Calcified Atherosclerosis in Different Vascular Beds and the Risk of Mortality

Abstract

Objective-The goal of this study was to determine differences in risks for total and cause-specific mortality related to calcified atherosclerosis in different vascular beds. Methods and Results-A total of 4544 patients underwent computed tomography scans that were interrogated for calcium in different vascular beds. Mortality assessment was conducted by death certificate adjudication. At baseline, the mean age was 56.8 years, and 43% were female. After an average of 7.8 years, there were 163 deaths. With full adjustment, the presence of calcium in the thoracic aorta (hazard ratio [HR], 2.1; 95% confidence interval [CI], 1.2-3.5), carotids (HR, 1.60; CI, 1.1-2.5), and iliac (HR, 1.67; CI, 1.0 -2.9) arteries were associated with total mortality, whereas the presence of coronary calcium was associated with cardiovascular disease (CVD) mortality (HR, 3.4; CI,). For severity of calcium burden, a 1-SD increment in the iliac arteries was the strongest predictor for all types of mortality. C-statistics were not significantly larger when noncoronary vascular beds were added to models with CVD risk factors or CVD risk factors plus coronary artery calcium. Key Words: calcification Ⅲ coronary artery disease Ⅲ electron beam computed tomography Ⅲ outcomes Ⅲ peripheral arterial disease C oronary artery calcium (CAC) is a significant predictor of future cardiac events independent of traditional risk factors. 1 When added to the traditional cardiovascular disease (CVD) risk factors, CAC improves the ability to correctly classify individual risk for incident CVD. 2 Similarly, the presence of calcified atherosclerosis in the thoracic aorta is independently associated with total mortality, 3 with earlier studies showing that the presence of calcified atherosclerosis of the abdominal aorta is associated with incident fatal and nonfatal CVD. 4 To our knowledge, no study has examined the association between calcified atherosclerosis in 5 distinct vascular beds and incident mortality. In this report, we present results of a study that tested the ability of calcified atherosclerosis from computed tomography (CT) in the carotid, coronary, thoracic aorta, abdominal aorta, and iliac vascular beds to predict incident total, CVD, and non-CVD mortality. From November 30, 2000, to July 30, 2003 consecutive patients underwent whole-body CT scanning as an adjunct to their preventive health care at a university-affiliated disease prevention center in San Diego, California. Most patients were asymptomatic and either self-referred or were referred on the recommendation of their personal physician. Participants completed a detailed health history questionnaire that collected information on hypertension, diabetes, high cholesterol, smoking, medications, family history of coronary heart disease, diet, exercise, and prior surgeries. The Human Research Protection Program at the University of California at San Diego approved the study protocol. Conclusion-The Methods Subjects ImagingCT was conducted using an Imatron C-150 scanner. At the time of the sc...

Comparison of Atherosclerotic Calcification in Major Vessel Beds on the Risk of All-Cause and Cause-Specific Mortality

“…Sex differences have been described for relations of CAC and AAC with coronary events. 39 However, for mortality these differences have not been found, 4,5,32 and neither did we. Probably, the explanation behind this contrast lies in the definition of coronary events and cardiovascular mortality.…”

“…There have been studies in specific populations, mainly persons with high cardiovascular risk, demonstrating strong relations between atherosclerosis in the thoracic aorta and higher risk of mortality. 4,32 A report from the Framingham study also demonstrated a relationship between radiograph-assessed abdominal aortic calcification and a higher risk of mortality. 33 In line with these findings, we found a strong association of aortic arch atherosclerosis with mortality, both cardiovascular and noncardiovascular.…”

“…29 Numerous studies have consistently demonstrated the associations of the presence and amount of coronary atherosclerosis with risk of all-cause mortality and cardiovascular mortality. 4,30,31 Especially from a population-based perspective, literature on atherosclerosis in other vessel beds and the risk of mortality are sparse, 5 and restricted to coronary and aortic atherosclerosis. There have been studies in specific populations, mainly persons with high cardiovascular risk, demonstrating strong relations between atherosclerosis in the thoracic aorta and higher risk of mortality.…”

Intake of Vitamin K Antagonists and Worsening of Cardiac and Vascular Disease: Results From the Population‐Based Gutenberg Health Study

“…Therefore, one might speculate that VKA cause inflammation and apoptosis of vascular smooth muscle cells while simultaneously reducing endothelial nitric oxide production, which could potentially accelerate the process of vascular and cardiac damage. It merits consideration that the influence of VKA treatment may affect specific vascular beds differently (eg according to the content of VKA‐dependent extracellular matrix protein GIa), which may also impact on the subsequent clinical outcome 31. As an interconnecting link, the increased level of systemic inflammation upon VKA intake may serve as a potential explanation for VKA‐induced propagation of (subclinical) atherosclerosis and cardiovascular disease.…”

Metabolismo mineral óseo en pacientes con enfermedad renal crónica: revisión sobre su fisiopatología y morbimortalidad

“…Adicionalmente, se sabe que IL-1 e IL-6 tienen efectos inhibitorios sobre PTH y dado que dichas citokinas están elevadas en pacientes en diálisis esto permitiría una relación entre los fenómenos de malnutrición-inflamación y enfermedad de bajo recambio óseo en pacientes en diálisis. De allí la importancia de la optimización en la terapia dialítica, en la mejora del estado nutricional del paciente y en el uso racional de fármacos, de lo contrario, como ha sido demostrado en varios estudios, la frecuencia de mortalidad se incrementa (60,61) .…”