<b>Evaluating Changes in Coronary Artery Calcium:</b> An Analytic Method That Accounts for Interscan Variability

Hokanson, John E.; MacKenzie, Todd A.; Kinney, Gregory L.; Snell‐Bergeon, Janet K.; Dabelea, Dana; Ehrlich, James; Eckel, Robert H.; Rewers, Marian

doi:10.2214/ajr.182.5.1821327

Cited by 179 publications

(170 citation statements)

References 31 publications

Supporting

Mentioning

165

Contrasting

Order By: Relevance

“…17,25 Treatment with phosphate binders resulted in significant progression of vascular calcification in coronary arteries and the abdominal aorta. Assessment of coronary artery calcification (CAC) progression using the square-root followup method in the work by Hokanson et al 26 has been shown to be the best method to predict mortality in a large cohort of asymptomatic patients. 26,27 These results support the conceptual risk of inducing positive calcium balance in patients with CKD, where disordered mineral metabolism results in dystrophic calcification.…”

Section: Discussionmentioning

confidence: 99%

“…Assessment of coronary artery calcification (CAC) progression using the square-root followup method in the work by Hokanson et al 26 has been shown to be the best method to predict mortality in a large cohort of asymptomatic patients. 26,27 These results support the conceptual risk of inducing positive calcium balance in patients with CKD, where disordered mineral metabolism results in dystrophic calcification. Short-term calcium balance studies suggest that the provision of 2000 mg/d elemental calcium in patients with CKD stage 3 results in substantial net positive calcium balance.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Effects of Phosphate Binders in Moderate CKD

Block

Wheeler

Persky

et al. 2012

Journal of the American Society of Nephrology

475

383

View full text Add to dashboard Cite

Some propose using phosphate binders in the CKD population given the association between higher levels of phosphorus and mortality, but their safety and efficacy in this population are not well understood. Here, we aimed to determine the effects of phosphate binders on parameters of mineral metabolism and vascular calcification among patients with moderate to advanced CKD. We randomly assigned 148 patients with estimated GFR=20-45 ml/min per 1.73 m 2 to calcium acetate, lanthanum carbonate, sevelamer carbonate, or placebo. The primary endpoint was change in mean serum phosphorus from baseline to the average of months 3, 6, and 9. Serum phosphorus decreased from a baseline mean of 4.2 mg/dl in both active and placebo arms to 3.9 mg/dl with active therapy and 4.1 mg/dl with placebo (P=0.03). Phosphate binders, but not placebo, decreased mean 24-hour urine phosphorus by 22%. Median serum intact parathyroid hormone remained stable with active therapy and increased with placebo (P=0.002). Active therapy did not significantly affect plasma C-terminal fibroblast growth factor 23 levels. Active therapy did, however, significantly increase calcification of the coronary arteries and abdominal aorta (coronary: median increases of 18.1% versus 0.6%, P=0.05; abdominal aorta: median increases of 15.4% versus 3.4%, P=0.03). In conclusion, phosphate binders significantly lower serum and urinary phosphorus and attenuate progression of secondary hyperparathyroidism among patients with CKD who have normal or near-normal levels of serum phosphorus; however, they also promote the progression of vascular calcification. The safety and efficacy of phosphate binders in CKD remain uncertain. CKD is a significant public health concern; roughly 13% of the US population has an estimated GFR (eGFR) below 60 ml/min per 1.73 m 2 or albuminuria. 1 The risks of death and cardiovascular disease in CKD are not fully explained by associated diabetes, hypertension, and other conventional risk factors. 2 With declining kidney function, serum phosphorus concentration increases but generally remains within the normal range until late in stage 4 or 5 CKD. A normal or near-normal serum phosphorus concentration is maintained at the expense of elevated levels of the phosphaturic hormones parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23). 3,4 Serum concentrations of phosphorus and hormones responsible for its regulation have been implicated as putative cardiovascular risk factors. [5][6][7][8][9]

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of Phosphate Binders in Moderate CKD

Block

Wheeler

Persky

et al. 2012

Journal of the American Society of Nephrology

475

383

View full text Add to dashboard Cite

show abstract

“…To eliminate the dependence of residual interscan variability on the baseline CAC score, square root transformation of the CAC score was performed before the estimation of CAC progression. Using the data published by Hokanson et al., progressors were defined as individuals with a difference of ≥2.5 units between the baseline and final square root of their CAC scores (ie, the “SQRT method” [the square root‐transformed difference]) 9, 22, 23. To put it differently, a change of <2.5 units between the baseline and final square root of the CAC score was considered to be within the margin of error for the estimation of the CAC score using MDCT and thus was attributed to interscan variability; such participants were classified as nonprogressors 9, 22, 23…”

Section: Methodsmentioning

confidence: 99%

2013 ACC/AHA Cholesterol Guideline Versus 2004 NCEP ATP III Guideline in the Prediction of Coronary Artery Calcification Progression in a Korean Population

Cho

Jung

Kang

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundSince the release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines, significant controversy has surrounded the applicability of the new cholesterol guidelines and the Pooled Cohort Equations. In this present study, we investigated whether eligibility for statin therapy determined by the 2013 ACC/AHA guidelines on the management of blood cholesterol is better aligned with the progression of coronary artery calcification (CAC) detected by coronary computed tomography angiography (CCTA) than the previously recommended 2004 National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III guidelines.Methods and ResultsWe enrolled 1246 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination. Application of the ACC/AHA guidelines to the study population increased the proportion of statin‐eligible subjects from 20.5% (according to ATP III) to 54.7%. Statin‐eligible subjects, as defined by ACC/AHA guidelines, showed a higher odds ratio for CAC score progression than those considered statin eligible according to ATP III guidelines (2.73 [95% CI, 2.07–3.61] vs 2.00 [95% CI, 1.49–2.68]).ConclusionsCompared with the ATP III guidelines, the new ACC/AHA guidelines result in better discrimination of subjects with cardiovascular risk detected by CAC score progression in an Asian population.

show abstract

“…Coronary artery calcification volume scores (CVS), presented in Agatson units (AU), were measured by electronbeam CT (C-150 Ultrafast CT scanner; Imatron, San Francisco, CA, USA) before and after 2.4±0.4 years followup, and progression of CAC was defined according to the method of Hokanson et al as an increase of ≥2.5 mm 3 in the square root-transformed calcium volume scores [33]. To avoid interference with other calcifications located outside atheromatous lesions, a region of interest was encircled in each coronary artery, and computer-driven measurements of the lesion area and its maximum density were recorded.…”

Section: Laboratory Measurementsmentioning

confidence: 99%

“…The total CAC score was presented as a mean value of measurements from two independent CT scans performed within 5 min of each other during each visit [5,33]. Among the participants of the CACTI study, APOA4 genotyping data were available for 1,373 subjects (96.7% of the study population), 634 with type 1 diabetes and 739 from the control group, and 1,141 of whom completed the follow-up visit and were evaluated for CAC progression (ESM Fig.…”

Section: Laboratory Measurementsmentioning

confidence: 99%