Diabetes and Hypertension Consistently Predict the Presence and Extent of Coronary Artery Calcification in Symptomatic Patients: A Systematic Review and Meta-Analysis

Abstract

Background: The relationship of conventional cardiovascular risk factors (age, gender, ethnicity, diabetes, dyslipidaemia, hypertension, obesity, exercise, and the number of risk factors) to coronary artery calcification (CAC) presence and extent has never before been assessed in a systematic review and meta-analysis. Methods: We included only English language studies that assessed at least three conventional risk factors apart from age, gender, and ethnicity, but excluded studies in which all patients had another confirmed condition such as renal disease. Results: In total, 10 studies, comprising 15,769 patients, were investigated in the systematic review and seven studies, comprising 12,682 patients, were included in the meta-analysis, which demonstrated the importance of diabetes and hypertension as predictors of CAC presence and extent, with age also predicting CAC presence. Male gender, dyslipidaemia, family history of coronary artery disease, obesity, and smoking were overall not predictive of either CAC presence or extent, despite dyslipidaemia being a key risk factor for coronary artery disease (CAD). Conclusion: Diabetes and hypertension consistently predict the presence and extent of CAC in symptomatic patients.

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

“…Meanwhile, moderate and heavy smokers had significantly higher plaque density compared to light smokers which indicates the progression of arterial calcification. It suggested that smoking dose and duration have continuing effects rather than simply a triggering effect which may be subsided after applying appropriate control measures [34]. Further, we observed stronger associations between moderate to heavy smokers in terms of higher number of daily smoking behavior or longer use with TAC volume even after adjusting for lesion density, indicating that increased vascular volume per se may likely play as central key roles in this pathological process.…”

Type 2 diabetes mellitus is associated with a lower fibrous cap thickness but has no impact on calcification morphology: an intracoronary optical coherence tomography study

“…As particularly small, superficial calcifications may have an impact on plaque vulnerability, the need for a more precise analysis, exploiting the superior resolution of OCT, has emerged recently. We and others have previously shown that patients with T2DM yield a more vulnerable phenotype of coronary plaques, which may contribute to the higher frequency of cardiovascular events in this population [ 6 , 30 , 31 ]. Part of this vulnerable phenotype may be reverted through statin use, as the OCT-FORMIDABLE register suggests [ 32 ], and this effect seems to be enhanced by an optimal glucose control in the diabetic population [ 33 ].…”

Diet, Lifestyle and Cardiovascular Diseases: Linking Pathophysiology to Cardioprotective Effects of Natural Bioactive Compounds

“…Arterial hypertension and endothelial growth factor-linked polymorphisms are reported to contribute to vascular damage [33,34]. Nicoll et al studied 15,769 patients on the relationships between conventional CV risk factors (age, gender, ethnicity, DM, dyslipidemia, hypertension, obesity, exercise) and coronary artery calcification, and found that hypertension and diabetes have the strongest association with coronary artery calcification [35].…”