Diabetes and progression of coronary calcium under the influence of statin therapy

Budoff, Matthew J.; Yu, Dawei; Nasir, Khurram; Mehrotra, Rajnish; Chen, Lynn; Takasu, Junichiro; Agrawal, Nisha; Liu, Sandy T.; Blumenthal, Roger S.

doi:10.1016/j.ahj.2004.07.034

Cited by 76 publications

(41 citation statements)

References 27 publications

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“…In our study, almost 90% of all MHD patients had detectable coronary calcification; only 16 of the 153 MHD patients who randomly underwent EBCT had CACS ϭ 0. Some but not all studies that have examined the potential risk factors of coronary artery calcification among patients with CKD have implicated both the conventional risk factors such as diabetes (31) and dyslipidemia (32,33) and CKD-specific factors such as inflammation (34 -37), fetuin deficiency (38,39), SHPT (40), hypercalcemia or high calcium load (41), and high calcium-phosphorus product (42); however, there have been contradictory data about the association of some of these factors and vascular calcification. One study did not find any associations between blood levels of minerals or PTH and CACS in nondialyzed patients with CKD (43).…”

Section: Discussionmentioning

confidence: 99%

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Shantouf¹,

Kövesdy²,

Kim³

et al. 2009

Clinical Journal of the American Society of Nephrology

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140

115

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Background and objectives: Recent in vitro studies have shown a link between alkaline phosphatase and vascular calcification in patients with chronic kidney disease (CKD). High serum levels of alkaline phosphatase are associated with increased death risk in epidemiologic studies of maintenance hemodialysis (MHD) patients. We hypothesized that coronary artery calcification is independently associated with increased serum alkaline phosphatase levels in MHD patients.Design, setting, participants, & measurements: We examined the association of coronary artery calcification score (CACS) and alkaline phosphatase in 137 randomly selected MHD patients for whom markers of malnutrition, inflammation, and bone and mineral disorders were also measured.Results: Serum alkaline phosphatase was the only measure with significant and robust association with CACS (P < 0.003), whereas either other biochemical markers had no association with CACS or their association was eliminated after controlling for case-mix variables. Serum alkaline phosphatase >120 IU/L was a robust predictor of higher CACS and was particularly associated with the likelihood of CACS >400 (multivariate odds ratio 5.0 95% confidence interval 1.6 to 16.3; P ‫؍‬ 0.007). Serum alkaline phosphatase of approximately 85 IU/L seemed to be associated with the lowest likelihood of severe coronary artery calcification, but in the lowest tertile of alkaline phosphatase, the CACS predictability was not statistically significant.Conclusions: An association between serum alkaline phosphatase level and CACS exists in MHD patients. Given the high burden of vascular calcification in patients with CKD, examining potential therapeutic interventions to modulate the alkaline phosphatase pathway may be warranted.

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Section: Discussionmentioning

confidence: 99%

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Shantouf¹,

Kövesdy²,

Kim³

et al. 2009

Clinical Journal of the American Society of Nephrology

Self Cite

140

115

View full text Add to dashboard Cite

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“…For patients with detectable CAC at baseline, progressors were defined as a CAC score change was >25%, which represents 2.5 times the published median inter-scan variabilities and is commonly used in longitudinal studies (15). Subjects with a CAC score of 0 and a follow-up score >4 were considered to have progressed.…”

Section: Discussionmentioning

confidence: 99%

“…We propose that a great proportion of the effect of diabetes on CAC is mediated by renal function, which was improved in this cohort after renal transplant. Other studies that have shown progression of CAC in diabetics have failed to adjust for measures of renal function (15). Sub-optimal glycemic control (HbA(1c) >7.5%) was found to be a strong risk factor for progression of CAC in a cohort of 109 type 1 diabetics (24).…”

Section: Cac Progression In Renal Transplant Recipientsmentioning

confidence: 90%

Determinants of Coronary Artery Calcification Progression in Renal Transplant Recipients

Schankel

Robinson

Bloom

et al. 2007

American Journal of Transplantation

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Coronary artery calcification (CAC) is associated with increased atherosclerotic burden and cardiovascular events. The objective of this study was to determine the natural history and risk factors associated with CAC progression in a cohort of incident asymptomatic renal transplant recipients with no history of coronary revascularization. Electron-beam computed tomography was performed in 82 subjects at time of transplantation and at least 1 year later. Mean (SD) and median CAC score increased for all subjects from 392.4 (747.9) and 75.8 at time of transplant to 475.3 (873.5), (p = 0.002[log]) and 98.9 (p < 0.001), respectively. Most subjects (89%) with no calcifications remained without calcification. Mean annualized rate (SD) of CAC score change was 52.5 (150) with a median of 0.5. Average yearly percent change was 67.3 (409.6) with a median of 1.4. In multivariate analysis, diastolic blood pressure at 3 months post-transplant, Caucasian race, glomerular filtration rate at 3.0, months post-transplant, body mass index and baseline CAC score were independent predictors of annualized rate of CAC change. There is significant progression of CAC post-renal transplantation in most subjects. Progression is most likely to occur in white patients and is associated with clinical factors such as blood pressure, body mass index, renal function and baseline CAC score.

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“…Annual coronary calcium scores greater or equal to 100 units were associated with a 2.5 to 3.0 times increase in risk [141]. In addition, individuals with diabetes who have progression of atherosclerosis may need additional therapy [143].…”

Section: Identification Of Patients At Riskmentioning

confidence: 99%

The Application of the LDL Principle

Schade¹,

Cavanaugh²,

Ramo³

et al. 2016

WJCD

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The LDL Principle has recently been invoked to describe the observation that lowering the LDL cholesterol (by whatever means) results in a lowering of atherosclerotic cardiovascular events. The scientific basis of the LDL Principle dates back to the discovery that the LDL receptor is the prime determinant of the circulating LDL-c concentration. Since that time, major advances have been made at both the basic and clinical science level in our understanding of the pathogenesis and reversal of atherosclerosis. The incorporation of atherogenic lipoproteins plus inflammatory mediators into plaque formation permits the targeted intervention into preventing plaque rupture. In addition, genetic studies identifying individuals with unique phenotypes of either abnormally high or low LDL-c concentrations have provided insight into possible therapeutic modalities that have recently provided the physician with the tools necessary to apply the LDL Principle to achieve reversal of atherosclerosis. The epidemic of atherosclerotic cardiovascular disease has resulted in numerous randomized controlled intervention trials in an attempt to identify approaches to reduce ASCD morbidity and mortality. Recently published data indicate that circulating LDL-c levels of 50 mg/dl or less are not only physiologic at birth but also effective in greatly reducing cardiovascular disease. In addition, the recent availability of two PCSK9 inhibitors provides the primary care physician with the possibility of achieving this low level of LDL-c even in statin intolerant patients. The widespread availability of the coronary artery calcium scan plus the inclusion of traditional cardiovascular risk factors in risk assessment has enabled the physician to readily identify asymptomatic individuals at high risk for cardiovascular events. Aggressively applying the LDL Principle to these individuals has the potential of greatly reducing cardiovascular mortality. This review will document the scientific basis for this principle and provide the arguments in favor of its aggressive application.

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Diabetes and progression of coronary calcium under the influence of statin therapy

Cited by 76 publications

References 27 publications

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Association of Serum Alkaline Phosphatase with Coronary Artery Calcification in Maintenance Hemodialysis Patients

Determinants of Coronary Artery Calcification Progression in Renal Transplant Recipients

The Application of the LDL Principle

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