CAC score as a possible criterion for administration of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers

Darabian, Sirous; Luo, Yunhua; Homat, Arman; Khosraviani, Khashayar; Wong, Nathan D.; Zeb, Irfan; Nasir, Khurram; Budoff, Matthew J.

doi:10.1097/mca.0000000000000303

Cited by 11 publications

(7 citation statements)

References 15 publications

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“…Therefore, the in vitro study and our present study share a concept that the deterioration of human aortic calcification by blocking angiotensin II pathway both in clinical and in vitro point of view. In terms of vascular calcification and ACEI and/or ARB, Darabian S et al reported that patients who received ACEI and/or ARB had a greater average of coronary artery calcification score [ 17 ], which is consistent with our results.…”

Section: Discussionsupporting

confidence: 92%

User of angiotensin-converting-enzyme inhibitor and/or angiotensin II receptor blocker might be associated with vascular calcification in predialysis chronic kidney disease patients: a retrospective single-center observational study

et al. 2021

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Background Vascular calcification is a prominent feature in chronic kidney disease (CKD) and diabetes mellitus. A recent report suggests that angiotensin II is protective to vascular calcification. Therefore, we investigated the relationship between vascular calcification and use of angiotensin-converting-enzyme inhibitor (ACEI) and/or angiotensin II receptor blocker (ARB) from a cross-sectional view. Methods A total of 121 predialysis CKD patients (age 71 ± 12 y; male 72; estimated glomerular filtration rate (eGFR) 20.2 (11.8 - 40.3) mL/min/1.73 m2) who underwent thoracoabdominal plain computed tomography scan were included in this study. The total vascular calcification volume (Calc) was calculated with a three-dimensional imaging software and standardized by body surface area (BSA). The relevance between log [Calc/BSA] and ACEI/ARB use was investigated by multivariate linear regression analyses with or without a time-duration factor of ACEI/ARB use. Results The Calc/BSA was 5.62 (2.01 - 12.7) mL/m2 in 121 patients. In multivariate analyses adjusted with age, sex, ACEI/ARB and log [eGFR], ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.2781, p = 0.0007). Even after the adjustment by age, sex, log [eGFR], phosphate, diabetes mellitus, systolic blood pressure, warfarin, hypertension, dyslipidemia, low-density lipoprotein cholesterol, diuretics and ACEI/ARB, ACEI/ARB use is significantly and positively associated with log [Calc/BSA] (β = 0.1677, p = 0.0487). When 90 patients whose time-duration of ACEI/ARB use was clear in medical records were studied, a multivariate analysis adjusted with age, sex, log [eGFR], and ACEI/ARB duration factors showed that the longer use of ACEI/ARB more than 2 years was significantly, independently and positively associated with log [Calc/BSA] (β = 0.2864, p = 0.0060). Conclusions ACEI/ARB user was associated with vascular calcification in predialysis patients with low eGFR. Prospective studies with larger numbers of patients or more in vitro studies are needed to confirm whether this phenomenon is due to the use of ACEI/ARB itself, the underlying disease condition or the prescription bias.

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Section: Discussionsupporting

confidence: 92%

User of angiotensin-converting-enzyme inhibitor and/or angiotensin II receptor blocker might be associated with vascular calcification in predialysis chronic kidney disease patients: a retrospective single-center observational study

et al. 2021

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“…18 It provides more robust risk prediction than carotid IMT, C-reactive protein, ankle-brachial index, and family history of premature heart disease 19 Incorporating CAC into the Multi-Ethnic Study of Atherosclerosis (MESA) clearly improves risk stratification and discrimination over scores based on chronologic age. 20 CAC has been shown to better identify those asymptomatic individuals who would benefit from statins, 21 aspirin, 22 ACE inhibitors 23 or the polypill 24 than risk calculators or other biomarkers. Recently, a study demonstrated that a CAC score of 0 confers a low risk of mortality over a period of 15 years in individuals estimated to be at low to intermediate FRS risk and over a 5-year low risk period in individuals at high FRS risk, unaffected by age or sex.…”

Section: Evidence Supporting Cac For Risk Assessmentmentioning

confidence: 99%

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

Hecht

Cronin

Blaha

et al. 2017

Journal of Cardiovascular Computed Tomography

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345

231

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“…Accumulating evidence has shown that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) exert numerous beneficial actions on cardiac and vascular structure and function beyond their blood pressure-lowering effects ( 44 , 45 ). In principle, the use of ACEIs and ARBs that produce endothelial protective effects could alleviate COVID-19 symptoms and potentially reduce the severity of the disease ( 46 ).…”

Section: Direct Influences Of Sars-cov-2 On Atherosclerosismentioning

confidence: 99%

Vigilance on New-Onset Atherosclerosis Following SARS-CoV-2 Infection

Zhang

2021

Front. Med.

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The pandemic of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has become a global challenge to public health. While its typical clinical manifestations are respiratory disorders, emerging evidence of cardiovascular complications indicates the adverse interaction between SARS-CoV-2 infection and cardiovascular outcomes. Given that viral infection has emerged as an additional risk factor for atherosclerosis, in this paper, we attempt to clarify the susceptibility to new-onset atherosclerosis in individuals infected with SARS-CoV-2. Mechanistically, serving as functional receptors for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2) mediates SARS-CoV-2 infection of endothelial cells (ECs) directly, leading to endothelial dysfunction and dysregulation of the renin-angiotensin system (RAS). In addition, high expression of CD147, an alternative receptor, and activation of the NLRP3 inflammasome may also contribute to atherosclerosis in the context of COVID-19. More importantly, SARS-CoV-2 attacks the immune system, which results in excessive inflammation and perpetuates a vicious cycle of deteriorated endothelial dysfunction that further promotes inflammation. The alterations in the blood lipid profile induced by COVID-19 should not be ignored in assessing the predisposition toward atherosclerosis in victims of COVID-19. A better understanding of the underlying mechanisms of SARS-CoV-2 infection and the long-term monitoring of inflammatory factors and endothelial function should be considered in the follow-up of patients who have recovered from COVID-19 for early detection and prevention of atherosclerosis.

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CAC score as a possible criterion for administration of angiotensin converting enzyme inhibitors and/or angiotensin receptor blockers

Cited by 11 publications

References 15 publications

User of angiotensin-converting-enzyme inhibitor and/or angiotensin II receptor blocker might be associated with vascular calcification in predialysis chronic kidney disease patients: a retrospective single-center observational study

User of angiotensin-converting-enzyme inhibitor and/or angiotensin II receptor blocker might be associated with vascular calcification in predialysis chronic kidney disease patients: a retrospective single-center observational study

2016 SCCT/STR guidelines for coronary artery calcium scoring of noncontrast noncardiac chest CT scans: A report of the Society of Cardiovascular Computed Tomography and Society of Thoracic Radiology

Vigilance on New-Onset Atherosclerosis Following SARS-CoV-2 Infection

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