischaemic stroke. The formation of bone along the spine may share pathways with calcium deposition in the aorta. We hypothesized that patients with DISH have increased vascular calcifications. Therefore we aimed to investigate the presence and extent of DISH in relation to thoracic aortic calcification (TAC) severity. Methods. This cross-sectional study included 4703 patients from the Second Manifestation of ARTerial disease cohort, consisting of patients with cardiovascular events or risk factors for cardiovascular disease. Chest radiographs were scored for DISH using the Resnick criteria. Different severities of TAC were scored arbitrarily from no TAC to mild, moderate or severe TAC. Using multivariate logistic regression, the associations between DISH and TAC were analysed with adjustments for age, sex, BMI, diabetes, smoking status, non-high-density lipoprotein cholesterol, cholesterol lowering drug usage, renal function and blood pressure. Results. A total of 442 patients (9.4%) had evidence of DISH and 1789 (38%) patients had TAC. The prevalence of DISH increased from 6.6% in the no TAC group to 10.8% in the mild, 14.3% in the moderate and 17.1% in the severe TAC group. After adjustments, DISH was significantly associated with the presence of TAC [odds ratio (OR) 1.46 [95% CI 1.17, 1.82)]. In multinomial analyses, DISH was associated with moderate TAC [OR 1.43 (95% CI 1.06, 1.93)] and severe TAC [OR 1.67 (95% CI 1.19, 2.36)]. Conclusions. Subjects with DISH have increased TACs, providing further evidence that patients with DISH have an increased burden of vascular calcifications.
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Affiliation(s)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht and Utrecht University , Utrecht
| | | | | | | | | | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center , Nijmegen, The Netherlands
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16
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Bellinge JW, Francis RJ, Lee SC, Bondonno NP, Sim M, Lewis JR, Watts GF, Schultz CJ. The effect of vitamin K1 on arterial calcification activity in subjects with diabetes mellitus: a post hoc analysis of a double-blind, randomized, placebo-controlled trial. Am J Clin Nutr 2022; 115:45-52. [PMID: 34637494 DOI: 10.1093/ajcn/nqab306] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 09/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Coronary and aortic artery calcifications are generally slow to develop, and their burden predicts cardiovascular disease events. In patients with diabetes mellitus, arterial calcification is accelerated and calcification activity can be detected using 18F-sodium fluoride positron emission tomography (18F-NaF PET). OBJECTIVES We aimed to determine whether vitamin K1 supplementation inhibits arterial calcification activity in individuals with diabetes mellitus. METHODS This was a post hoc analysis of the ViKCoVaC (effect of Vitamin-K1 and Colchicine on Vascular Calcification activity in subjects with Diabetes Mellitus) double-blind randomized controlled trial conducted in Perth, Western Australia. Individuals with diabetes mellitus and established coronary calcification (coronary calcium score > 10), but without clinical coronary artery disease, underwent baseline 18F-NaF PET imaging, followed by oral vitamin K1 supplementation (10 mg/d) or placebo for 3 mo, after which 18F-NaF PET imaging was repeated. We tested whether individuals randomly assigned to vitamin K1 supplementation had reduced development of new 18F-NaF PET positive lesions within the coronary arteries and aorta. RESULTS In total, 149 individuals completed baseline and follow-up imaging studies. Vitamin K1 supplementation independently decreased the odds of developing new 18F-NaF PET positive lesions in the coronary arteries (OR: 0.35; 95% CI: 0.16, 0.78; P = 0.010), aorta (OR: 0.27; 95% CI: 0.08, 0.94; P = 0.040), and in both aortic and coronary arteries (OR: 0.28; 95% CI: 0.13, 0.63; P = 0.002). CONCLUSIONS In individuals with diabetes mellitus, supplementation with 10 mg vitamin K1/d may prevent the development of newly calcifying lesions within the aorta and the coronary arteries as detected using 18F-NaF PET. Further long-term studies are needed to test this hypothesis.This trial was registered at anzctr.org.au as ACTRN12616000024448.
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Affiliation(s)
- Jamie W Bellinge
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Roslyn J Francis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Sing C Lee
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Nicola P Bondonno
- Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Marc Sim
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Joshua R Lewis
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Institute for Nutrition Research, School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia.,Centre for Kidney Research, Children's Hospital Westmead, School of Public Health, University of Sydney, Westmead, New South Wales, Australia
| | - Gerald F Watts
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Carl J Schultz
- Division of Internal Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
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17
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Sweeney T, Ogunmoroti O, Ndumele CE, Zhao D, Varma B, Allison MA, Budoff MJ, Fashanu OE, Sharma A, Bertoni AG, Michos ED. Associations of adipokine levels with the prevalence and extent of valvular and thoracic aortic calcification: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2021; 338:15-22. [PMID: 34785427 PMCID: PMC8665862 DOI: 10.1016/j.atherosclerosis.2021.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/16/2021] [Accepted: 11/02/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Extra-coronary calcification (ECC) is a marker of atherosclerosis and independently associated with cardiovascular disease (CVD). Adipokines may mediate the effect of obesity on atherosclerosis. However, the relationship of adipokines with ECC is not well-established. We examined the associations of leptin, resistin and adiponectin with ECC in a diverse community-based cohort. METHODS We performed a cross-sectional analysis of 1897 adults without clinical CVD in the MESA cohort. Serum adipokine levels and non-contrast cardiac CT scans were obtained at Exam 2 or 3 (randomly assigned). ECC was quantified by Agatston score and included calcification of the mitral annulus (MAC), aortic valve (AVC), ascending thoracic aorta (ATAC) and descending thoracic aorta (DTAC). We used multivariable regression to evaluate the associations between leptin, resistin and adiponectin [per 1 SD ln(adipokine] with ECC prevalence (score >0) and extent [ln(score+1)]. RESULTS The mean age of participants was 65 ± 10 years; 49% women. After adjusting for demographic factors, adiponectin was inversely associated with AVC prevalence and extent; leptin positively associated with MAC prevalence and extent; and resistin positively associated with ATAC prevalence and extent and DTAC extent. After adjustment for BMI and other CVD risk factors, adiponectin remained inversely associated with AVC prevalence, and resistin remained associated with greater ATAC prevalence and extent. Leptin was not associated with measures of ECC after full adjustment. No adipokine was associated with MAC after full adjustment. CONCLUSIONS We identified significant associations between select adipokines and specific markers of ECC. Adipokines may play a role in the development of systemic atherosclerosis.
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Affiliation(s)
- Ty Sweeney
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Oluseye Ogunmoroti
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chiadi E Ndumele
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Di Zhao
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bhavya Varma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego, San Diego, CA, USA
| | | | | | - Apurva Sharma
- Icahn School of Medicine, Mount Sinai Hospital, New York City, NY, USA
| | - Alain G Bertoni
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Han D, Kuronuma K, Rozanski A, Budoff MJ, Miedema MD, Nasir K, Shaw LJ, Rumberger JA, Gransar H, Blumenthal RS, Blaha MJ, Berman DS. Implication of thoracic aortic calcification over coronary calcium score regarding the 2018 ACC/AHA Multisociety cholesterol guideline: results from the CAC Consortium. Am J Prev Cardiol 2021; 8:100232. [PMID: 34467259 PMCID: PMC8385171 DOI: 10.1016/j.ajpc.2021.100232] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 07/26/2021] [Accepted: 08/02/2021] [Indexed: 12/16/2022] Open
Abstract
TAC in segments of the ascending and descending thoracic aorta can be assessed by routine CAC scanning. TAC assessment with the threshold of 300 improved risk prediction and reclassification for CVD mortality when added to the ASCVD risk score and CAC. TAC >300 may improve patient selection for those who would benefit more strongly from statin use, from intermediate ASCVD risk patients who should consider a statin (CAC=1-100), and those where a statin is not recommended (CAC=0).
Objective TAC is associated with an increased atherosclerotic cardiovascular disease (ASCVD) risk, but it is unclear how to interpret thoracic aortic calcification (TAC) findings in conjunction with ASCVD risk and coronary artery calcium (CAC) score according to 2018 ACC/AHA Multisociety cholesterol guidelines. We evaluate the incremental value of thoracic aortic calcification TAC over CAC for predicting and reclassifying ASCVD mortality risk. Method The study included 30,630 asymptomatic individuals (mean age: 55 ± 8 years, male: 64%) from the CAC Consortium. TAC was categorized as TAC 0, 1-300, and >300. Patients were categorized as low (<5%), borderline (5–7.5%), intermediate (7.5–20%), or high (≥20%) 10-year ASCVD risk according to the Pooled Cohorts Equation. In the intermediate risk group, the utility of TAC beyond CAC for statin eligibility was assessed according to the guideline. CAC was categorized as CAC=0 (no statin), CAC 1-100 (favors statin), or CAC>100 (initiate stain). Results During the median 11.2 years (IQR 9.2–12.4) follow-up, 345 (1.1%) CVD deaths occurred. TAC>300 was associated with increased CVD mortality after adjusting for ASCVD risk and CAC (HR:4.72, 95% CI: 3.39–6.57, p<0.001). In borderline and intermediate risk groups, TAC improved discrimination when added to a model included ASCVD risk and CAC (C-statistic: 0.77 vs. 0.68 in borderline group; 0.67 vs. 0.63 in intermediate group, both p < 0.05). The addition of TAC over CAC improved risk reclassification in borderline, intermediate and high-risk groups (categorical net reclassification index: 0.40, 0.29, and 0.49, respectively, all p < 0.001). Of intermediate risk participants for whom consideration of CAC was recommended based on the guideline, TAC >300 was associated with an increased CVD mortality risk across each statin eligibility group (all p < 0.001, compared to TAC 0). Conclusion TAC was independently associated with CVD death. Among individuals with borderline or intermediate ASCVD risk, a TAC threshold of 300 may provide added prognostic and reclassification value beyond the current guideline-based approach.
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Affiliation(s)
- Donghee Han
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Keiichiro Kuronuma
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York, United States
| | - Matthew J Budoff
- Department of Medicine, Harbor-UCLA Medical Center, University of California Los Angeles, Los Angeles, CA, United States
| | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Khurram Nasir
- Division Cardiovascular Prevention and Wellness, Houston Methodist Hospital, Houston, TX, United States
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York United States
| | | | - Heidi Gransar
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Johns Hopkins University, Baltimore, MD, United States
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048, United States
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19
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Akbay E, Çoner A, Akinci S, Adar A, Çakan F, Müderrisoğlu H. Aortic arch calcification: a novel parameter for prediction of masked hypertension. Blood Press Monit 2021; 26:257-262. [PMID: 33734125 DOI: 10.1097/mbp.0000000000000529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Masked hypertension is directly related to increased cardiovascular morbidity and mortality but remains underdiagnosed in clinical practice. The aim of the study was to search the role of aortic arch calcification (AAC) in the diagnosis of masked hypertension. METHODS AND RESULTS Among the patients who underwent ambulatory blood pressure monitoring (ABPM) in our clinic, those with office blood pressure (OBP) <140/90 mmHg were included in the study population. According to OBP, they were divided into two groups as normal (<130/85 mmHg) and high normal (130-139/85-89 mmHg) OBP groups. Subjects were also investigated for the presence of masked hypertension with ABPM and searched in masked hypertension and control groups. Masked hypertension was defined as in the latest 2017 ACC/AHA Hypertension guideline and was diagnosed as the daytime BP ≥ 135/85 mmHg and nighttime BP ≥ 120/70 mmHg. AAC was evaluated on direct X-ray telecardiography. Diagnosis of masked hypertension was searched depending on the presence of AAC and OBP measurements as well. A total of 216 volunteers were involved in the study [mean age 45.2 ± 12.2 years; female gender 120 (55.5%)]. One hundred ten volunteers (50.9%) had masked hypertension according to the ABPM. AAC was significantly more common in the masked hypertension group (44.5% vs. 26.4%) (P = 0.005). AAC had a positive predictive value of 79% in those with high normal OBP in the diagnosis of masked hypertension, and also AAC had a negative predictive value of 74% in those with normal OBP. CONCLUSION AAC can be used as a reliable diagnostic tool to exclude and predict masked hypertension during office examination.
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Affiliation(s)
- Ertan Akbay
- Department of Cardiology, Baskent University Hospital, Alanya Medical and Research Center, Alanya
| | - Ali Çoner
- Department of Cardiology, Baskent University Hospital, Alanya Medical and Research Center, Alanya
| | - Sinan Akinci
- Department of Cardiology, Baskent University Hospital, Alanya Medical and Research Center, Alanya
| | - Adem Adar
- Department of Cardiology, Faculty of Medicine, Karabük University, Karabük
| | - Fahri Çakan
- Department of Cardiology, Faculty of Medicine, Karabük University, Karabük
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20
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Edy E, Rankin AJ, Lees JS, Barrientos PH, Woodward R, Stoumpos S, Koktzoglou I, Edelman RR, Radjenovic A, Mark PB, Roditi GH. Cardiovascular magnetic resonance for the detection of descending thoracic aorta calcification in patients with end-stage renal disease. J Cardiovasc Magn Reson 2021; 23:85. [PMID: 34162405 PMCID: PMC8223384 DOI: 10.1186/s12968-021-00769-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vascular calcification is an independent predictor of cardiovascular disease in patients with chronic kidney disease. Computed tomography (CT) is the gold-standard for detecting vascular calcification. Radial volumetric-interpolated breath-hold examination (radial-VIBE), a free-breathing gradient-echo cardiovascular magnetic resonance (CMR) sequence, has advantages over CT as it is ionising radiation-free. However, its capability in detecting thoracic aortic calcification (TAC) has not been investigated. This study aims to compare radial-VIBE to CT for the detection of TAC in the descending aorta of patients with end-stage renal disease (ESRD) using semi-automated methods, and to investigate the association between TAC and coronary artery calcification (CAC). METHODS Paired cardiac CT and radial-VIBE CMR scans from ESRD patients participating in 2 prospective studies were obtained. Calcification volume was quantified using semi-automated methods in a 9 cm segment of the thoracic aorta. Correlation and agreement between TAC volume measured on CMR and CT were assessed with Spearman's correlation coefficient (ρ), linear regression, Bland-Altman plots and intraclass correlation coefficient (ICC). Association between CAC Agatston score and TAC volume determined by CT and CMR was measured with Spearman's correlation coefficient. RESULTS Scans from 96 participants were analysed. Positive correlation was found between CMR and CT calcification volume [ρ = 0.61, 95% confidence interval (CI) 0.45-0.73]. ICC for consistency was 0.537 (95% CI 0.378-0.665). Bland-Altman plot revealed that compared to CT, CMR volumes were systematically higher at low calcification volume, and lower at high calcification volume. CT did not detect calcification in 41.7% of participants, while radial-VIBE CMR detected signal which the semi-quantitative algorithm reported as calcification in all of those individuals. Instances of suboptimal radial-VIBE CMR image quality were deemed to be the major contributors to the discrepancy. Correlations between CAC Agatston score and TAC volume measured by CT and CMR were ρ = 0.404 (95% CI 0.214-0.565) and ρ = 0.211 (95% CI 0.008-0.396), respectively. CONCLUSION Radial-VIBE CMR can detect TAC with strong positive association to CT, albeit with the presence of proportional bias. Quantification of vascular calcification by radial-VIBE remains a promising area for future research, but improvements in image quality are necessary.
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Affiliation(s)
- Elbert Edy
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
| | - Alastair J Rankin
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Jennifer S Lees
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Pauline Hall Barrientos
- Department of Clinical Physics and Bioengineering, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Rosemary Woodward
- Clinical Research Imaging, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Sokratis Stoumpos
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Ioannis Koktzoglou
- Radiology, NorthShore University HealthSystem, Evanston, IL, 60201, USA
- Radiology, University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Robert R Edelman
- Radiology, NorthShore University HealthSystem, Evanston, IL, 60201, USA
- Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Aleksandra Radjenovic
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
| | - Patrick B Mark
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- Renal and Transplant Unit, Queen Elizabeth University Hospital, Glasgow, UK
| | - Giles H Roditi
- Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK
- Department of Radiology, NHS Greater Glasgow and Clyde, Glasgow, UK
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21
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Jan YT, Tsai PS, Longenecker CT, Lin DC, Yun CH, Sung KT, Liu CC, Kuo JY, Hung CL, Wu TH, Lin JL, Hou CJY, Tsai CT, Chien CY, So A. Thoracic Aortic Calcification and Pre-Clinical Hypertension by New 2017 ACC/AHA Hypertension Guidelines. Diagnostics (Basel) 2021; 11:diagnostics11061027. [PMID: 34205037 PMCID: PMC8226485 DOI: 10.3390/diagnostics11061027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/06/2021] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
The recently revised 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension (HTN) guidelines employ a lower blood pressure threshold to define HTN, aiming for earlier prevention of HTN-related cardiovascular diseases (CVD). Thoracic aortic calcification (TAC), a new surrogate marker of aging and aortic medial layer degeneration, and different stages of HTN, according to the 2017 ACC/AHA HTN guidelines, remain unknown. We classified 3022 consecutive asymptomatic individuals enrolled into four HTN categories using the revised 2017 ACC/AHA guidelines: normal blood pressure (NBP), elevated blood pressure (EBP), and stage 1 (S1) and stage 2 (S2) HTN. The coronary artery calcification score and TAC metrics (total Agaston TAC score, total plaque volume (mm3), and mean density (Hounsfield units, HU)) were measured using multi-detector computed tomography. Compared to NBP, a graded and significant increase in the TAC metrics was observed starting from EBP and S1 and S2 HTN, using the new 2017 ACC/AHA guidelines (NBP as reference; all trends: p < 0.001). These differences remained consistent after being fully adjusted. Older age (>50 years), S1 and S2 HTN, prevalent diabetes, and chronic kidney disease (<60 mL/min/1.73 m2) are all independently contributing factors to higher TAC risk using multivariate stepwise logistic regressions (all p ≤ 0.001). The optimal cutoff values of systolic blood pressure, diastolic blood pressure, and pulse pressure were 121, 74, and 45 mmHg, respectively, for the presence of TAC after excluding subjects with known CVD and ongoing HTN medication treatment. Our data showed that the presence of TAC starts at a stage of elevated blood pressure not categorized as HTN from the updated 2017 ACC/AHA hypertension guidelines.
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Affiliation(s)
- Ya-Ting Jan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Pei-Shan Tsai
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | | | - Dao-Chen Lin
- Division of Endocrine and metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan;
- Department of Radiology, Taipei Veterans General Hospital, Taipei 112, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chun-Ho Yun
- Department of Radiology, MacKay Memorial Hospital, Taipei 104, Taiwan;
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
| | - Kuo-Tzu Sung
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chuan-Chuan Liu
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
- Health Evaluation Center, MacKay Memorial Hospital, Taipei 104, Taiwan
- Department of Medical Technology, Yuanpei University of Science and Technology, Hsin-Chu City 306, Taiwan
| | - Jen-Yuan Kuo
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
- Graduate Institute of Health Care Organization Administration, College of Public Health National Taiwan University, Taipei 100, Taiwan;
| | - Tung-Hsin Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (Y.-T.J.); (P.-S.T.); (K.-T.S.)
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Jiun-Lu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan;
| | - Charles Jia-Yin Hou
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Cheng-Ting Tsai
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei 104, Taiwan
| | - Chen-Yen Chien
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan; (J.-Y.K.); (C.-L.H.); (C.J.-Y.H.); (C.-T.T.)
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 112, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, MacKay Memorial Hospital, Taipei 104, Taiwan
- Correspondence: (T.-H.W.); (C.-Y.C.)
| | - Aaron So
- Imaging Program, Lawson Health Research Institute, London, ON N6C 2R5, Canada;
- Department of Medical Biophysics, University of Western Ontario, London, ON N6A 3K7, Canada
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22
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Obisesan OH, Osei AD, Berman D, Dardari ZA, Uddin SMI, Dzaye O, Orimoloye OA, Budoff MJ, Miedema MD, Rumberger J, Mirbolouk M, Boakye E, Johansen MC, Rozanski A, Shaw LJ, Han D, Nasir K, Blaha MJ. Thoracic Aortic Calcium for the Prediction of Stroke Mortality (from the Coronary Artery Calcium Consortium). Am J Cardiol 2021; 148:16-21. [PMID: 33667445 PMCID: PMC8113160 DOI: 10.1016/j.amjcard.2021.02.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 12/12/2022]
Abstract
Thoracic aortic calcium(TAC) is an important marker of extracoronary atherosclerosis with established predictive value for all-cause mortality. We sought to explore the predictive value of TAC for stroke mortality, independent of the more established coronary artery calcium (CAC) score. The CAC Consortium is a retrospectively assembled database of 66,636 patients aged ≥18 years with no previous history of cardiovascular disease, baseline CAC scans for risk stratification, and follow-up for 12 ± 4 years. CAC scans capture the adjacent thoracic aorta, enabling assessment of TAC from the same images. TAC was available in 41,066 (62%), and was primarily analyzed as present or not present. To account for competing risks for nonstroke death, we utilized multivariable-adjusted Fine and Gray competing risk regression models adjusted for traditional cardiovascular risk factors and CAC score. The mean age of participants was 53.8 ± 10.3 years, with 34.4% female. There were 110 stroke deaths during follow-up. The unadjusted subdistribution hazard ratio (SHR) for stroke mortality in those who had TAC present compared with those who did not was 8.80 (95% confidence interval [CI]: 5.97, 12.98). After adjusting for traditional risk factors and CAC score, the SHR was 2.21 (95% CI:1.39,3.49). In sex-stratified analyses, the fully adjusted SHR for females was 3.42 (95% CI: 1.74, 6.73) while for males it was 1.55 (95% CI: 0.83, 2.90). TAC was associated with stroke mortality independent of CAC and traditional risk factors, more so in women. The presence of TAC appears to be an independent risk marker for stroke mortality.
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Affiliation(s)
| | - Albert D Osei
- Medstar Union Memorial Hospital, Baltimore, Maryland
| | | | - Zeina A Dardari
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Omar Dzaye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, California
| | | | | | | | - Ellen Boakye
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Alan Rozanski
- Division of Cardiology, Mount Sinai St. Luke's Hospital, New York
| | | | - Donghee Han
- Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Michael J Blaha
- Johns Hopkins University School of Medicine, Baltimore, Maryland.
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23
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Yao H, Sun Z, Zang G, Zhang L, Hou L, Shao C, Wang Z. Epidemiological Research Advances in Vascular Calcification in Diabetes. J Diabetes Res 2021; 2021:4461311. [PMID: 34631895 PMCID: PMC8500764 DOI: 10.1155/2021/4461311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/27/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
Vascular calcification is the transformation of arterial wall mesenchymal cells, particularly smooth muscle cells (SMCs), into osteoblast phenotypes by various pathological factors. Additionally, vascular transformation mediates the abnormal deposition of calcium salts in the vascular wall, such as intimal and media calcification. Various pathological types have been described, such as calcification and valve calcification. The incidence of vascular calcification in patients with diabetes is much higher than that in nondiabetic patients, representing a critical cause of cardiovascular events in patients with diabetes. Because basic research on the clinical transformation of vascular calcification has yet to be conducted, this study systematically expounds on the risk factors for vascular calcification, vascular bed differences, sex differences, ethnic differences, diagnosis, severity assessments, and treatments to facilitate the identification of a new entry point for basic research and subsequent clinical transformation regarding vascular calcification and corresponding clinical evaluation strategies.
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Affiliation(s)
- Haipeng Yao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhen Sun
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Guangyao Zang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lili Zhang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Lina Hou
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Chen Shao
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
| | - Zhongqun Wang
- Department of Cardiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China
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24
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Salam YM, Guileyardo JM, Roberts WC. Relation of the quantity of coronary calcium to the quantity of aortic calcium determined from radiographs at necropsy. Proc (Bayl Univ Med Cent) 2020; 34:247-249. [PMID: 33678957 DOI: 10.1080/08998280.2020.1847948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Described herein are radiographs of the heart and aorta at necropsy after "cleaning" these structures of extraneous tissue. As a consequence, the quantity of calcium is far more discernible than by computed tomography or magnetic resonance or ultrasonic imaging during life or before extraneous tissues are removed at necropsy. We illustrate these radiographic images at necropsy in three patients to show that the relative amount of calcific deposits in the coronary arteries and aorta may be subjectively similar or one of these structures may have far more calcium in the arterial walls than the other. The reasons for these differences are unclear.
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Affiliation(s)
- Yusuf M Salam
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas.,University of Texas Health School of Public Health, Dallas, Texas
| | | | - William C Roberts
- Baylor Scott & White Heart and Vascular Institute, Dallas, Texas.,Department of Pathology, Baylor University Medical Center, Dallas, Texas.,Department of Internal Medicine (Cardiology), Baylor University Medical Center, Dallas, Texas
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25
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Kälsch H, Mahabadi AA, Moebus S, Reinsch N, Budde T, Hoffmann B, Stang A, Jöckel KH, Erbel R, Lehmann N. Association of progressive thoracic aortic calcification with future cardiovascular events and all-cause mortality: ability to improve risk prediction? Results of the Heinz Nixdorf Recall (HNR) study. Eur Heart J Cardiovasc Imaging 2020; 20:709-717. [PMID: 30508179 DOI: 10.1093/ehjci/jey173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/16/2016] [Indexed: 11/12/2022] Open
Abstract
AIMS Thoracic aortic calcification (TAC) is measured by computed tomography (CT). We investigated the association of TAC-progression with incident cardiovascular (CV) events and all-cause mortality in a population-based cohort and to determine its predictive value for these endpoints. METHODS AND RESULTS In 3080 participants (45-74 years, 53.6% women), risk factors and TAC via CT were measured at baseline and at a second examination after 5.1 ± 0.3 years. Hard coronary, hard CV events as well as CV events including revascularization and all-cause mortality were recorded during a follow-up time of 7.8 ± 2.2 years after the second CT scan. Cox regression analysis determined the association of TAC-progression with observed endpoints. The predictive value of TAC-progression was assessed using Harrell's C index. We observed 81 hard coronary, 154 hard CV, 231 CV events including revascularization, and 266 deaths. In the crude analysis, event rates increased continuously with the level of TAC-change over 5 years for all endpoints. After adjustment, the significant association of TAC-progression with hard CV events [hazard ratio (HR) 1.28, 95% confidence interval (CI) 1.05-1.57] and all-cause mortality (HR 1.34, 95% CI 1.14-1.58) persisted, per one standard deviation increase in TAC-progression (log(TAC + 1)). Regarding aortic segments separately, HRs were consistently higher for descending thoracic aorta. When adding TAC (baseline and progression) to the model containing classical risk factors and coronary artery calcification (CAC), Harrell's C indices did not increase for any of the observed endpoints. CONCLUSION TAC-progression is associated with incident hard CV events and all-cause mortality but fails to improve event prediction over CAC.
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Affiliation(s)
- Hagen Kälsch
- Department of Cardiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Str. 21, Essen, Germany.,University of Witten/Herdecke, Department of Health, Alfred-Herrhausen-Straße 50, Witten, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
| | - Susanne Moebus
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
| | - Nico Reinsch
- University of Witten/Herdecke, Department of Health, Alfred-Herrhausen-Straße 50, Witten, Germany.,Department of Electrophysiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Str. 21, Essen, Germany
| | - Thomas Budde
- Department of Cardiology, Alfried Krupp Krankenhaus, Alfried-Krupp-Str. 21, Essen, Germany
| | - Barbara Hoffmann
- Institute for Occupational, Social and Environmental Medicine, Centre for Health and Society, Medical Faculty, University of Düsseldorf, Gurlittstr. 55 / II, 40223 Düsseldorf, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
| | - Nils Lehmann
- Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Holsterhauser Str. 55, Essen, Germany
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Eelderink C, Te Velde-Keyzer CA, Frenay ARS, Vermeulen EA, Bachtler M, Aghagolzadeh P, van Dijk PR, Gansevoort RT, Vervloet MG, Hillebrands JL, Bakker SJL, van Goor H, Pasch A, de Borst MH. Serum Calcification Propensity and the Risk of Cardiovascular and All-Cause Mortality in the General Population: The PREVEND Study. Arterioscler Thromb Vasc Biol 2020; 40:1942-1951. [PMID: 32493170 DOI: 10.1161/atvbaha.120.314187] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Vascular calcification contributes to the cause of cardiovascular disease. The calciprotein particle maturation time (T50) in serum, a measure of calcification propensity, has been linked with adverse outcomes in patients with chronic kidney disease, but its role in the general population is unclear. We investigated whether serum T50 is associated with cardiovascular mortality in a large general population-based cohort. Approach and Results: The relationship between serum T50 and cardiovascular mortality was studied in 6231 participants of the PREVEND (Prevention of Renal and Vascular End-Stage Disease) cohort. All-cause mortality was the secondary outcome. Mean (±SD) age was 53±12 years, 50% were male, and mean serum T50 was 329±58 minutes. A shorter serum T50 is indicative of a higher calcification propensity. Serum T50 was inversely associated with circulating phosphate, age, estimated glomerular filtration rate, and alcohol consumption, whereas plasma magnesium was positively associated with serum T50 (P<0.001, total multivariable model R2=0.281). During median (interquartile range) follow-up for 8.3 (7.8-8.9) years, 364 patients died (5.8%), of whom 95 (26.1%) died from a cardiovascular cause. In multivariable Cox proportional hazard models, each 60 minutes decrease in serum T50 was independently associated with a higher risk of cardiovascular mortality (fully adjusted hazard ratio [95% CI], 1.22 [1.04-1.36], P=0.021). This association was modified by diabetes mellitus; stratified analysis indicated a more pronounced association in individuals with diabetes mellitus. CONCLUSIONS Serum T50 is independently associated with an increased risk of cardiovascular mortality in the general population and thus may be an early and potentially modifiable risk marker for cardiovascular mortality.
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Affiliation(s)
- Coby Eelderink
- From the Division of Nephrology (C.E., C.A.t.V.-K., R.T.G., S.J.L.B., M.H.d.B.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Charlotte A Te Velde-Keyzer
- From the Division of Nephrology (C.E., C.A.t.V.-K., R.T.G., S.J.L.B., M.H.d.B.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Anne-Roos S Frenay
- Department of Internal Medicine and Division of Pathology, Department of Pathology and Medical Biology (A.-R.S.F., J.-L.H., H.v.G.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Emma A Vermeulen
- Department of Nephrology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands (E.A.V., M.G.V.)
| | - Matthias Bachtler
- Department of Clinical Research, University Hospital Bern (Inselspital), Switzerland (M.B., P.A.)
| | - Parisa Aghagolzadeh
- Department of Clinical Research, University Hospital Bern (Inselspital), Switzerland (M.B., P.A.).,Department of Cardiovascular Medicine, University of Lausanne Medical School, Switzerland (P.A.)
| | - Peter R van Dijk
- Division of Endocrinology (P.R.v.D.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ronald T Gansevoort
- From the Division of Nephrology (C.E., C.A.t.V.-K., R.T.G., S.J.L.B., M.H.d.B.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Marc G Vervloet
- Department of Nephrology and Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands (E.A.V., M.G.V.)
| | - Jan-Luuk Hillebrands
- Department of Internal Medicine and Division of Pathology, Department of Pathology and Medical Biology (A.-R.S.F., J.-L.H., H.v.G.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Stephan J L Bakker
- From the Division of Nephrology (C.E., C.A.t.V.-K., R.T.G., S.J.L.B., M.H.d.B.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Harry van Goor
- Department of Internal Medicine and Division of Pathology, Department of Pathology and Medical Biology (A.-R.S.F., J.-L.H., H.v.G.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Andreas Pasch
- Calciscon AG, Nidau, Switzerland (A.P.).,Department of Physiology and Pathophysiology, Johannes Kepler University Linz, Austria (A.P.)
| | - Martin H de Borst
- From the Division of Nephrology (C.E., C.A.t.V.-K., R.T.G., S.J.L.B., M.H.d.B.), University of Groningen, University Medical Center Groningen, The Netherlands
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Fujimoto K, Shioi A, Miki Y, Kakutani Y, Morioka T, Shoji T, Emoto M, Inaba M. Adenosine Attenuates Aortic Smooth Muscle Cell Calcification through A 3 Adenosine Receptor. TOHOKU J EXP MED 2020; 249:275-283. [PMID: 31875581 DOI: 10.1620/tjem.249.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Vascular calcification is a typical feature of atherosclerosis and is associated with adverse cardiovascular events such as myocardial infarction and stroke. Several studies have suggested that adenosine, an ATP metabolite may function as an endogenous regulator of arterial calcification. However, its effects on vascular smooth muscle cell calcification have not been clarified. In this study, we investigated the inhibitory effects of adenosine on vascular calcification in vitro by utilizing the culture of human aortic smooth muscle cells (HASMCs). Osteoblastic differentiation of HASMCs was induced by the treatment with oncostatin M and osteogenic differentiation medium. Adenosine and its metabolically stable analogue, 2-chloroadenosine (CADO) significantly reduced matrix mineralization and alkaline phosphatase (ALP) activities in HASMCs. The mRNA expression of tissue non-specific alkaline phosphatase (TNAP) was down-regulated by adenosine and CADO, but the mRNA expression of other osteoblastic differentiation markers, such as Runt-related transcription factor 2 (RUNX2) and bone sialoprotein (BSP)-II, was not significantly affected by these two reagents. Among the adenosine receptor (AR) subtype-selective agonists used, only IB-MECA (A3 AR-selective agonist) significantly decreased in vitro mineralization and ALP activities in HASMCs, but not with CCPA (A1 AR-selective agonist), CGS21680 (A2a AR-selective agonist), or BAY60-6583 (A2b AR-selective agonist). Importantly, IB-MECA also down-regulated expression of TNAP mRNA. Finally, knockdown of A3 AR, but not A1 AR, A2a AR, or A2b AR, significantly reversed the inhibitory actions of adenosine, CADO, or IB-MECA on in vitro calcification and ALP activities in HASMCs. These data suggest that adenosine attenuates HASMC calcification through A3 AR.
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Affiliation(s)
- Kenta Fujimoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Atsushi Shioi
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Yuya Miki
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Yoshinori Kakutani
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine.,Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine
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28
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Heidari H, Ran H, Spinka G, Hengstenberg C, Binder T, Goliasch G, Schneider M. Atherosclerotic plaque detected by transesophageal echocardiography is an independent predictor for all-cause mortality. Int J Cardiovasc Imaging 2020; 36:1437-1443. [PMID: 32301042 PMCID: PMC7381477 DOI: 10.1007/s10554-020-01840-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 12/03/2022]
Abstract
Atherosclerotic lesions in the great arteries are frequent findings in the elderly. Numerous studies have shown their strong predictive value for cardiovascular disease, embolic events, and mortality. We sought to determine the risk of all-cause mortality depending on the localization of plaques in the thoracic aorta evaluated by transesophageal echocardiography (TEE). A total of 2,054 patients (median age 65 years, interquartile range 52–73; 58% men) who underwent a TEE examination between 01/2007 and 03/2015 were retrospectively analyzed. For each patient, the presence of atherosclerotic lesions in the ascending aorta, the aortic arch, and in the descending aorta, as well as cardiovascular risk factors and survival were documented. Median follow-up period was 48 months (interquartile range 38–58). Multivariate Cox regression analysis indicated plaque in the ascending aorta (HR of 1.36, 95% CI 1.01–1.83, P = 0.046), the aortic arch (HR of 1.78, 95% CI 1.29–2.45, P < 0.001), the descending aorta (HR of 2.01, 95% CI 1.54–2.77, P < 0.001), and plaque in any part of the thoracic aorta (HR of 1.84, 95% CI 1.42–2.4, P < 0.001), as independent predictors for all-cause mortality after adjusting for age, sex, arterial hypertension, hyperlipidemia, smoking, and diabetes. In this study, we could demonstrate that more than mild plaque at any site of the thoracic aorta predicts all-cause mortality. Assessment of atherosclerotic lesions in all segments of the thoracic aorta should be part of every routine TEE examination.
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Affiliation(s)
- Houtan Heidari
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Hong Ran
- Department of Echocardiography, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
| | - Georg Spinka
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Thomas Binder
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria
| | - Matthias Schneider
- Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Wien, Austria.
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29
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Craiem D, Casciaro M, Pascaner A, Soulat G, Guilenea F, Sirieix ME, Simon A, Mousseaux E. Association of calcium density in the thoracic aorta with risk factors and clinical events. Eur Radiol 2020; 30:3960-3967. [PMID: 32100088 DOI: 10.1007/s00330-020-06708-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/13/2020] [Accepted: 02/04/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES In the ascending aorta, calcification density was independently and inversely associated with cardiovascular disease (CVD) risk prediction. Until now, the density of thoracic aorta calcium (TAC) was estimated as the Agatston score divided by the calcium area (DAG). We thought to analyze TAC density in a full Hounsfield unit (HU) range and to study its association with TAC volume, traditional risk factors, and CVD events. METHODS Non-enhanced CT images of 1426 patients at intermediate risk were retrospectively reviewed. A calcium density score was estimated as the average of the maximum HU attenuation in all calcified plaques of the entire thoracic aorta (DAV). RESULTS During a mean 4.0 years follow-up, there were 26 events for a total of 674 patients with TAC > 0. TAC volume and DAV were positively correlated (R = 0.72). The median DAV value was 457 HU (IQ 323-603 HU) and was exponentially related to DAG (R = 0.86). DAV was inversely associated with systolic pressure (p < 0.05), pulse pressure (p < 0.01), hypertension (p < 0.05), and 10-year FRS (p < 0.001) after adjusting for TAC volume. When TAC volume and DAV were included in a logistic model, a significant improvement was shown in CVD risk estimation beyond coronary artery calcium (CAC) (AUC = 0.768 vs 0.814, p < 0.05). In multivariable Cox models, TAC volume and DAV showed an independent association with CVD. CONCLUSIONS In intermediate risk patients, TAC density was inversely associated with several risk factors after adjustment for TAC volume. A significant improvement was observed over CAC when TAC volume and density were added into the risk prediction model. KEY POINTS • Calcifications in the aorta can be non-invasively assessed using CT images • A higher calcium score is associated with a higher cardiovascular risk • Measuring the calcifications size and the density separately can improve the risk prediction.
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Affiliation(s)
- Damian Craiem
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB) Universidad Favaloro-CONICET, Solis 453, CP 1078, Buenos Aires, Argentina. .,Université Paris Descartes, Paris, France.
| | - Mariano Casciaro
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB) Universidad Favaloro-CONICET, Solis 453, CP 1078, Buenos Aires, Argentina
| | - Ariel Pascaner
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB) Universidad Favaloro-CONICET, Solis 453, CP 1078, Buenos Aires, Argentina
| | - Gilles Soulat
- Université Paris Descartes, Paris, France.,Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
| | - Federico Guilenea
- Instituto de Medicina Traslacional, Trasplante y Bioingeniería (IMeTTyB) Universidad Favaloro-CONICET, Solis 453, CP 1078, Buenos Aires, Argentina
| | | | | | - Elie Mousseaux
- Université Paris Descartes, Paris, France.,Hôpital Européen Georges Pompidou, INSERM U970, Paris, France
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30
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Shioi A, Morioka T, Shoji T, Emoto M. The Inhibitory Roles of Vitamin K in Progression of Vascular Calcification. Nutrients 2020; 12:nu12020583. [PMID: 32102248 PMCID: PMC7071387 DOI: 10.3390/nu12020583] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/17/2020] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Vitamin K is a fat-soluble vitamin that is indispensable for the activation of vitamin K-dependent proteins (VKDPs) and may be implicated in cardiovascular disease (CVD). Vascular calcification is intimately associated with CV events and mortality and is a chronic inflammatory process in which activated macrophages promote osteoblastic differentiation of vascular smooth muscle cells (VSMCs) through the production of proinflammatory cytokines such as IL-1β, IL-6, TNF-α, and oncostatin M (OSM) in both intimal and medial layers of arterial walls. This process may be mainly mediated through NF-κB signaling pathway. Vitamin K has been demonstrated to exert anti-inflammatory effects through antagonizing NF-κB signaling in both in vitro and in vivo studies, suggesting that vitamin K may prevent vascular calcification via anti-inflammatory mechanisms. Matrix Gla protein (MGP) is a major inhibitor of soft tissue calcification and contributes to preventing both intimal and medial vascular calcification. Vitamin K may also inhibit progression of vascular calcification by enhancing the activity of MGP through facilitating its γ-carboxylation. In support of this hypothesis, the procalcific effects of warfarin, an antagonist of vitamin K, on arterial calcification have been demonstrated in several clinical studies. Among the inactive MGP forms, dephospho-uncarboxylated MGP (dp-ucMGP) may be regarded as the most useful biomarker of not only vitamin K deficiency, but also vascular calcification and CVD. There have been several studies showing the association of circulating levels of dp-ucMGP with vitamin K intake, vascular calcification, mortality, and CVD. However, additional larger prospective studies including randomized controlled trials are necessary to confirm the beneficial effects of vitamin K supplementation on CV health.
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Affiliation(s)
- Atsushi Shioi
- Department of Vascular Medicine and Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan;
- Correspondence: ; Tel.: +81666453931
| | - Tomoaki Morioka
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-85858, Japan; (T.M.); (M.E.)
| | - Tetsuo Shoji
- Department of Vascular Medicine and Vascular Science Center for Translational Research, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan;
| | - Masanori Emoto
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka 545-85858, Japan; (T.M.); (M.E.)
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31
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Desai MY, Cremer PC, Schoenhagen P. Thoracic Aortic Calcification: Diagnostic, Prognostic, and Management Considerations. JACC Cardiovasc Imaging 2019; 11:1012-1026. [PMID: 29976300 DOI: 10.1016/j.jcmg.2018.03.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 12/18/2022]
Abstract
Thoracic aortic calcification (TAC) is associated with adverse cardiovascular outcomes, and for the cardiovascular imager, is predominantly encountered in 4 settings: 1) incidentally, for example, during a coronary artery calcium scan; 2) as part of dedicated screening; 3) in the evaluation of an embolic event; or 4) in procedural planning. This review focuses on TAC in these contexts. Within atherosclerosis, TAC is common, variable in extent, and begins in the intima with a patchy distribution. In metabolic disorders, aortitis, and radiation-associated cardiovascular disease, calcification preferentially involves the media and is often more concentric. As an incidental finding, atherosclerotic TAC provides limited incremental discriminative value, and current data do not support screening. After an embolic event, the demonstration of thoracic atheroma provides diagnostic clarity, but has limited treatment implications. Before any procedure, the plan often changes if the most severe form of TAC, a porcelain aorta, is discovered.
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Affiliation(s)
- Milind Y Desai
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Paul C Cremer
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Cardiovascular Section, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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32
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Villena García AC, Cardo AG, Hidalgo CM, Palomo L, Lillo E, Espíldora J, Trigo JM, Chaparro MÁS, Valdivielso P. 18FDG PET/CT & arterial inflammation: predicting cardiovascular events in lung cancer. QJM 2019; 112:401-407. [PMID: 30715503 DOI: 10.1093/qjmed/hcz036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND 18F-FDG PET/CT predicts cardiovascular disease. To analyze the predictive value of cardiovascular events from inflammation and arterial calcification in patients who underwent an 18F-FDG PET/CT for lung cancer. METHODS A retrospective study of 274 patients with primary lung neoplasia. We determined: (i) TBR (target-to-background ratio), and (ii) the calcium score, at eight common arterial segments. We took as arteriosclerosis, a TBR ≥1.6 and ≥15 Calcium Score sum. We registered cardiovascular risk factors, comorbidities, histology, stage, treatment, status at the last clinical review, cause of death and cardiovascular event during the follow-up. RESULTS The territory presenting the greatest uptake of 18F-FDG, was the thoracic aorta with an average of 1.77 (± 0.27 TBR) in the aortic arch, while the greatest degree of calcification was obtained in the abdominal aorta (52% with a Calcium Score ≥ 3). 24% of the patients presented a sum Calcium Score ≥15, and 17% a TBR ≥1.6. Patients with high TBR, (17%), had not a higher frequency of cardiovascular comorbidities beforehand, nor did they in the follow-up. However, those with a sum Calcium Score ≥15 (24%), were older, had more cardiovascular risk factors and ischemic events during follow-up. The calcium score, but not the TBR, predicted the emergence of a cardiovascular event (HR 4.9 IC95% 2.1-9.1, P < 0.05). CONCLUSION In our cohort, a high Calcium Score was an independent predictor for developing cardiovascular events.
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Affiliation(s)
- A C Villena García
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | - A Gutierrez Cardo
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | - C M Hidalgo
- Department of Medicine and Dermatology, University of Malaga, Málaga, Spain
| | - L Palomo
- Department of Medicine and Dermatology, University of Malaga, Málaga, Spain
| | - E Lillo
- Nuclear Medicine, Molecular imaging department, Centro de Investigaciones Médico Sanitarias (CIMES)
| | | | - J Manuel Trigo
- Oncology, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - M Á Sánchez Chaparro
- Internal Medicine, Hospital Clínico Universitario Virgen de la Victoria, Department of Medicine and Dermatology, Insituto de Investigaciones Biomédicas de Málaga (IBIMA), University of Malaga, Málaga, Spain
| | - P Valdivielso
- Internal Medicine, Hospital Clínico Universitario Virgen de la Victoria, Department of Medicine and Dermatology, Insituto de Investigaciones Biomédicas de Málaga (IBIMA), University of Malaga, Málaga, Spain
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33
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Ezeigwe A, Fashanu OE, Zhao D, Budoff MJ, Otvos JD, Thomas IC, Mora S, Tibuakuu M, Michos ED. The novel inflammatory marker GlycA and the prevalence and progression of valvular and thoracic aortic calcification: The Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2019; 282:91-99. [PMID: 30716566 PMCID: PMC6401213 DOI: 10.1016/j.atherosclerosis.2019.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 12/09/2018] [Accepted: 01/10/2019] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND AIMS GlycA is a novel composite biomarker of systemic inflammation reflecting posttranslational glycosylation of acute phase reactants. GlycA has been associated with coronary artery calcium, cardiovascular disease (CVD) events and mortality. Vascular calcifications outside of the coronary arteries are risk markers of CVD and mortality. Whether GlycA is linked to extra-coronary calcifications (ECC) is not well established. METHODS We studied 6462 MESA participants free of clinical CVD who had plasma GlycA measured at baseline. ECCs [calcification in aortic valve (AVC), mitral annulus (MAC), ascending and descending thoracic aorta (ATAC, DTAC)] were ascertained at baseline and follow-up visit (median 2.3-yrs later) by cardiac CT. Poisson regression models with robust variance estimation assessed associations of GlycA with prevalent and incident ECC. Linear mixed models assessed the cross-sectional and 2-year change in ECC. Models were adjusted for demographic and lifestyle factors. RESULTS In cross-sectional analysis, GlycA (per SD increment) was positively associated with prevalent AVC, ATAC and DTAC with adjusted prevalence ratios (95% CI) of 1.08 (1.01-1.14), 1.18 (1.03-1.34) and 1.10 (1.06-1.14), respectively. There was also a significant association between GlycA and baseline extent of both ATAC and DTAC. Longitudinally, GlycA was positively associated with incident MAC and DTAC, with adjusted incidence ratios of 1.18 (1.03-1.37) and 1.17 (1.07-1.28), respectively. GlycA was also associated with 2-year change in MAC and DTAC extent. CONCLUSIONS In this diverse cohort free from clinical CVD, we found GlycA was positively associated with prevalent and incident ECC measures, in particular for progression of MAC and DTAC.
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Affiliation(s)
- Angelica Ezeigwe
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Oluwaseun E Fashanu
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Agnes Hospital, Baltimore, MD, USA
| | - Di Zhao
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - James D Otvos
- Laboratory Corporation of America Holdings (LabCorp), Morrisville, NC, USA
| | - Isac C Thomas
- Department of Medicine, Division of Cardiovascular Medicine, University of California San Diego, San Diego, CA, USA
| | - Samia Mora
- Center for Lipid Metabolomics, Divisions of Preventive and Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Martin Tibuakuu
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Medicine, St. Luke's Hospital, Chesterfield, MO, USA
| | - Erin D Michos
- The Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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34
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Regan EA, Lowe KE, Make BJ, Lynch DA, Kinney GL, Budoff MJ, Mao SS, Dyer D, Curtis JL, Bowler RP, Han MK, Beaty TH, Hokanson JE, Kern E, Humphries S, Curran-Everett D, van Beek EJR, Silverman EK, Crapo JD, Finigan JH. Identifying Smoking-Related Disease on Lung Cancer Screening CT Scans: Increasing the Value. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2019; 6:233-245. [PMID: 31342730 DOI: 10.15326/jcopdf.6.3.2018.0142] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Lung cancer screening (LCS) via chest computed tomography (CT) scans can save lives by identifying early-stage tumors. However, most smokers die of comorbid smoking-related diseases. LCS scans contain information about smoking-related conditions that is not currently systematically assessed. Identifying these common comorbid diseases on CT could increase the value of screening with minimal impact on LCS programs. We determined the prevalence of 3 comorbid diseases from LCS eligible scans and quantified related adverse outcomes. Methods We studied COPD Genetic Epidemiology study (COPDGene®) participants (n=4078) who met criteria for LCS screening at enrollment (age > 55 years, and < 80 years, > 30 pack years smoking, current smoker or former smoker within 15 years of smoking cessation). CT scans were assessed for coronary artery calcification (CAC), emphysema, and vertebral bone density. We tracked the following clinically significant events: myocardial infarctions (MIs), strokes, pneumonia, respiratory exacerbations, and hip and vertebral fractures. Results Overall, 77% of eligible CT scans had one or more of these diagnoses identified. CAC (> 100 mg) was identified in 51% of scans, emphysema in 44%, and osteoporosis in 54%. Adverse events related to the underlying smoking-related diseases were common, with 50% of participants reporting at least one. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46%, of participants respectively. New diagnosis of disease was associated with significantly more adverse events than in participants who did not have CT diagnoses for both osteoporosis and cardiovascular risk. Conclusions Expanded analysis of LCS CT scans identified individuals with evidence of previously undiagnosed cardiovascular disease, emphysema or osteoporosis that corresponded with adverse events. LCS CT scans can potentially facilitate diagnoses of these smoking-related diseases and provide an opportunity for treatment or prevention.
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Affiliation(s)
- Elizabeth A Regan
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado.,School of Public Health, University of Colorado, Denver
| | - Katherine E Lowe
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado.,School of Public Health, University of Colorado, Denver
| | - Barry J Make
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - David A Lynch
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | | | - Matthew J Budoff
- Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
| | - Song Shou Mao
- Division of Cardiology, Harbor-University of California-Los Angeles Medical Center, Los Angeles
| | - Debra Dyer
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - Jeffrey L Curtis
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor.,Pulmonary and Critical Care Medicine, Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Russell P Bowler
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - MeiLan K Han
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor
| | - Terri H Beaty
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Elizabeth Kern
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - Stephen Humphries
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | | | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scottland
| | - Edwin K Silverman
- Channing Division of Network Medicine, Brigham Women's Hospital, Boston, Massachusetts
| | - James D Crapo
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
| | - James H Finigan
- Division of Pulmonary Medicine National Jewish Health, Denver, Colorado
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Ngai D, Lino M, Bendeck MP. Cell-Matrix Interactions and Matricrine Signaling in the Pathogenesis of Vascular Calcification. Front Cardiovasc Med 2018; 5:174. [PMID: 30581820 PMCID: PMC6292870 DOI: 10.3389/fcvm.2018.00174] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/21/2018] [Indexed: 12/15/2022] Open
Abstract
Vascular calcification is a complex pathological process occurring in patients with atherosclerosis, type 2 diabetes, and chronic kidney disease. The extracellular matrix, via matricrine-receptor signaling plays important roles in the pathogenesis of calcification. Calcification is mediated by osteochondrocytic-like cells that arise from transdifferentiating vascular smooth muscle cells. Recent advances in our understanding of the plasticity of vascular smooth muscle cell and other cells of mesenchymal origin have furthered our understanding of how these cells transdifferentiate into osteochondrocytic-like cells in response to environmental cues. In the present review, we examine the role of the extracellular matrix in the regulation of cell behavior and differentiation in the context of vascular calcification. In pathological calcification, the extracellular matrix not only provides a scaffold for mineral deposition, but also acts as an active signaling entity. In recent years, extracellular matrix components have been shown to influence cellular signaling through matrix receptors such as the discoidin domain receptor family, integrins, and elastin receptors, all of which can modulate osteochondrocytic differentiation and calcification. Changes in extracellular matrix stiffness and composition are detected by these receptors which in turn modulate downstream signaling pathways and cytoskeletal dynamics, which are critical to osteogenic differentiation. This review will focus on recent literature that highlights the role of cell-matrix interactions and how they influence cellular behavior, and osteochondrocytic transdifferentiation in the pathogenesis of cardiovascular calcification.
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Affiliation(s)
- David Ngai
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University of Toronto, Toronto, ON, Canada
| | - Marsel Lino
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University of Toronto, Toronto, ON, Canada
| | - Michelle P Bendeck
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.,Ted Rogers Centre for Heart Research, University of Toronto, Toronto, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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TerBush MJ, Rasheed K, Young ZZ, Ellis JL, Glocker RJ, Doyle AJ, Raman KG, Stoner MC. Aortoiliac calcification correlates with 5-year survival after abdominal aortic aneurysm repair. J Vasc Surg 2018; 69:774-782. [PMID: 30292612 DOI: 10.1016/j.jvs.2018.05.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 05/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND An anatomic severity grade (ASG) score to categorize and to define anatomic factors for abdominal aortic aneurysm (AAA) repair was proposed. Other studies have previously reported that aortic anatomic complexity is a marker of survival and resource utilization after repair, although it remains unclear whether individual components of the ASG score independently contribute to survival. This study analyzed and validated an aortic and iliac artery calcium scoring system that can potentially predict survival after AAA repair. METHODS Patients who underwent infrarenal AAA repairs from July 2007 to May 2012 were analyzed using complete 5-year records. Those who died ≤30 days of surgery were excluded. Calcium score (CS) was defined using the ASG scoring system for its basis by preoperative imaging <6 months before surgery. A CS for any patient was 0 to 5 points, the sum of the points assigned to aortic neck (2 points total) and iliac artery (3 points total) calcification. A receiver operating characteristic curve was used to determine a CS threshold for mortality. The 5-year survivors and deaths were compared in regard to comorbidities, pharmacology, and CS at or above the defined threshold. Each variable with a P value <.1 between the groups was then placed into a Cox proportional hazards model, with statistical significance of P < .05. RESULTS There were 356 patients who underwent AAA repair with complete 5-year follow-up data; 26% died within 5 years of surgery. Of these, 13% had CS of 0 with 15% mortality, 28% had CS of 1 with 21% mortality, 24% had CS of 2 with 24% mortality, 23% had CS of 3 with 35% mortality, 10% had CS of 4 with 40% mortality, and 2% had CS of 5 with 17% mortality. The receiver operating characteristic curve demonstrated an appropriate threshold of CS 3. Of these patients, 65% had a CS <3, whereas 35% had a CS ≥3. Patients with a CS ≥3 had a lower 5-year survival probability (P = .003). Comparing 5-year survivors and deaths in a Cox proportional hazards analysis, CS ≥3 was associated with a hazard ratio of 1.579 (95% confidence interval, 1.038-2.402; P = .0328). CONCLUSIONS A CS ≥3 is linked to a lower 5-year survival after AAA repair in our population. This system potentially can be another measure for risk stratification and serve as a means to predict midterm mortality in AAA repairs. Future study will be needed for further validation to predict midterm mortality and to better guide surgical decision-making.
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Affiliation(s)
- Matthew J TerBush
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Khurram Rasheed
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Zane Z Young
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Jennifer L Ellis
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Roan J Glocker
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Adam J Doyle
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Kathleen G Raman
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Michael C Stoner
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY.
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Chowdhury MM, Zieliński LP, Sun JJ, Lambracos S, Boyle JR, Harrison SC, Rudd JHF, Coughlin PA. Editor's Choice - Calcification of Thoracic and Abdominal Aneurysms is Associated with Mortality and Morbidity. Eur J Vasc Endovasc Surg 2018; 55:101-108. [PMID: 29225032 PMCID: PMC5772171 DOI: 10.1016/j.ejvs.2017.11.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/07/2017] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Cardiovascular events are common in people with aortic aneurysms. Arterial calcification is a recognised predictor of cardiovascular outcomes in coronary artery disease. Whether calcification within abdominal and thoracic aneurysm walls is correlated with poor cardiovascular outcomes is not known. PATIENTS AND METHODS Calcium scores were derived from computed tomography (CT) scans of consecutive patients with either infrarenal (AAA) or descending thoracic aneurysms (TAA) using the modified Agatston score. The primary outcome was subsequent all cause mortality during follow-up. Secondary outcomes were cardiovascular mortality and morbidity. RESULTS A total of 319 patients (123 TAA and 196 AAA; median age 77 [71-84] years, 72% male) were included with a median follow-up of 30 months. The primary outcome occurred in 120 (37.6%) patients. In the abdominal aortic aneurysm group, the calcium score was significantly related to both all cause mortality and cardiac mortality (odds ratios (OR) of 2.246 (95% CI 1.591-9.476; p < 0.001) and 1.321 (1.076-2.762; p = 0.003)) respectively. In the thoracic aneurysm group, calcium score was significantly related to all cause mortality (OR 6.444; 95% CI 2.574-6.137; p < 0.001), cardiac mortality (OR 3.456; 95% CI 1.765-4.654; p = 0.042) and cardiac morbidity (OR 2.128; 95% CI 1.973-4.342; p = 0.002). CONCLUSIONS Aortic aneurysm calcification, in either the thoracic or the abdominal territory, is significantly associated with both higher overall and cardiovascular mortality. Calcium scoring, rapidly derived from routine CT scans, may help identify high risk patients for treatment to reduce risk.
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Affiliation(s)
- Mohammed M Chowdhury
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK.
| | - Lukasz P Zieliński
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - James J Sun
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Simon Lambracos
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Jonathan R Boyle
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - Seamus C Harrison
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
| | - James H F Rudd
- Division of Cardiovascular Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Patrick A Coughlin
- Division of Vascular and Endovascular Surgery, Addenbrooke's Hospital, Cambridge University Hospital Trust, Cambridge, UK
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Chowdhury MM, Makris GC, Tarkin JM, Joshi FR, Hayes PD, Rudd JHF, Coughlin PA. Lower limb arterial calcification (LLAC) scores in patients with symptomatic peripheral arterial disease are associated with increased cardiac mortality and morbidity. PLoS One 2017; 12:e0182952. [PMID: 28886041 PMCID: PMC5590737 DOI: 10.1371/journal.pone.0182952] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/27/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS The association of coronary arterial calcification with cardiovascular morbidity and mortality is well-recognized. Lower limb arterial calcification (LLAC) is common in PAD but its impact on subsequent health is poorly described. We aimed to determine the association between a LLAC score and subsequent cardiovascular events in patients with symptomatic peripheral arterial disease (PAD). METHODS LLAC scoring, and the established Bollinger score, were derived from a database of unenhanced CT scans, from patients presenting with symptomatic PAD. We determined the association between these scores outcomes. The primary outcome was combined cardiac mortality and morbidity (CM/M) with a secondary outcome of all-cause mortality. RESULTS 220 patients (66% male; median age 69 years) were included with follow-up for a median 46 [IQR 31-64] months. Median total LLAC scores were higher in those patients suffering a primary outcome (6831 vs. 1652; p = 0.012). Diabetes mellitus (p = 0.039), ischaemic heart disease (p = 0.028), chronic kidney disease (p = 0.026) and all-cause mortality (p = 0.012) were more common in patients in the highest quartile of LLAC scores. The area under the curve of the receiver operator curve for the LLAC score was greater (0.929: 95% CI [0.884-0.974]) than for the Bollinger score (0.824: 95% CI [0.758-0.890]) for the primary outcome. A LLAC score ≥ 4400 had the best diagnostic accuracy to determine the outcome measure. CONCLUSION This is the largest study to investigate links between lower limb arterial calcification and cardiovascular events in symptomatic PAD. We describe a straightforward, reproducible, CT-derived measure of calcification-the LLAC score.
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Affiliation(s)
- Mohammed M. Chowdhury
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
- * E-mail:
| | - Gregory C. Makris
- Division of Vascular and Interventional Radiology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, United Kingdom
| | - Jason M. Tarkin
- Division of Cardiovascular Medicine, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | | | - Paul D. Hayes
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | - James. H. F. Rudd
- Division of Cardiovascular Medicine, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
| | - Patrick A. Coughlin
- Division of Vascular and Endovascular Surgery, Addenbrooke’s Hospital, Cambridge University Hospital Trust, Cambridge, United Kingdom
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Erbel R, Churzidse S. Calcification of the aortic wall indicates risk but not beyond current clinically used risk factors assessment. Atherosclerosis 2017; 257:256-258. [DOI: 10.1016/j.atherosclerosis.2017.01.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/18/2017] [Indexed: 01/16/2023]
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Kim J, Budoff MJ, Nasir K, Wong ND, Yeboah J, Al-Mallah MH, Shea S, Dardari ZA, Blumenthal RS, Blaha MJ, Cainzos-Achirica M. Thoracic aortic calcium, cardiovascular disease events, and all-cause mortality in asymptomatic individuals with zero coronary calcium: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2017; 257:1-8. [PMID: 28033543 PMCID: PMC5325775 DOI: 10.1016/j.atherosclerosis.2016.12.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 11/28/2016] [Accepted: 12/09/2016] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS TAC is associated with incident CVD and all-cause mortality. Nevertheless, the independent 10-year prognostic value of TAC in individuals with CAC = 0 beyond traditional risk factors is not well established. METHODS 3415 MESA participants with baseline CAC = 0 were followed for CHD, CVD events and all-cause mortality. TAC was measured in the ascending and descending aorta in all participants and quantified using Agatston's score. Multivariable Cox proportional hazards regression models were used to study the associations between TAC and incident CHD, CVD events and all-cause mortality. Likelihood ratio tests were used to compare prediction models including traditional risk factors plus TAC versus risk factors alone. RESULTS 406 participants (11.9%) had TAC>0 at baseline. Over a median follow-up of 11.3 years, unadjusted event rates per 1000 person-years were higher in TAC>0 than in TAC = 0 participants: CHD 2.18 vs. 2.03; CVD 6.85 vs. 3.42; all-cause mortality 12.84 vs. 4.96. However, in multivariable Cox regression analyses adjusting for CVD risk factors, neither TAC>0, TAC>100 nor log(TAC+1) were independently associated with any of the study outcomes, nor improved their prediction compared to traditional risk factors alone (p value of likelihood ratio tests >0.05). CONCLUSIONS In a multi-ethnic, modern US population of asymptomatic individuals with CAC = 0 at baseline, the prevalence of TAC>0 was low, and TAC did not improve 10-year estimation of prognosis beyond traditional risk factors. In the presence of CAC = 0, measurement of TAC is unlikely to provide sufficient additional prognostic information to further improve risk assessment.
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Affiliation(s)
- Joonseok Kim
- Division of Cardiovascular Health and Disease, Department of Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45257, USA; Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Center at Harbor-UCLA, Division of Cardiology, Torrance, CA 90502, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA; Center for Prevention and Wellness Research, Baptist Health South Florida, Miami, FL 33139, USA
| | - Nathan D Wong
- Division of Cardiology, University of California, Irvine, CA 92697, USA
| | - Joseph Yeboah
- Division of Cardiology, Department of Medicine, Wake Forest University, Winston-Salem, NC 27157, USA
| | - Mouaz H Al-Mallah
- Division of Cardiology, Henry Ford Hospital, Detroit, MI 48202, USA; King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia
| | - Steve Shea
- Departments of Medicine and Epidemiology, Columbia University, New York, NY 10032, USA
| | - Zeina A Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21205, USA.
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD 21205, USA
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High prevalence of subclinical atherosclerosis in Brazilian postmenopausal women with low and intermediate risk by Framingham score. Int J Cardiovasc Imaging 2016; 33:401-410. [DOI: 10.1007/s10554-016-1002-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/12/2016] [Indexed: 01/07/2023]
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Aortic Valve and Thoracic Aortic Calcification Measurements: How Low Can We Go in Radiation Dose? J Comput Assist Tomogr 2016; 41:148-155. [PMID: 27560017 DOI: 10.1097/rct.0000000000000477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE This study aimed to determine the lowest radiation dose and iterative reconstruction level(s) at which computed tomography (CT)-based quantification of aortic valve calcification (AVC) and thoracic aortic calcification (TAC) is still feasible. METHODS Twenty-eight patients underwent a cardiac CT and 20 patients a chest CT at 4 different dose levels (routine dose and approximately 40%, 60%, and 80% reduced dose). Data were reconstructed with filtered back projection, 3 iDose levels, and 3 iterative model-based reconstruction levels. Two observers scored subjective image quality. The AVC and TAC were quantified using mass and compared to the reference scan (routine dose reconstructed with filtered back projection). RESULTS In cardiac CT at 0.35 mSv (60% reduced), all scans reconstructed with iDose (all levels) were diagnostic, calcification detection errors occurred in only 1 patient, and there were no significant differences in mass scores compared to the reference scan. Similar results were found for chest CT at 0.48 mSv (75% reduced) with iDose levels 4 and 6 and iterative model reconstruction levels 1 and 2. CONCLUSIONS Iterative reconstruction enables AVC and TAC quantification on CT at submillisievert dose.
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Kurugol S, Come CE, Diaz AA, Ross JC, Kinney GL, Black-Shinn JL, Hokanson JE, Budoff MJ, Washko GR, San Jose Estepar R. Automated quantitative 3D analysis of aorta size, morphology, and mural calcification distributions. Med Phys 2016; 42:5467-78. [PMID: 26328995 DOI: 10.1118/1.4924500] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this work is to develop a fully automated pipeline to compute aorta morphology and calcification measures in large cohorts of CT scans that can be used to investigate the potential of these measures as imaging biomarkers of cardiovascular disease. METHODS The first step of the automated pipeline is aorta segmentation. The algorithm the authors propose first detects an initial aorta boundary by exploiting cross-sectional circularity of aorta in axial slices and aortic arch in reformatted oblique slices. This boundary is then refined by a 3D level-set segmentation that evolves the boundary to the location of nearby edges. The authors then detect the aortic calcifications with thresholding and filter out the false positive regions due to nearby high intensity structures based on their anatomical location. The authors extract the centerline and oblique cross sections of the segmented aortas and compute the aorta morphology and calcification measures of the first 2500 subjects from COPDGene study. These measures include volume and number of calcified plaques and measures of vessel morphology such as average cross-sectional area, tortuosity, and arch width. RESULTS The authors computed the agreement between the algorithm and expert segmentations on 45 CT scans and obtained a closest point mean error of 0.62 ± 0.09 mm and a Dice coefficient of 0.92 ± 0.01. The calcification detection algorithm resulted in an improved true positive detection rate of 0.96 compared to previous work. The measurements of aorta size agreed with the measurements reported in previous work. The initial results showed associations of aorta morphology with calcification and with aging. These results may indicate aorta stiffening and unwrapping with calcification and aging. CONCLUSIONS The authors have developed an objective tool to assess aorta morphology and aortic calcium plaques on CT scans that may be used to provide information about the presence of cardiovascular disease and its clinical impact in smokers.
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Affiliation(s)
- Sila Kurugol
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Carolyn E Come
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Alejandro A Diaz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - James C Ross
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Greg L Kinney
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80045
| | | | - John E Hokanson
- Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado 80045
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center at Harbor and UCLA Medical Center, Torrance, California 90502
| | - George R Washko
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
| | - Raul San Jose Estepar
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115
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van der Bijl N, Klok FA, Huisman MV, de Roos A, Kroft LJM. Coronary or thoracic artery calcium score in provoked and unprovoked pulmonary embolism: a case-control study. J Thromb Haemost 2016; 14:931-5. [PMID: 26865284 DOI: 10.1111/jth.13289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Accepted: 12/18/2015] [Indexed: 01/10/2023]
Abstract
UNLABELLED Essentials Patients with unprovoked pulmonary embolism (PE) are at increased risk of arterial thromboembolism. Coronary and thoracic aorta calcium were evaluated in patients with and without (unprovoked) PE. No association was found between (unprovoked) PE and coronary or aortic calcification. Assessment of both calcium scores on computed tomography pulmonary angiography was highly reproducible. SUMMARY Objective To evaluate the potential association between (unprovoked) pulmonary embolism (PE) and the presence and extent of coronary artery calcium (CAC) and thoracic aorta calcium (TAC). Methods CAC and TAC derived from computed tomography pulmonary angiography of 100 patients with PE were compared to that of 100 patients in whom PE was ruled out. Results Intraobserver and interobserver agreements for both TAC and CAC were excellent (intraclass correlation > 0.95 for both). In patients with PE vs. patients without PE, no significant differences were found in the presence of CAC or TAC (CAC 64% vs. 67%, odds ratio [OR] 1.0, 95% confidence interval [CI] 0.67-1.6; TAC 46% vs. 59%, OR 1.2, 95% CI 0.80-2.1). Mean CAC and TAC scores were significantly lower in patients with PE than in patients without PE (CAC 3.4 vs. 4.9, absolute difference 1.5, 95% CI 0.2-2.8; TAC 1.1 vs. 1.8, absolute difference 0.9, 95% CI 0.2-1.2). No significant differences were found in the presence of CAC or TAC or in mean CAC and TAC scores between patients with unprovoked PE vs. patients with provoked PE, or between patients with unprovoked PE vs. no PE. Conclusion No significant differences were found between the extent of CAC and TAC in patients with unprovoked PE compared to those with provoked PE or without PE. The observed difference in the extend of CAC and TAC between patients with and without PE was dependent on prevalent cardiovascular risk factors.
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Affiliation(s)
- N van der Bijl
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - M V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - A de Roos
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - L J M Kroft
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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Bos D, Leening MJG, Kavousi M, Hofman A, Franco OH, van der Lugt A, Vernooij MW, Ikram MA. Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality: The Rotterdam Study. Circ Cardiovasc Imaging 2016; 8:CIRCIMAGING.115.003843. [PMID: 26659376 DOI: 10.1161/circimaging.115.003843] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Atherosclerosis is a major contributor to global morbidity and mortality. Although atherosclerosis is a systemic disease, its burden varies considerably across vessel beds, which may translate into differences in mortality risk. METHODS AND RESULTS From 2003 to 2006, a sample of 2408 elderly participants (mean age, 69.6±6.7 years; 52.4% female) from the population-based Rotterdam Study underwent computed tomography to quantify atherosclerotic calcification in the coronary arteries, aortic arch, extracranial, and intracranial internal carotid arteries. Mortality follow-up was complete until January 1, 2012. We investigated associations of calcification in each vessel bed with mortality using Cox regression, adjusting for age, sex, and cardiovascular risk factors. Next, all vessel beds were included into 1 model to investigate independency of associations. Finally, we investigated the predictive value of calcification beyond the predictors included in the Pooled Cohort equations. During 15 775 person-years of follow-up, 283 participants died. Larger calcification volumes in all vessels were related to higher risks of all-cause mortality, cardiovascular, and noncardiovascular mortality, independent of cardiovascular risk factors. Most prominent associations were found for aortic arch calcification and cardiovascular mortality (age- and sex-adjusted hazard ratio per 1-SD increase 2.72 [95% confidence interval, 1.85-4.02]), independent of calcification elsewhere (hazard ratio, 1.75 (95% confidence interval, 1.13-2.72]). Calcification in any vessel improved prediction for all 3 outcomes. CONCLUSIONS Atherosclerotic load in major vessel beds is associated with an increased risk of death. In particular, aortic arch calcification volume yields unique information with regard to mortality in addition to atherosclerosis in other vessel beds.
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Affiliation(s)
- Daniel Bos
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Maarten J G Leening
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Maryam Kavousi
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Albert Hofman
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Oscar H Franco
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Aad van der Lugt
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - Meike W Vernooij
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands
| | - M Arfan Ikram
- From the Departments of Radiology (D.B., A.L., M.W.V., M.A.I.), Epidemiology (D.B., M.J.G.L., M.K., A.H., O.H.F., M.W.V., M.A.I.), Cardiology (M.J.G.L.), and Neurology (M.A.I.), Erasmus MC, Rotterdam, The Netherlands.
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Craiem D, Chironi DG, Casciaro ME, Sirieix ME, Mousseaux E, Simon A. Association of thoracic aorta calcium and non cardiac vascular events in cardiac disease-free individuals. Atherosclerosis 2016; 245:22-7. [DOI: 10.1016/j.atherosclerosis.2015.11.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 10/01/2015] [Accepted: 11/26/2015] [Indexed: 12/30/2022]
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Joshi FR, Rajani NK, Abt M, Woodward M, Bucerius J, Mani V, Tawakol A, Kallend D, Fayad ZA, Rudd JH. Does Vascular Calcification Accelerate Inflammation? J Am Coll Cardiol 2016; 67:69-78. [DOI: 10.1016/j.jacc.2015.10.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
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Aortic root, not valve, calcification correlates with coronary artery calcification in patients with severe aortic stenosis: A two-center study. Atherosclerosis 2015; 243:631-7. [DOI: 10.1016/j.atherosclerosis.2015.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/20/2015] [Accepted: 10/07/2015] [Indexed: 01/07/2023]
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Abstract
Although recent advances in noninvasive imaging technologies have potentially improved diagnostic efficiency and clinical outcomes of patients with acute chest pain, controversy remains regarding much of the accumulated evidence. This article reviews the role of coronary computed tomography (CT) angiography in the assessment of coronary risk, and its usefulness in the emergency department in facilitating appropriate disposition decisions. Also discussed is coronary artery calcification incidentally found on CT scans when done for indications such as evaluation of pulmonary embolism or lung cancer. The evidence base and clinical applications for both techniques are described, together with cost-effectiveness and radiation exposure considerations.
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Affiliation(s)
- Swapnesh Parikh
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA
| | - Matthew J Budoff
- Internal Medicine Department, Los Angeles Biomedical Research Institute, 1124 West Carson Street, Torrance, CA 90502, USA.
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50
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Kinugasa M, Mori S, Takaya T, Ito T, Tanaka H, Satomi-Kobayashi S, Fujiwara S, Nishii T, Kono AK, Okita Y, Hirata KI. Serum phosphate is an independent predictor of the total aortic calcification volume in non-hemodialysis patients undergoing cardiovascular surgery. J Cardiol 2015; 68:308-15. [PMID: 26572956 DOI: 10.1016/j.jjcc.2015.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/08/2015] [Accepted: 10/05/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND A high serum phosphate level is a well-known risk factor for vascular calcification (VC) in patients on hemodialysis (HD). However, the association between the serum phosphate level and VC in non-HD patients is unclear. Our aim was to assess the impact of serum phosphate level on aortic calcification (AC) volume in non-HD patients undergoing cardiovascular surgery. METHODS A total of 117 patients who underwent thoracoabdominal computed tomography as a preoperative general evaluation before cardiovascular surgery were enrolled. The total AC volume was quantified using the volume-rendering method by extracting the area ≥130HU within the entire aorta. The total AC volume index (AC-VI) was estimated as the total AC volume divided by the body surface area. RESULTS In the 117 patients (64.7±13.1 years, 39% women), the median total AC-VI was 1.23mL/m(2). The mean estimated glomerular filtration rate (eGFR), adjusted serum calcium levels, and serum phosphate levels were 63.8±19.9mL/min/1.73m(2), 9.1±0.4mg/dL, and 3.6±0.6mg/dL, respectively. When the patients were classified into four quartiles based on their total AC-VI value, the serum phosphate level showed a positive correlation with a probability of being in the highest AC-VI quartile (R(2)=0.0146, p=0.0383) whereas the adjusted serum calcium level did not show a significant correlation (R(2)=0.0040, p=0.2615). A similar relationship between the serum phosphate level, adjusted serum calcium level, and AC-VI was confirmed when the total AC-VI was divided into the thoracic AC-VI and abdominal AC-VI. Multivariate analysis indicated that the serum phosphate level was an independent positive predictor of higher total AC-VI quartiles (β=0.8013, p=0.0160). CONCLUSIONS An increase in serum phosphate level was associated with an increased AC burden in non-HD patients undergoing cardiovascular surgery.
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Affiliation(s)
- Mitsuo Kinugasa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan; Division of Cardiology, National Hospital Organization Kobe Medical Center, Kobe, Japan
| | - Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| | - Tatsuro Ito
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Seimi Satomi-Kobayashi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nishii
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi K Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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