Relation of Oral Anticoagulation to Cardiac Valvular and Coronary Calcium Assessed by Multislice Spiral Computed Tomography

Koos, Ralf; Mahnken, Andreas H.; Mühlenbruch, Georg; Brandenburg, Vincent; Pflueger, Benjamin; Wildberger, Joachim E.; Kühl, Harald P.

doi:10.1016/j.amjcard.2005.05.014

Cited by 159 publications

(142 citation statements)

References 8 publications

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“…Vitamin K antagonists such as warfarin induce the incomplete g-carboxylation of matrix g-carboxyglutamic acid protein and attenuate the synthesis and function of matrix g-carboxyglutamic acid protein. 24 Previous observational studies in Western countries showed that aortic valve calcifications were significantly larger in patients treated with oral anticoagulants, 25,26 a finding that is compatible with our current data from Japanese patients. In a society with many elderly, such as in Western countries and Japan, the use of oral anticoagulants to prevent thromboembolic events has increased correspondingly with the rising prevalence of atrial fibrillation, but the effects of warfarin on the progression of CAVD were independent of the presence of atrial fibrillation in this study.…”

Section: Prognostic Factors For Progression Of Early-stage Cavdsupporting

confidence: 82%

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Yamamoto

Yoshida

et al. 2010

Hypertens Res

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Calcific aortic valve disease (CAVD) is the most common etiology of acquired valvular heart disease, and hypertension is a principal underlying disease. The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis is a retrospective observational study to clarify the prognostic factors for progression of CAVD in Japanese. Data from 556 subjects who met the following criteria were analyzed: (1) X50 years old; (2) calcification in any aortic valve leaflet or peak aortic jet velocity X2 m s À1 on an echocardiographic study performed between July 2004 and June 2007; and (3) availability of earlier echocardiographic data from within the previous 2-5 years to assess the progression of CAVD. The subjects were divided into two groups according to CAVD severity on the preceding echocardiographic examination. In early-stage subjects with calcification in one or zero leaflets who were without aortic stenosis on the preceding echocardiographic study (n¼157), the prognostic factors for progression were the following: (1) no use of angiotensin receptor blockers (ARB) and (2) use of warfarin. In late-stage subjects with calcification in two or three leaflets and/or aortic stenosis on the preceding echocardiographic study (n¼399), progression was observed in females and in subjects with low hemoglobin and a concentric left ventricle. There was no relation between medications and changes in CAVD. Prognostic factors for the progression of CAVD were different between the early and late stages. Initiation of ARB treatment during the early stage may be effective, and we should be vigilant about progression of CAVD in patients treated with warfarin.

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Section: Prognostic Factors For Progression Of Early-stage Cavdsupporting

confidence: 82%

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Yamamoto

Yoshida

et al. 2010

Hypertens Res

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“…Because vascular calcification is frequently limited to the media, without affecting the lumen, it remains difficult to make definitive conclusions. However, a small computed tomography study found that warfarin use was associated with both valvular and coronary calcification (41). Histopathologic examination of aortic valves replaced for aortic stenosis found that those patients treated with warfarin had a two-fold increase in valvular calcification (42).…”

Section: Warfarin's Effect On the Vasculaturementioning

confidence: 99%

Vitamin K-dependent Proteins, Warfarin, and Vascular Calcification

Danziger

2008

Clinical Journal of the American Society of Nephrology

211

146

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Vitamin K-dependent proteins (VKDPs) require carboxylation to become biologically active. Although the coagulant factors are the most well-known VKDPs, there are many others with important physiologic roles. Matrix Gla Protein (MGP) and Growth Arrest Specific Gene 6 (Gas-6) are two particularly important VKDPs, and their roles in vascular biology are just beginning to be understood. Both function to protect the vasculature; MGP prevents vascular calcification and Gas-6 affects vascular smooth muscle cell apoptosis and movement. Unlike the coagulant factors, which undergo hepatic carboxylation, MGP and Gas-6 are carboxylated within the vasculature. This peripheral carboxylation process is distinct from hepatic carboxylation, yet both are inhibited by warfarin administration. Warfarin prevents the activation of MGP and Gas-6, and in animals, induces vascular calcification. The relationship of warfarin to vascular calcification in humans is not fully known, yet observational data suggest an association. Given the high risk of vascular calcification in those patients with chronic kidney disease, the importance of understanding warfarin's effect on VKDPs is paramount. Furthermore, recognizing the importance of VKDPs in vascular biology will stimulate new areas of research and offer potential therapeutic interventions.

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“…In humans, VKA use was associated with coronary artery plaque calcification in patients with suspected coronary artery disease (CAD), where calcification of coronary plaques significantly increased with prolonged VKA use [32,33]. Also, increased calcification of aortic valves was observed in patients receiving preoperative VKAs relative to non-treated patients [34,35]. Chronic kidney disease (CKD) patients, a population with a high prevalence of cardiovascular mortality and vascular calcifications, have been associated with subclinical vitamin K deficiency [35,36].…”

Section: Vitamin K-antagonists As Indicators Of Vitamin K Importance mentioning

confidence: 99%

New Perspectives for the Nutritional Value of Vitamin K in Human Health

Viegas¹,

Simes²

2016

J Nutr Disorders Ther

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Vitamin K is an essential micronutrient in the post-translational modification of specific glutamic acid residues (Glu) into γ-carboxyglutamic acid residues (Gla) in target proteins known as vitamin K-dependent proteins (VKDPs). In healthy conditions of sufficient vitamin K status, a vitamin K recycling system maintains sufficient vitamin K levels for proper γ-carboxylation of VKDPs, and vitamin K antagonists (VKAs) widely used as anticoagulants inhibit vitamin K recycling. Besides its well-known function in the maintenance of normal coagulation, vitamin K has been reported to have other diverse physiological functions with impact in human health. In extra-hepatic tissues vitamin K deficiency results in impairment of VKDPs γ-carboxylation with important implications in bone and cardiovascular health. Although most of the vitamin K effects have been associated with regulation of mineralization in connective tissues through the action of matrix Gla protein (MGP) and osteocalcin (OC), the discovery of Gla-rich protein (GRP) opens new perspectives on the potential therapeutic range of vitamin K.

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Relation of Oral Anticoagulation to Cardiac Valvular and Coronary Calcium Assessed by Multislice Spiral Computed Tomography

Cited by 159 publications

References 8 publications

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Prognostic factors for progression of early- and late-stage calcific aortic valve disease in Japanese: The Japanese Aortic Stenosis Study (JASS) Retrospective Analysis

Vitamin K-dependent Proteins, Warfarin, and Vascular Calcification

New Perspectives for the Nutritional Value of Vitamin K in Human Health

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