Update on using coronary calcium screening by computed tomography to measure risk for coronary heart disease

Abstract-A considerable proportion of pregnant women develop high blood pressure in pregnancy. Although it is assumed that this condition subsides after pregnancy, many of these women develop the metabolic syndrome later in life and are at increased risk to develop coronary heart disease. Atherosclerosis development is considered in between risk factors and occurrence of vascular symptoms. We set out to cross-sectionally study the relation of high blood pressure during pregnancy with risk of coronary calcification. The study population was composed 491 healthy postmenopausal women selected from a population-based cohort study. Information on high blood pressure during pregnancy was obtained using a questionnaire. ypertensive disorders are common complications of pregnancy and rank among the leading causes of maternal and perinatal morbidity and mortality worldwide. 1-3 Depending on the definitions used and the populations studied, high blood pressure is reported to affect 2% to 35% of all pregnancies. 4 In the various classification schemes proposed, hypertension specific for and secondary to pregnancy is referred to as gestational hypertension, pregnancy-induced hypertension, or, when proteinuria is observed as well, pre-eclampsia. Pre-eclampsia, in particular, is associated with an increased risk of adverse pregnancy outcome for both the mother and the fetus.During the last decade, evidence has accumulated that hypertensive disorders of pregnancy, pre-eclampsia, in particular, are associated with future hypertension and cardiovascular events. Pre-eclampsia and cardiovascular disease (CVD) share chronic hypertension, increased total cholesterol, decreased insulin sensitivity, and increased body mass index as common risk factors. 5 Large epidemiological studies have demonstrated that women who have had pre-eclampsia are at high (2-fold) risk to develop CVD in later life. 6 -11 Many of the women who have had pre-eclampsia in pregnancy and who have no signs of clinical disease after pregnancy exhibit the phenotype of the metabolic syndrome (overweight, latent hypertension, dyslipidemia, insulin resistance, and hyperhomocysteinemia) and impaired endothelial function at 3 to 12 months postpartum. [12][13][14][15] Apparently, exposure of the women with this phenotype to the additional metabolic and cardiovascular challenges of pregnancy induces transient clinical disease (ie, pre-eclampsia) that subsides after pregnancy but is likely to re-emerge later in life as CVD. 16 -18 This knowledge has lead to the novel concept of pregnancy as a cardiovascular challenge test with the development of high blood pressure or pre-eclampsia as a marker of increased risk to develop atherosclerosis and vascular events in the future. To further expand on this notion toward the development of atherosclerosis, we studied the relation of high blood pressure during pregnancy with coronary atherosclerosis. Increased coronary calcium is indeed one of the strongest predictors of

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“…22 There appears to be several valid indications for using CAC quantification as a screening test for CHD. 23 …”

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confidence: 99%

High Blood Pressure in Pregnancy and Coronary Calcification

et al. 2007

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“…The extent of coronary artery calcification correlates closely with total coronary atherosclerosis upon histological examination [44]. Studies also have demonstrated that the CCS is closely related to the severity of coronary artery disease and the number of stenosed vessels determined by coronary angiography [45][46][47].…”

Section: Computed Tomographymentioning

confidence: 88%

Atherosclerosis imaging and heart failure

2006

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Coronary atherosclerosis is the most important primary etiologic factor predisposing to the development of heart failure. The mechanisms by which coronary atherosclerosis lead to heart failure likely involve the initial development of regional myocardial dysfunction, later progressing to global ventricular failure and symptomatic congestive disease. A variety of imaging strategies have been investigated for their value in identifying and characterizing markers of atherosclerosis in the effort to detect early cardiac disease. Non-invasive imaging techniques for assessing anatomic or functional manifestations of atherosclerosis include carotid ultrasonography, coronary computed tomography, cardiovascular magnetic resonance imaging, brachial artery reactivity testing, and the ankle-brachial index. Many of these imaging methods are shown to have accuracy, reliability, and the potential to add value to an office-based cardiovascular risk assessment. Further development of such imaging methods could facilitate early intervention in the development of myocardial dysfunction while enhancing our understanding of the natural course of atherosclerotic disease.

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“…These proteins are not normally expressed in healthy arterial tissue and are only found in atheromatous arteries. Small to moderate amounts of calcification may destabilise the plaque by making it less tolerant of shear stress [11]. In addition, it has been shown that vulnerable plaques tend to be associated with less calcification than stable ones [11].…”

Section: Introductionmentioning

confidence: 99%