High coronary artery calcium scores pose an extremely elevated risk for hard events

Wayhs, Roberto; Zelinger, Allan; Raggi, Paolo

doi:10.1016/s0735-1097(01)01737-5

Cited by 298 publications

(162 citation statements)

References 43 publications

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“…Furthermore, we have demonstrated that concentric hypertrophy (wall thickness and concentricity) was associated with elevated CRP, although this association appears to be mediated via the risk factors for LVH rather than by LVH itself. Thus, patients with concentric LVH may be at increased risk for incident atherothrombotic events because of the synergistic combination of increased atherosclerotic burden [43][44][45][46][47] in the setting of coexisting risk factors associated with a proinflammatory milieu. 48 -51 Previous data have suggested that LVH may be associated with CAC.…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

et al. 2007

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Abstract-To elucidate mechanisms by which left ventricular (LV) hypertrophy (LVH) increases the risk of atherosclerotic heart disease, we sought to determine whether LVH is independently associated with coronary artery calcium (CAC) and serum C-reactive protein (CRP) levels in the general population. The Dallas Heart Study is a population-based sample in which 2633 individuals underwent cardiac MRI to measure LV structure, electron beam CT to measure CAC, and measurement of plasma CRP. We used univariate and multivariable analyses to determine whether LV mass and markers of concentric LV hypertrophy or dilation were associated with CAC and CRP. Increasing quartiles of LV mass indexed to fat-free mass, LV wall thickness, and concentricity, but not LV volume, were associated with CAC in both men and women (PϽ0.001). After adjustment for traditional cardiovascular risk factors and statin use, LV wall thickness and concentricity remained associated with CAC in linear regression (PϽ0.001 for each). These associations were particularly robust in blacks. LV wall thickness and concentricity were also associated with elevated CRP levels (Pϭ0.001 for both) in gender-stratified univariate analyses, although these associations did not persist in multivariable analysis. In conclusion, concentric LVH is an independent risk factor for subclinical atherosclerosis. LVH is also associated with an inflammatory state as reflected in elevated CRP levels, although this relationship appears to be mediated by comorbid conditions. These data likely explain in part why individuals with LVH are at increased risk for myocardial infarction. , whether determined by the ECG 1-9 or echocardiogram, 6 -8,10 -18 has been associated with various adverse cardiovascular outcomes, including mortality, myocardial infarction, and heart failure. Although there has been considerable speculation as to why LVH is such an important marker of risk, 19,20 the basic mechanisms that predispose patients with LVH to develop atherosclerotic heart disease (ASHD) are not known. Previous hypotheses have included abnormalities in the coronary vasculature 21-25 or platelets, 26 increased blood viscosity, 27 and a prothrombotic state. 28 In addition to these factors, which may contribute to reduced myocardial oxygen supply, myocardial oxygen demand is also increased in patients with LVH. 20 Another simple explanation for the association of LVH and ASHD is that LVH reflects target organ damage from concomitant risk factors, such as hypertension, thus providing a noninvasive barometer of the extent of ASHD. The association of LVH with atherosclerosis in other vascular territories, for example, the carotid artery, 29 supports this hypothesis. There are scant data as to whether LVH is associated with the burden of coronary atherosclerosis as estimated by coronary artery calcium (CAC). 30 -32 Yet another emerging hypothesis is that LVH itself is a low-level inflammatory state, as has been suggested recently from animal 33 and human studies. 34,35 If this is the case, one co...

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

et al. 2007

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“…Whether coronary calcium is independent and superior to conventional risk factors as a predictor for future cardiac events is not yet well established. 11 Future randomized large prospective studies (eg, Prospective Army Coronary Calcium study 12 ) may provide the definitive evidence of the predictive value of CS.…”

Section: Ebct For Coronary Calciummentioning

confidence: 99%

Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging

et al. 2002

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“…Detection and quantification of arterial calcification now can be easily achieved by the use of newer imaging techniques such as electron-beam computed tomography (EBCT) and multislice computed tomography (2,3). In the general population, coronary artery calcium (CAC) score as measured by EBCT was found to be an independent predictor of subsequent cardiac events in both symptomatic and asymptomatic individuals (3,4).…”

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confidence: 99%

Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease

Qunibi

2005

Journal of the American Society of Nephrology

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Patients with chronic kidney disease (CKD) have a higher burden of atherosclerotic coronary artery disease compared with age-and gender-matched individuals with normal renal function. Cardiovascular calcification (CVC), a marker of atherosclerosis, is also more prevalent in these patients and is associated with serious clinical consequences. The pathogenesis of CVC is complex and includes factors that promote calcification and others that inhibit calcification. Thus, multiple therapeutic interventions should be used simultaneously to reduce the burden of calcification in patients with CKD. Thus far, interventional attempts have focused on curtailing the effects of factors that promote calcification such as management of known traditional factors for atherosclerotic coronary artery disease and on adopting specific approaches to normalize mineral metabolism, deliver adequate dialysis, and control serum cholesterol level. By contrast, interventions that may bolster the effects of inhibitors of calcification have not yet been studied well but are beginning to attract attention. Ideally, the goal of interventions is not only to slow or halt progression of calcification but also to reverse pre-existing calcification. Whether this goal is achievable is not currently known. This review examines the potential of various therapeutic interventions in reducing the CVC burden in patients with CKD. Moreover, the review is intended to stimulate more research in this area because the efficacy of these interventions has not been examined in controlled clinical trials.

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High coronary artery calcium scores pose an extremely elevated risk for hard events

Abstract: A high CS (> or = 1,000) on a screening EBT in an asymptomatic person portends a very high risk of an HCE in the short term. This risk appears to be greater than the risk associated with a severe perfusion abnormality on MPI.

Cited by 298 publications

References 43 publications

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

Left Ventricular Hypertrophy, Subclinical Atherosclerosis, and Inflammation

Computed Tomography and Magnetic Resonance Imaging for Noninvasive Coronary Angiography and Plaque Imaging

Reducing the Burden of Cardiovascular Calcification in Patients with Chronic Kidney Disease

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