冠脉钙化不能准确预测高危成人近期内的冠脉事件

冠状动脉硬化可引起冠心病死亡、心肌梗死等冠脉事件,但在冠脉事件发生前患者大多没有临床症状。对这些患者,有人提出用冠状动脉电子束CT(EBCT)行无创性冠状动脉钙化扫描,进行冠脉钙化评分来预测近期内冠脉事件发生的可能性。此研究为一前瞻性研究,通过与冠状动脉危险因素评估相比较,评定了EBCT冠状动脉钙化评分对预测无症状高危成人近期是否会发生冠脉事件的准确性。     

冠状动脉钙化研究进展

冠心病是临床常见病、多发病,冠状动脉钙化是冠状动脉粥样硬化的特征性病理表现之一,并呈年龄依赖性。现就冠状动脉钙化的发生机制、相关危险因素、冠状动脉钙化的检测手段及冠状动脉钙化的临床意义等方面作论述。     

冠状动脉钙化病变治疗的新进展:环形轨道旋磨系统临床应用的结果评价

正严重冠状动脉钙化病变约占经皮冠状动脉介入治疗(PCI)的6%~20%~([1-2])。冠状动脉钙化不仅是主要不良心血管事件(major adverse cardiac events,MACE)发生的高危因素,也常导致支架置入后发生膨胀不良、贴壁不良等其他并发症。冠状动脉钙化程度随着年龄的增长显著增加~([3]),随着中国老龄化社会的到来,冠状动脉钙化病变在PCI治疗中的比例将不断增加,故而开发新的高效安全的治疗手段     

冠状动脉钙化形成机制与新型评估综述

冠状动脉钙化（coronary artery calcification，CAC）在冠心病患者中普遍存在，严重的钙化病变会增加治疗难度以及并发症的发生，了解CAC的病理生理机制能更好地指导诊疗。冠状动脉钙化分为内膜型和中膜型两种类型，各有相应的形成机制与危险因素，前人已充分论述。过去冠状动脉钙化被认为是一种被动的、与年龄相关的退行性改变，现在更多地被认为是一个主动的、受调控的过程。很少有文献从被动、主动方向论述冠脉钙化形成机制。本文旨在从冠状动脉钙化不同形成过程入手，分析钙化病变的相关遗传因素和调节机制，并且介绍了几种新型潜在的评估钙化的方式，为钙化病变的诊疗提供新思路。     

冠状动脉钙化研究进展

冠状动脉钙化是动脉粥样硬化的一个重要的危险因素,多项研究揭示冠状动脉钙化和粥样硬化斑块负荷有着密切的关系,因此冠状动脉钙化程度的测量在预测未来心血管事件及死亡率中起着重要的作用。现将通过对冠状动脉钙化的危险因素、发病机制、冠状动脉钙化积分评测及方法、钙化与心血管疾病的关系、冠状动脉钙化与肾脏疾病的关系、冠状动脉钙化与全因死亡及钙化的治疗等方面做一综述。     

富含Gla蛋白参与冠状动脉钙化机制的研究进展

冠状动脉钙化在冠状动脉粥样硬化性心脏病患者中较为常见,目前对其发生、发展及形成机制尚不清楚。富含Gla蛋白(GRP)是新近发现的维生素K依赖性蛋白,研究表明GRP通过与矿物质结合发挥抑制钙化晶体的形成及成熟、参与基质Gla蛋白-胎球蛋白A钙化的抑制途径、阻断钙化诱导剂的信号通路及抗炎作用,起到抑制血管钙化的作用。本文就GRP参与冠状动脉钙化机制的研究进展进行综述,为冠状动脉钙化的预防、治疗提供新的方向。     

维持性血液透析患者冠状动脉钙化及其进展的危险因素

目的:探讨维持性血液透析患者冠状动脉钙化发生及进展的危险因素。方法:选择在广东省人民医院血液净化中心维持性血液透析≥6月的患者62例,完善相关实验室检查,螺旋CT检测冠状动脉钙化评分,入组后每6个月检测血钙、磷、全段甲状旁腺激素(i PTH),并在随访2年后再次复查冠状动脉钙化评分。结果:本组患者冠状动脉钙化的总发生率为70.97%,其中冠状动脉钙化积分100的患者占68.18%。有、无冠状动脉钙化两组患者在年龄、总胆固醇水平、合并腹主动脉钙化、左房直径、右房直径有显著差异。多因素分析发现,总胆固醇水平是发生冠状动脉钙化的独立危险因素。共有47例患者完成了2年后的冠状动脉CT复查,其中61.70%的患者钙化积分进展。平均血钙水平较高是钙化进展的独立危险因素。结论:维持性血液透析患者冠状动脉钙化发生率高,血胆固醇升高是冠状动脉钙化发生的危险因素;血钙水平较高与冠状动脉钙化进展有关。     

冠状动脉钙化在冠心病高危人群发生频率的研究

冠状动脉钙化和动脉粥样硬化存在着密切关系,病理研究证实钙化仅发生于血管壁有粥样硬化的病变处,是冠状动脉粥样硬化发展到一定程度的结果.本文应用多层螺旋CT(MSCT)血管成像方法对40岁以上疑似冠心病及正常人群冠状动脉钙化研究,探讨冠心病高危人群冠状动脉钙化发生率.     

冠状动脉钙化研究进展

冠状动脉钙化(CAC)是导致一般人群和冠状动脉性心脏病患者不良结局的危险因素。CAC的发病机制和骨形成有共同的途径,目前已经确定了一些导致CAC发生和发展的危险因素。用药物治疗控制CAC的努力没有取得成功,而冠状动脉钙化的患者经皮冠脉介入术和冠状动脉搭桥术后的无事件生存率也较低。虽然应用药物洗脱支架和斑块修饰装置对钙化血管的预后有一定改善,但不良事件发生率仍然很高。在未来,仍需创新的药物和器械治疗来改善CAC患者的不良预后。     

维持性血液透析患者心外膜脂肪组织与冠状动脉钙化、趋化素的关系

目的探讨维持性血液透析患者心外膜脂肪组织与冠状动脉钙化、趋化素的关系。方法选取天津市第五中心医院维持性血液透析患者90例,依据Framingham危险评分分为低危组(10%)、中危组(10%~20%)和高危组(20%)。选取60例健康体检者作为对照组。检测血趋化素、C反应蛋白、血常规、血生化,对维持性血液透析患者行胸多层螺旋CT检查,飞利蒲工作站软件测量心外膜脂肪组织体积和冠状动脉钙化评分。分析维持性血液透析患者心外膜脂肪组织体积与冠状动脉钙化评分、趋化素、C反应蛋白、Framingham危险评分等之间的关系。结果维持性血液透析组血趋化素、C反应蛋白、血中性粒细胞与淋巴细胞比率较对照组升高(P0.01);维持性血液透析高危组、中危组心外膜脂肪组织体积、冠状动脉钙化评分、趋化素明显高于低危组(P0.05或P0.01),高危组心外膜脂肪组织体积、趋化素明显高于中危组(P0.05);维持性血液透析患者冠状动脉钙化评分、趋化素、C反应蛋白及Framingham危险评分为心外膜脂肪组织的影响因素(P0.05或P0.01)。结论维持性血液透析患者血趋化素、C反应蛋白、血中性粒细胞与淋巴细胞比率升高,维持性血液透析患者存在微炎症状态。维持性血液透析患者高危组、中危组心外膜脂肪组织体积、冠状动脉钙化评分、趋化素均高于低危组,心外膜脂肪组织与维持性血液透析患者冠状动脉钙化评分、趋化素及Framingham危险评分相关,心外膜脂肪组织可预测维持性血液透析患者心血管疾病发生风险。     

The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification

OBJECTIVES

To examine whether the gender difference in coronary artery calcification, a measure of atherosclerotic plaque burden, is lost in type 1 diabetic patients, and whether abnormalities in established coronary heart disease risk factors explain this.

BACKGROUND

Type 1 diabetes abolishes the gender difference in coronary heart disease mortality because it is associated with a greater elevation of coronary disease risk in women than men. The pathophysiological basis of this is not understood.

METHODS

Coronary artery calcification and coronary risk factors were compared in 199 type 1 diabetic patients and 201 nondiabetic participants of similar age (30 to 55 years) and gender (50% female) distribution. Only one subject had a history of coronary disease. Calcification was measured with electron beam computed tomography.

RESULTS

In nondiabetic participants there was a large gender difference in calcification prevalence (men 54%, women 21%, odds ratio 4.5, p < 0.001), half of which was explained by established risk factors (odds ratio after ADJUSTMENT = 2.2). Diabetes was associated with a greatly increased prevalence of calcification in women (47%), but not men (52%), so that the gender difference in calcification was lost (p = 0.002 for the greater effect of diabetes on calcification in women than men). On adjustment for risk factors, diabetes remained associated with a threefold higher odds ratio of calcification in women than men (p = 0.02).

CONCLUSIONS

In type 1 diabetes coronary artery calcification is greatly increased in women and the gender difference in calcification is lost. Little of this is explained by known coronary risk factors.     

Antioxidant vitamin intake and subclinical coronary atherosclerosis

Numerous studies have evaluated the association between antioxidants and coronary atherosclerosis but have been limited by its study among individuals with advanced atherosclerosis. The authors studied 865 consecutive patients, 39-45 years of age, without known coronary artery disease and presenting for a periodic physical examination. Antioxidant intake was assessed with the Block Dietary Questionnaire, and coronary atherosclerosis was identified by measuring coronary artery calcification using electron beam computed tomography. The mean age was 42 (+/-2), 83% were male, and the prevalence of coronary artery calcification was 20%. Vitamin supplements were used by 56% of the participants, and the mean (+/-SD) daily intake (dietary plus supplemental) of vitamins A, C, and E were 1683 mg (+/-1245), 371 mg (+/-375), and 97 mg (+/-165), respectively. There was no significant correlation between coronary artery calcification score and individual vitamin or total antioxidant vitamin intake, even after adjusting for traditional cardiac risk factors. The highest quartile of vitamin E was positively associated with calcification (odds ratio=1.77; 95% confidence interval, 1.02-3.06). Antioxidant vitamin intake is not significantly related to coronary artery calcification, implying that there is no effect on the development of early coronary atherosclerosis. High doses of vitamin E may confer an increased risk of calcified atherosclerosis.     

Coronary artery calcification and emphysema

OBJECTIVE:

It is thought that emphysema patients are at a higher risk of coronary artery disease. The present study is one of very few that evaluated the prevalence of significant coronary artery disease in emphysema patients using coronary artery calcification measured by electron beam computed tomography.

METHODS:

A retrospective chart review evaluated 1720 consecutive patients, some of whom were self-referred. All patients had both heart and lungs imaged with electron beam computed tomography when they were seen at the Inner Imaging Center, a cardiac imaging center affiliated with the Beth Israel Hospital in New York, New York. Multiple logistic regression was performed to determine which factors were independently associated with coronary artery calcification.

RESULTS:

Age, sex, hypertension and smoking were the risk factors independently associated with coronary artery calcification in the population studied. The emphysema group was significantly higher on measures of smoking and hypertension compared with the control group. Comparison of scores between the two groups using different categories for coronary artery calcification scores did not show a statistically significant difference using χ² analysis (P=0.088). However, there was a significant difference between dichotomized coronary artery calcification scores of lower than 100 and 100 or higher in patients with and without emphysema, respectively (P=0.013). Coexisting smoking and hypertension may contribute to the higher incidence of coronary artery calcfication in emphysema patients. Symptoms of chest pain and shortness of breath were not different between the emphysema and control groups.

CONCLUSION:

Emphysema patients have a higher prevalence of significant coronary artery calcification, defined as a coronary artery calcification score higher than 100.     

Subclinical coronary atherosclerosis is more pronounced in men and women with lower socio-economic status: associations in a population-based study. Coronary atherosclerosis and social status.

BACKGROUND: Social inequalities of manifest coronary heart diseases are well documented in modern societies. Less evidence is available on subclinical atherosclerotic disease despite the opportunity to investigate processes underlying this association. Therefore, we examined the relationship between coronary artery calcification as a sign of subclinical coronary atherosclerosis, socio-economic status and established cardiovascular risk factors in a healthy population. DESIGN: Cross-sectional. METHODS: In a population-based sample of 4487 men and women coronary artery calcification was assessed by electron beam computed tomography quantified by the Agatston score. Socio-economic status was assessed by two indicators, education and income. First, we investigated associations between the social measures and calcification. Second, we assessed the influence of cardiovascular risk factors on this association. RESULTS: After adjustment for age, men with 10 and less years of formal education had a 70% increase in calcification score compared with men with high education. The respective increase for women was 80%. For income the association was weaker (among men 20% higher for the lowest compared with the highest quartile; and among women 50% higher, respectively). Consecutive adjustment for cardiovascular risk factors significantly attenuated the observed association of socio-economic status with calcification. CONCLUSIONS: Social inequalities in coronary heart diseases seem to influence signs of subclinical coronary atherosclerosis as measured by coronary artery calcification. Importantly, cumulation of major cardiovascular risk factors in lower socio-economic groups accounted for a substantial part of this association.     

Coronary artery calcification and risk factors for atherosclerosis in patients with venous thromboembolism

BACKGROUND: Venous thromboembolism (VTE) and atherosclerosis may be associated and may share common risk factors. We conducted a retrospective case-control study to investigate the association between VTE and coronary atherosclerotic disease (CAD) by means of measuring coronary artery calcification and evaluating clinical risk factors. METHODS: From 385 consecutive patients suspected of VTE, we randomly selected 89 cases with idiopathic VTE and 89 controls without VTE, frequency matched on gender and age. Risk factors for atherosclerosis were noted for both groups. Coronary artery calcification was quantified on pulmonary computed tomography (CT) angiographic images. The coronary artery calcification and risk factors were compared between the case and control groups. The associations between VTE and the presence of coronary artery calcium and risk factors were assessed with logistic regression analysis. RESULTS: A higher prevalence of coronary artery calcium was found in the case group (51.7%) than in the control group (28.1%) (p=0.001). The presence of coronary artery calcium was significantly associated with VTE with an odds ratio of 4.3 (95% confidence interval, 1.9-10.1) in a multivariable model. Diabetes mellitus and hypertension were also significantly associated with VTE. CONCLUSION: A significant association between VTE and CAD suggests that CAD is an independent risk factor for VTE. Diabetes and hypertension are also independent risk factors for VTE.     

Coronary artery and abdominal aortic calcification are associated with cardiovascular disease in type 2 diabetes

Aims/hypothesis The goals of this study were to determine whether coronary calcium is associated with the presence of clinical cardiovascular disease in individuals with type 2 diabetes and if the measurement of abdominal aortic calcium may have an independent or added benefit as a surrogate marker for clinical vascular disease.Methods A cross-sectional study of subjects with type 2 diabetes enrolled in seven medical centres in the USA participating in a Veterans Affairs Cooperative Study of glycaemic control. Enrolled subjects included 309 veterans over 40 years of age with type 2 diabetes, with or without stable cardiovascular disease, who had inadequate glycaemic control (HbA₁c>7.5%) on oral agents and/or insulin. The study assessed lifestyle behaviours, standard cardiovascular risk factors and coronary artery and abdominal aorta calcification by electron beam computed tomography.Results Subjects with coronary artery or abdominal aorta calcification present had a strikingly higher prevalence of peripheral artery disease, coronary artery disease and all combined cardiovascular disease. Prevalence of each condition increased from 5- to 13-fold with increasing quintiles of coronary artery calcification and from 2- to 3-fold with increasing abdominal aorta calcification. These associations persisted after adjustment for lifestyle behaviours and standard cardiovascular risk factors.Conclusions/interpretation These results support the notion that vascular calcium in type 2 diabetes provides additional information beyond that of standard risk factors in identifying the presence of cardiovascular disease. Subclinical measures of atherosclerosis such as arterial calcification may help more precisely stratify these individuals and alert healthcare providers to those individuals who have particularly accelerated atherosclerosis.     

Vascular Calcification: Pathophysiology and Risk Factors

Vascular calcification can occur in nearly all arterial beds and in both the medial and intimal layers. The initiating factors and clinical consequences depend on the underlying disease state and location of the calcification. The best studied manifestation is coronary artery calcification, in part because of the obvious clinical consequences, but also because of CT-based imaging modalities. In the general population, the presence of coronary artery calcification increases cardiovascular risk above that predicted by traditional Framingham risk factors, suggesting the presence of nontraditional risk factors. In patients with chronic kidney disease (CKD), coronary artery calcification is more prevalent and markedly more severe than in the general population. In these CKD patients, nontraditional risk factors such as oxidative stress, advanced glycation end products, and disordered mineral metabolism are also more prevalent and more severe and offer mechanistic insight into the pathogenesis of vascular calcification.     

The association between coronary artery calcification and mean platelet volume in the general population

Patients with coronary artery calcification have an increased risk of coronary vascular events and mortality. Coronary artery calcification can be quantified using the coronary calcium score (CCS) from multi-detected row computed tomography (MDCT), and the score is proportionally related to the severity of atherosclerotic disease. Mean platelet volume (MPV) is gaining interest as a new independent cardiovascular risk factor. Accordingly, the aim of our study was to evaluate the relationship between CCS and MPV in the general population. A total of 2116 individuals were enrolled from a health promotion center between July 2007 and June 2010. Among them, 259 subjects were included in the final analysis. MDCT was used to measure CCS and CCS?>?1 was defined as the presence of coronary calcification. The MPV value was significantly higher in the coronary artery calcification group than in the control group. Multivariate analyses showed that MPV was positively associated with coronary calcification (OR, 1.61; 95% CI 1.02–2.55). In summary, there was a significant association between coronary artery calcification and MPV in the general population. Therefore, the detection of elevated MPV should alert clinicians to the coexistence of multiple underlying CVD risk factors warranting early evaluation and treatment.     

Association of traditional and nontraditional cardiovascular risk factors with coronary artery calcification

Coronary artery calcification assessed by computed tomography is an emerging marker of coronary atherosclerosis. The authors examined the association of coronary calcium scores with traditional and nontraditional cardiovascular risk factors. In 1999-2000, they measured coronary artery calcium in 360 participants free of known coronary artery disease who had participated in 2 centers of the Atherosclerosis Risk in Communities (ARIC) Study. They related coronary calcium scores to risk factors measured in 1987-1989. Most traditional risk factors were associated with the coronary calcium score. For example, the multivariately adjusted odds ratio for an elevated score (> or = 100 versus < 100) was 3.5-fold greater per 10 years of age, 3.2-fold greater in men than in women, 3.1-fold greater with diabetes (statistically nonsignificant), and 1.4- to 1.7-fold greater per standard deviation greater increments of plasma cholesterol and pack-years of cigarettes smoked. Carotid artery intima-media thickness also was positively associated with coronary calcification. In contrast, a wide variety of hemostatic and inflammatory markers and serum chemistry values were unrelated to calcium scores. These findings reaffirmed the established role of traditional risk factors in the etiology of coronary artery disease, as assessed by computed tomography, but did not identify any important nontraditional risk factors.