Associations of cigarette smoking and burden of thoracic aortic calcification in asymptomatic individuals: A dose-response relationship

Tsai, Jui‐Peng; Jan, Ya Ting; Yun, Chun Ho; Sung, Kuo Tzu; Liu, Chuan Chuan; Kuo, Junne-Yih; Hung, Chung‐Lieh; Wu, Tung Hsin; Lin, Jin-Ching; Hou, Charles Jia Yin; Yeh, Hung I.; Bezerra, Hiram G.

doi:10.1371/journal.pone.0227680

Cited by 9 publications

(6 citation statements)

References 35 publications

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“…Previous studies have suggested that hypertension is inversely associated with TAC density after controlling for TAC volume, 10 which supports our current results because we found that women had a higher prevalence of both low TAC density and hypertension. Furthermore, our results build upon previous studies that have observed an association between cigarette smoking and the presence of TAC in women, 5,13 as we demonstrate that cigarette smoking may particularly confer a higher risk of developing low-density, high-risk plaque of the ascending and descending thoracic aorta.…”

Section: Discussionsupporting

confidence: 88%

Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women

Razavi,

Kim,

van Assen

et al. 2023

Circ: Cardiovascular Imaging

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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 (mm 2 ) 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 mm 2 ; 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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Section: Discussionsupporting

confidence: 88%

Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women

Razavi,

Kim,

van Assen

et al. 2023

Circ: Cardiovascular Imaging

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“…Advanced age [ 7 ], hypertension [ 2 ], dyslipidemia [ 2 ], diabetes mellitus [ 2 ], higher visceral and subcutaneous fat content [ 8 , 9 ], and chronic smoking [ 2 , 10 ] were highlighted as important risk factors for AAC. However, the pathophysiology of AAC is different from most vessel disorders and not thoroughly elucidated [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Prevalence and risk factors for the development of abdominal aortic calcification among the US population: NHANES study

Rahman

Chobufo

Farah

et al. 2021

Arch Med Sci Atheroscler Dis

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Introduction: Abdominal aortic calcification (AAC) is an important marker of subclinical cardiovascular disease and its prognosis. Advanced age, hypertension, smoking, dyslipidemia, diabetes mellitus, and higher truncal fat are known markers of AAC in studies conducted around the world. However, literature for these risk factors and their co-occurrence is limited in the US. Material and methods: We used data from dual energy X-ray absorptiometry (Hologic, v4.0) to detect the occurrence of AAC in a sample population (n = 3140) of the NHANES survey using a computer-assisted interviewing system to assess the risk factors for AAC. Results: We found the national prevalence of AAC in the US to be 28.8%.

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“…Porcelain aorta is more common in the elderly population, with a study revealing the median age of 79 years 6 . Our patient was a 52‐year‐old female, and this early extensive calcification of the porcelain aorta and coronaries could be attributed to smoking and dyslipidemia, which are risk factors known to accelerate atherosclerosis and aortic calcification 7,8 . This case report shows that PCI is a valuable treatment option for multivessel coronary disease when surgical revascularization is not feasible.…”

Section: Discussionmentioning

confidence: 69%

Percutaneous transluminal coronary angioplasty in a 52‐year‐old patient with porcelain aorta and calcified coronaries: A case report

Dhungana,

Sharma,

Poudel

et al. 2024

Clinical Case Reports

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Key Clinical MessagePorcelain aorta, characterized by extensive calcification of the aortic wall is often associated with coronary calcification. It can pose an increased risk of thromboembolic complications during interventional and surgical procedures. We present a case of a 52‐year‐old female, a chronic smoker with dyslipidemia with complaints of exertional chest pain for past 6 months. She was diagnosed as a case of non‐ST elevation myocardial infarction (NSTEMI) with multivessel CAD, with porcelain aorta and calcified coronaries based on abnormal ECG, elevated troponin and coronary angiography findings. Percutaneous transluminal coronary angioplasty (PTCA) was the treatment modality chosen considering the risk of thromboembolism with aortic manipulation during coronary artery bypass grafting (CABG). Repeat ECG after the procedure showed resolution of ST segment depression. Her hospital stay was uneventful. She was discharged on dual antiplatelet therapy, statin and metoprolol. One‐week follow‐up revealed normal ECG and blood reports, with further outpatient department visits scheduled every 3 months. Porcelain aorta and coronary calcification is a challenging case for cardiologists. PTCA if done meticulously could be preferable to coronary‐artery by‐pass grafting (CABG) in such patients. Despite the risks like aortic rupture and thromboembolic complications, PTCA in a case of multivessel CAD with porcelain aorta and calcified coronaries could be a life‐saving procedure.

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Associations of cigarette smoking and burden of thoracic aortic calcification in asymptomatic individuals: A dose-response relationship

Cited by 9 publications

References 35 publications

Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women

Thoracic Aortic Calcium Density and Area in Long-Term Atherosclerotic Cardiovascular Disease Risk Among Men Versus Women

Prevalence and risk factors for the development of abdominal aortic calcification among the US population: NHANES study

Percutaneous transluminal coronary angioplasty in a 52‐year‐old patient with porcelain aorta and calcified coronaries: A case report

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