Vertebrobasilar artery calcification: Prevalence and risk factors in the general population

Toorn, Janine E. van der; Engelkes, Sophie R.; Ikram, M. Kamran; Vernooij, Meike W.; Kavousi, Maryam; Bos, Daniël

doi:10.1016/j.atherosclerosis.2019.05.001

Cited by 31 publications

(25 citation statements)

References 45 publications

(47 reference statements)

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“…With regard to the second profile in men, hypertension has been established as an important risk factor for arteriosclerosis at different locations [ 20 , 29 ]. In our study, the second profile in men was most strongly associated with severe ICAC and ECAC, and with the presence of VBAC, while we found less pronounced associations with other locations.…”

Section: Discussionmentioning

confidence: 99%

“…Coronary artery calcification (CAC), aortic arch calcification (AAC), extracranial carotid artery calcification (ECAC), and aortic valve calcification (AVC) were quantified using dedicated software (Syngo Calcium Scoring; Siemens, Forcheim, Germany). Intracranial carotid artery calcification (ICAC) and vertebrobasilar artery calcification (VBAC) were quantified using a semiautomatic scoring method that allows to manually segment calcification in each consecutive CT slice after which the calcification volume is computed using the pixel size and the increment [ 2 , 19 , 20 ]. A detailed description of the evaluation methods is provided elsewhere [ 2 , 3 , 19 – 21 ].…”

Section: Methodsmentioning

confidence: 99%

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Arterial calcification at multiple sites: sex-specific cardiovascular risk profiles and mortality risk—the Rotterdam Study

Toorn

Rueda‐Ochoa

Schaft

et al. 2020

BMC Med

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Background Evidence has pointed towards differences in the burden of arteriosclerosis according to its location and sex. Yet there is a scarcity of population-based data on aggregated sex-specific cardiovascular risk profiles, instead of single risk factors, and mortality risk according to the location of arteriosclerosis. We assessed sex-specific cardiovascular risk profiles and mortality risk associated with arteriosclerosis. Methods From the population-based Rotterdam Study, 2357 participants (mean age 69 years, 53% women) underwent non-contrast computed tomography to quantify calcification, as a proxy for arteriosclerosis, in the coronary arteries (CAC), aortic arch (AAC), extracranial (ECAC) and intracranial carotid arteries (ICAC), vertebrobasilar arteries (VBAC), and aortic valve (AVC). Principal component analysis (PCA) of eight distinct cardiovascular risk factors was performed, separately for women and men, to derive risk profiles based on the shared variance between factors. We used sex-stratified multivariable logistic regression to examine the associations between PCA-derived risk profiles and severe calcification at different locations. We investigated the associations of severe calcification with mortality risk using sex-stratified multivariable Cox regression. Results PCA identified three cardiovascular risk profiles in both sexes: (1) anthropometry, glucose, and HDL cholesterol; (2) blood pressure; and (3) smoking and total cholesterol. In women, the strongest associations were found for profile 2 with severe ECAC and ICAC (adjusted OR [95% CI] 1.32 [1.14–1.53]) and for profile 3 with severe at all locations, except AVC. In men, the strongest associations were found for profile 2 with VBAC (1.31 [1.12–1.52]) and profile 3 with severe AAC (1.28 [1.09–1.51]). ECAC and AVC in women and CAC in men showed the strongest, independent associations with cardiovascular mortality (HR [95% CI] 2.11 [1.22–3.66], 2.05 [1.21–3.49], 2.24 [1.21–3.78], respectively). Conclusions Our findings further underline the existence of sex- and location-specific differences in the etiology and consequences of arteriosclerosis. Future research should unravel which distinct pathological processes underlie differences in risk profiles for arteriosclerosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Arterial calcification at multiple sites: sex-specific cardiovascular risk profiles and mortality risk—the Rotterdam Study

Toorn

Rueda‐Ochoa

Schaft

et al. 2020

BMC Med

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“…To investigate to which extent any association would be driven by shared risk factors, model 2 was additionally adjusted for shared risk factors including educational level, smoking status, BMI, hypertension (24), hypercholesterolemia (25), diabetes mellitus, history of cardiovascular disease, and granulocyte count. We chose to use granulocyte count as markers of inflammation, since these blood cells in particular are related to larger volumes of arterial calcification (26).…”

Section: Discussionmentioning

confidence: 99%

“…As calcification volumes were larger in men than in women, the tertiles were computed sex-specifically. Also, considering differences in risk factors for atherosclerosis and cancer between men and women ( 27 ), we performed analyses stratified by sex.…”

Section: Methodsmentioning

confidence: 99%

Aortic Arch Calcification and the Risk of Cancer: A Population-Based Cohort Study

et al. 2020

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Background: Atherosclerosis and cancer share multiple disease pathways. Yet, it is unclear if atherosclerosis is associated with a subsequent higher cancer risk. We determined the association of atherosclerotic calcification in the aortic arch, as proxy for systemic atherosclerosis, with the risk of cancer. Methods: Between 2003 and 2006, 2,404 participants (mean age: 69.5 years, 52.5% women) from the prospective population-based Rotterdam Study underwent computed tomography to quantify calcification in the aortic arch. Participants were followed for the onset of cancer, death, loss to follow-up, or January 1st, 2015, whichever came first. We computed sex-specific tertiles of aortic arch calcification volumes. Next, we examined the association between the volume and severity (i.e., tertiles) of aortic arch calcification and the risk of cancer using Cox proportional hazard models. Results: During a median (interquartile range) follow-up of 9.6 years (8.9–10.5), 348 participants were diagnosed with cancer. Participants with the greatest severity of aortic arch calcification had a higher risk of cancer [hazard ratio for the third tertile compared to the first tertile of aortic arch calcification volume in the total population is 1.39 (95% CI = 1.04–1.86)]. Conclusions: Individuals with the most severe aortic arch calcification had a higher risk of cancer. While this could reflect the impact of long-term exposure to shared risk factors, it might also point toward the co-occurrence of both conditions.

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“…Afterward, we determined the intraclass correlation between the C-factor based on calcification volumes of all five vessel beds, i.e., the overall C-factor, and the C-factors based on the different combinations of calcification volumes of two, three or four vessel beds, to examine the robustness of the C-factor. As described previously, calcification volumes in the separate vessel beds have correlation coefficients ranging from 0.24 to 0.60 [ 4 , 12 , 15 ]. Hence, the overall C-factor should have an intraclass correlation coefficient of at least 0.60 with the other C-factors to outperform the correlation between all the separate vessel beds.…”

Section: Methodsmentioning

confidence: 99%

C-factor: a summary measure for systemic arterial calcifications

Kuiper

Ikram

Kavousi

et al. 2021

BMC Cardiovasc Disord

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Background Arterial calcification, the hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites. Hitherto, a single measure capturing the systemic burden of arterial calcification was lacking. In this paper, we propose the C-factor as an overall measure of calcification burden. Methods To quantify calcification in the coronary arteries, aortic arch, extra- and intracranial carotid arteries, and vertebrobasilar arteries, 2384 Rotterdam Study participants underwent cardiac and extra-cardiac non-enhanced CT. We performed principal component analyses on the calcification volumes of all twenty-six possible combinations of these vessel beds. Each analysis’ first principal component represents the C-factor. Subsequently, we determined the correlation between the C-factor derived from all vessel beds and the other C-factors with intraclass correlation coefficient (ICC) analyses. Finally, we examined the association of the C-factor and calcification in the separate vessel beds with cardiovascular, non-cardiovascular, and overall mortality using Cox–regression analyses. Results The ICCs ranged from 0.80 to 0.99. Larger calcification volumes and a higher C-factor were all individually associated with higher risk of cardiovascular, non-cardiovascular, and overall mortality. When included simultaneously in a model, the C-factor was still associated with all three mortality types (adjusted hazard ratio per standard deviation increase (HR) > 1.52), whereas associations of the separate vessel beds with mortality attenuated substantially (HR < 1.26). Conclusions The C-factor summarizes the systemic component of arterial calcification on an individual level and appears robust among different combinations of vessel beds. Importantly, when mutually adjusted, the C-factor retains its strength of association with mortality while the site-specific associations attenuate.

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Vertebrobasilar artery calcification: Prevalence and risk factors in the general population

Cited by 31 publications

References 45 publications

Arterial calcification at multiple sites: sex-specific cardiovascular risk profiles and mortality risk—the Rotterdam Study

Arterial calcification at multiple sites: sex-specific cardiovascular risk profiles and mortality risk—the Rotterdam Study

Aortic Arch Calcification and the Risk of Cancer: A Population-Based Cohort Study

C-factor: a summary measure for systemic arterial calcifications

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