Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography

Detrano, Robert; Hsiai, Tzung K.; Wang, ShaoJung; Puentes, Gail; Fallavollita, James A.; Shields, Paul; Stanford, William; Wolfkiel, Christopher J.; Georgiou, Demetrious; Budoff, Matthew J.; Reed, Judd E.

doi:10.1016/0735-1097(95)00460-2

Cited by 406 publications

(205 citation statements)

References 27 publications

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“…Several other studies, including a study in young adults, 34 have found relationships between EBCT-measured coronary calcium and coronary risk factors. 34 -36 Coronary calcium has also been found to predict mortality 37 and CHD events. [37][38][39] These findings confirm that coronary calcium is a marker of atherosclerosis and suggest that it is a useful tool in studying the origins of atherosclerotic heart disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Bild

Folsom

Lowe

et al. 2001

ATVB

136

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Abstract-Whereas cardiovascular risk factor levels are substantially different in black and white Americans, the relative rates of cardiovascular disease in the 2 groups are not always consistent with these differences. To compare the prevalence of coronary calcification, an indicator of coronary atherosclerosis, in young adult blacks and whites, we performed electron-beam computed tomography of the heart in 443 men and women aged 28 to 40 years recruited from a population-based cohort. The presence of calcium, defined as at least 1 focus of at least 2.05 mm 2 in area and Ͼ130 Hounsfield units in density within the coronary arteries, was identified in 16.1% of black men, 11.8% of black women, 17.1% of white men, and 4.6% of white women (Pϭ0.04 for comparison across groups). Coronary calcium was associated with age and male sex, and after adjustment for age, race, and sex, coronary calcium was positively associated with body mass index, weight, systolic blood pressure, total cholesterol, low density lipoprotein cholesterol, triglycerides, and fasting insulin and negatively associated with education (all PϽ0.05). Independent risk factors included male sex, body mass index, and low density lipoprotein cholesterol. Race was not significantly associated with coronary calcium in men or women, before or after adjustment for risk factors. Coronary calcification is associated with increased levels of cardiovascular risk factors in young adults, and its prevalence is not significantly different in blacks and whites. Key Words: coronary heart disease Ⅲ risk factors Ⅲ race Ⅲ coronary artery calcification R elative levels of coronary risk factors in blacks and whites suggest that blacks would be at higher risk for coronary heart disease (CHD). 1-6 CHD mortality rates appear to reflect higher risk factor levels in blacks, 7 but CHD incidence is lower in black men than in white men. 8 Clues to possible racial differences in rates of CHD may be found by identifying subclinical disease for which treatment has not been instituted and which is not subject to the biases of disease ascertainment or death certificate coding. 9 -12 To compare the prevalence of a marker of coronary atherosclerosis in a population-based sample of young adult blacks and whites, to examine risk factor correlates, and to determine whether any racial differences in prevalence might be explained by risk factor differences, we measured coronary calcification by using electron-beam computed tomography (EBCT) of the heart and risk factors in men and women aged 28 to 40 years who have participated in an ongoing epidemiological study of the coronary disease risk factors. Coronary calcium is a specific marker for coronary atherosclerosis 13 and can be quantified by EBCT. 14 -16 Methods ParticipantsParticipants in the present study were from the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The baseline CARDIA examination took place from 1985 to 1986 and included 5115 women and men from 4 centers (Birmingham, Ala; Chicago, Ill; Minneapolis, Min...

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Section: Discussionmentioning

confidence: 99%

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Bild

Folsom

Lowe

et al. 2001

ATVB

136

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“…The severity of calcification as measured by EBT can also predict silent myocardial infarction (20). Even in asymptomatic patients, coronary calcification is a strong predictor of cardiovascular morbidity and mortality (24). Thus, the hemodynamic and functional changes associated with vascular calcification and remodeling have real and significant clinical impact that can affect morbidity and mortality among dialysis patients.…”

Section: Clinical Impact Of Calcificationmentioning

confidence: 99%

“…Both decreasing DBP (the principal moving force for coronary perfusion) (25) and increasing PP (26) are associated with poor survival in hemodialysis patients (24). However, high postdialysis DBP of 90 mmHg or greater has also been associated with increased cardiovascular mortality (27).…”

Section: Clinical Impact Of Calcificationmentioning

confidence: 99%

Cardiovascular Calcifications in Uremic Patients

London

2003

Journal of the American Society of Nephrology

193

137

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Abstract. Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calciumfree, metal-free phosphate binders such as sevelamer can reduce calcification scores.

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“…9 Four large studies have been published regarding cardiac prognosis and EBCT calcium score. Detrano and colleagues 15 examined the relative prognostic value of coronary calcium for predicting coronary heart diseaserelated events in 491 patients (mean age, 55±12 years) referred for angiography who also underwent EBCT scanning. Thirteen documented coronary heart disease-related deaths (sudden cardiac death in 12 and a fatal infarction in 1) and 8 nonfatal myocardial infarctions occurred, with an 86% complete follow-up during a period of 30±13 months.…”

Section: Coronary Calcium As a Prognostic Indicatormentioning

confidence: 99%

“…[15][16][17][18] The National Heart, Lung, and Blood Institute (NHLBI) recently put forward an RFP (request for proposals) using EBCT, among other noninvasive methods, to study subclinical cardiovascular disease (RFP-…”

mentioning

confidence: 99%

Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons

Rumberger

Brundage²,

Rader

et al. 1999

Mayo Clinic Proceedings

742

449

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Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography

Abstract: Electron beam computed tomographic calcium scores correlate moderately well with angiographic findings. These scores predict coronary heart disease-related events in patients undergoing angiography as well as do the number of angiographically affected arteries.

Cited by 406 publications

References 27 publications

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Prevalence and Correlates of Coronary Calcification in Black and White Young Adults

Cardiovascular Calcifications in Uremic Patients

Electron Beam Computed Tomographic Coronary Calcium Scanning: A Review and Guidelines for Use in Asymptomatic Persons

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