Pulse Pressure Is an Independent Predictor for the Progression of Aortic Wall Calcification in Patients With Controlled Hyperlipidemia

Abstract

Abstract-Recent epidemiological studies suggested that calcifications of the aorta and the coronary arteries are important predictors for cardiovascular morbidity and mortality. However, the relation between blood pressure components and the progression of vascular wall calcification has remained unclear. We quantified calcium deposits in the abdominal aorta as the percentage of aortic calcification volume (%ACV) using computed tomography in patients with hyperlipidemia. Those who had aortic calcification were treated with lipid-lowering agents and followed-up for Ͼ2 years (6.3Ϯ3.2 years). The relationship between the components of blood pressure and the increase in %ACV per year (⌬%ACV/year) was assessed in subjects in whom serum lipid levels were well controlled during the follow-up periods. An age-and sex-adjusted correlation analysis showed that ⌬%ACV/year was significantly correlated to body mass index (rϭ0. Key Words: hypertension Ⅲ calcium Ⅲ aorta Ⅲ pulse Ⅲ imaging Ⅲ risk factors C alcification in the aorta and coronary arteries is a strong predictor for cardiovascular morbidity and mortality. 1,2 Previous studies have shown the close relationships between arterial wall calcification and abnormal serum lipid levels. Arterial wall calcification is common in patients with familial hypercholesterolemia, a genetic disorder of cholesterol metabolism. [3][4][5] Several studies have identified the relationship between the serum level of low-density lipoprotein cholesterol (LDL-C) and arterial wall calcification; moreover, lipid-lowering therapy using 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors has been reported to inhibit the progression of arterial wall calcification. 6,7 In patients receiving long-term hemodialysis, elevated serum triglyceride (TG) levels and reduced high-density lipoprotein cholesterol (HDL-C) levels are risk factors for coronary artery calcification. 8 These studies suggested that abnormal serum lipid levels promote calcium deposition in the arterial wall.Several studies have examined the influence of hypertension on the progression of arterial wall calcification. In these studies, antihypertensive therapy has been shown to inhibit the formation of calcified lesions, suggesting that hypertension promotes calcium deposition in the arterial wall. 9 -11 However, it remains undetermined which blood pressure (BP) component, ie, systolic BP (SBP), diastolic BP (DBP), mean BP (MBP), or pulse pressure (PP) is responsible for the accelerated formation of calcification, probably because the abnormal serum lipid levels may have made it difficult to assess the effect of BP alone on the formation of calcified lesions.Computed tomography (CT) is a useful tool to evaluate the level of arterial wall calcification. Most of the previous studies used the "calcium score" determined by CT as a semiquantitative index of calcification of the aorta or coronary arteries. [3][4][5][6][7] However, the calcium score may not accurately reflect subtle changes in calcium deposit levels. To accurat...

Validity and Usefulness of Aortic Arch Calcification in Chest X-Ray

“…In addition, the relationship between lipids and aortic calcification is likely to remain controversial, because several studies have indicated that no correlation is present between abdominal aortic calcification and serum lipid components 34) . In this study, there was no association between AAC grade and the presence of dyslipidemia, although our cohort included 67.8% patients with dyslipidemia, including statin users (18%).…”

“…5. Second, an index of lower abdominal aortic calcification using a plain CT scan was also measured, as previously described 18) . Using the TES-100 image software program, the percentage of calcified area against the whole vascular area was calculated from images of four consecutive slices just above the bifurcation of the common iliac arteries.…”

Influence of Differential Calcification in the Descending Thoracic Aorta on Aortic Pulse Pressure

“…5 These studies have correlated the calcification with hemodynamic indices and have established the link between calcification and PP (β=0.4, P<0.01). 6 One study reported a greater number of calcified lesions in the descending thoracic aorta than its other segments, especially the ascending thoracic aorta. 7 Histopathological studies have demonstrated, albeit in a relatively young and healthy selected cohort, that elastic fiber concentration progressively decreases…”

Association Between Different Measures of Blood Pressure and Coronary Artery Calcium in Postmenopausal Women

“…In a separate study and compared with SBP, DBP, and MAP, PP was the strongest predictor of the progression of calcium attributable to atherosclerosis in the abdominal aorta. 27 Conversely, MAP has been found to be associated with incident CVD in younger but not older men. 28 These results, combined with previous reports on PP, 29 demonstrate increasing evidence that among individuals 50 years of age or older, PP is an independent predictor of atherosclerosis, coronary artery disease, and CHD.…”