Type 2 diabetes does not attenuate racial differences in coronary calcification

Aims

Coronary artery calcification (CAC) is a strong predictor of atherosclerotic cardiovascular disease (CVD). Whites appear to have a higher prevalence of CAC than African-Americans (AAs), but it is unknown if type 2 diabetes, a major cardiovascular risk factor, attenuates this difference. We investigated the relationship of race and CAC in a sample of patients with type 2 diabetes without clinical CVD.

Methods

Multivariable analyses of self-reported ethnicity and CAC scores, stratified by gender, in 861 subjects [32% AA, 66.9% male] with type 2 diabetes.

Results

AA race was associated with lower CAC scores in age-adjusted models in males [Tobit ratio for AAs vs. Whites 0.14 (95% CI 0.08-0.24, p < 0.001)] and females [Tobit ratio 0.26 (95% CI 0.09-0.77, p = 0.015)]. This persisted in men after adjustment for traditional, metabolic and inflammatory risk factors, but adjustment for plasma triglycerides [0.48 (95% CI 0.15-1.49, p = 0.201)] and HOMA-IR [0.28 (95% CI 0.08-1.03, p = 0.055)] partially attenuated the association in women.

Conclusions

Relative to African-Americans, White race is a strong predictor of CAC, even in the presence of type 2 diabetes. The relationship in women appears less robust possibly due to gender differences in metabolic risk factors.     

Relationship of change in traditional cardiometabolic risk factors to change in coronary artery calcification among individuals with detectable subclinical atherosclerosis: The multi-ethnic study of atherosclerosis

Background/Objectives

Data describing relationships between change in risk factors and coronary artery calcification (CAC) are lacking and could inform optimal cardiovascular disease prevention and treatment strategies. This study aimed to examine how change in traditional cardiometabolic risk factors related to change in CAC among individuals with detectable subclinical atherosclerosis.

Methods

Latent growth modeling was used to examine change in cardiometabolic risk factors (waist circumference, body mass index, systolic and diastolic blood pressure, high- and low-density lipoprotein cholesterol, triglycerides, and glucose) related to change in CAC up to an average 4.9-year follow-up in a multi-ethnic cohort of 3398 asymptomatic individuals (57.8% men) who had detectable CAC (score > 0) at baseline, adjusting for baseline risk factor levels and CAC values, age, gender, race/ethnicity, smoking, family history of CVD, income, and use of antihypertensive, lipid-lowering, and glucose-lowering medications.

Results

Greater declines in blood pressure (systolic and diastolic) and low-density lipoprotein cholesterol at follow-up were each associated with greater CAC progression. The observed inverse associations were attributable to greater CAC progression in participants taking antihypertensive and lipid-lowering drugs who, as expected, had declines in blood pressure and lipid levels, respectively. These inverse associations did not emerge in participants not taking these medications.

Conclusions

Among individuals with subclinical atherosclerosis, the unexpected inverse associations observed between change in blood pressure and lipid levels with CAC progression emphasize the importance of considering medication use, and, when feasible, the severity and duration of disease, in exploring associations between risk factors and CAC change.     

老年人骨质疏松与冠状动脉钙化的关系

目的　探讨骨质疏松与动脉硬化的关系。方法　对 59例冠心病、原发性高血压、脑动脉硬化症等老年患者采用双能 X线骨密度仪测定腰椎、髋部、前臂的骨密度 ,螺旋 CT检测冠状动脉钙化积分及冠脉总钙化积分 ,同时测定血甲状旁腺激素全段、骨钙素、血钙。根据骨密度分骨质疏松组、非骨质疏松组。结果　骨质疏松组冠状动脉各分支钙化积分及冠脉总钙化积分高于非骨质疏松组 (P<0 .0 5)。钙化积分与甲状旁腺激素呈正相关 ,与骨钙素、血钙呈负相关 ,与各部位的骨密度呈负相关。结论　提示骨质疏松症与心血管疾病有密切的关系 ,骨质疏松时骨吸收增加 ,骨钙动员入血 ,异常沉积在血管内膜中 ,造成动脉粥样硬化、钙化     

Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors

Background

Ethnic differences in prevalence and severity of coronary artery disease are well established and are usually attributed to risk factors variation. This study investigates the differences in coronary artery narrowing and coronary calcification between two age- and gender-matched cohorts of South Asian and Caucasian symptomatic angina patients.

Methods

We identified 101 symptomatic angina patients of South Asian origin who had undergone CT angiography and calcium scoring, and compared them with 101 age and gender matched Caucasian patients.

Results

South Asians had a greater mean number of arterial segments with both obstructive and non-obstructive plaque than Caucasians (p = 0.006 and p = 0.0003, respectively) and higher prevalence of triple-vessel disease (p = 0.0004). Similarly, South Asians had a higher mean CAC score (p < 0.0001) and the percentage of South Asians with CAC > 0 and in all categories of CAC score 100–1000 were also higher, as was the number of arterial segments with calcified and non-calcified plaque. These results were more marked in patients aged > 50 but in those ≤ 50, Caucasians showed a higher mean number of diseased segments (p = 0.019), with non-obstructive plaque (p = 0.02), possibly suggesting that Caucasians are likely to have more diffuse atherosclerosis at an earlier age. CAC prevalence and severity in this age-group were not significantly different between South Asians and Caucasians.

Conclusion

Despite similar conventional risk factors for CAD, symptomatic South Asians seem to have more aggressive and diffuse arterial calcification compared to Caucasians. These differences are more profound above the age of 50, suggesting potential genetic or other risk factors yet to be determined.     

螺旋CT检测冠状动脉钙化的临床应用

目的：研究螺旋CT检测冠状动脉钙化(CAC)在冠心病诊断中的应用价值。方法：27例既往确诊为冠心病或经心电图负荷试验和／或冠状动脉造影临床确诊的冠心病患(冠心病组)和35例非冠心病患(对照组)分别进行螺旋CT检查。结果：受检随着年龄的增长钙化率逐渐增高，冠心病组冠状动脉钙化率比对照组明显增高，但随年龄的增长冠心病组钙化的特异性降低(降至11．12％)。钙化血管以累及一支血管最常见，多为左前降支(LAD)，三支血管钙化主要见于60岁以上。结论：螺旋CT检测冠状动脉钙化对早期诊断冠心病和预测冠心病事件有与病理相符的临床价值。     

Effect of smoking and other traditional risk factors on the onset of coronary artery calcification: Results of the Heinz Nixdorf recall study

Background

Coronary artery calcium (CAC) indicates coronary atherosclerosis and can be present in very early stages of the disease. The conversion from no CAC to any CAC reflects an important step of the disease process as cardiovascular risk is increased in persons even with mildly elevated CAC. We sought to identify risk factors that determined incident CAC>0 in men and women from an unselected general population with a special focus on the role of smoking.

Methods

All 4814 persons that were initially studied in the Heinz Nixdorf Recall Study were invited to participate in the follow-up examination after 5.1 ± 0.3 years. All traditional Framingham risk factors were quantified using standard techniques. Smokers were categorized in never, former and present smokers. The CAC scores were measured from EBCT using the Agatston method.

Results

Overall, out of 342 men and 919 women with zero CAC at baseline, 107 (31.3%) men and 210 (22.9%) women had CAC>0 at second examination. In multivariable analysis, age (OR estimate per 5 years: 1.34 (95%CI: 1.21–1.47)), LDL cholesterol (per 10 mg/dL: 1.05 (95%CI: 1.01–1.10)), systolic blood pressure (per 10 mmHg: 1.19 (95%CI: 1.11–1.28)) and current smoking (1.49 (95%CI: 1.04–2.15)) were independent predictors of CAC onset. The probability of CAC onset steadily increased with age from 23.3% (men) and 15.3% (women) at age 45–49 years to 66.7% (men) and 42.9% (women) at age 70–74 years. The difference in age-dependent conversion rates was quantified by years between reaching a given level of CAC onset probability. We found a consistent pattern with respect to smoking status: presently (formerly) smoking middle-aged men convert to positive CAC 10 (5) years earlier than never smokers, for women (middle-aged to elderly) this time span is 8 (5) years.

Conclusion

Several traditional CVD risk factors are associated with CAC onset during 5 years follow-up. CAC onset is accelerated by approximately 10 (5) years for present (former) compared to never smokers.     

Impact of obesity on aortic root calcification and coronary calcification using multi-detector CT

ObjectiveThe impact of obesity measured by BMI on cardiovascular diseases remains controversial. We investigated the impact of obesity measured by BMI on the prevalence and correlation of aortic root calcification (ARC) and coronary artery calcification (CAC) in patients assessed by multi-detector CT (MDCT) angiography.Materials and methodsA total of 175 patients with intermediate pretest probability of ischemic heart disease based on age, sex, and symptoms who referred from cardiology clinic to 64-MDCT angiography examination for assessment of coronary artery disease were eligible for enrollment in this cross sectional study. The patients were divided into 2 groups according to their BMI. Non obese group (BMI < 25) composed of 73 (42%) patients (male 41 (56%), female 32 (44%) with a mean age 55 ± 8 years. Obese group (BMI ≥ 25) composed of 102 (58%) patients (male 45 (44%), female 58 (56%) with mean age 56 ± 7 years).ResultsARC was significantly associated with coronary artery calcification pattern in both non obese and obese groups (r = 461, P = 0.000) and (r = 0.358, P = 0.000) respectively. The significant association between ARC and CAC persisted even after adjustment for age, hypertension, smoking, hyperlipdemia and presence of multiple cardiac risk factor in both non obese and obese groups (95% C.I. = 0.106, 0.259, P = 0.000) and (95% C.I. = 0.108, 0.610, P = 0.006) respectively.ConclusionARC was significantly correlated with CAC irrespective of BMI status.     

冠状动脉造影与冠状动脉内超声检查对钙化斑块检出的比较

目的 探讨冠状动脉造影（CAG）检查结合临床资料分析能否正确检出患者在拟行介入治疗的冠状动脉狭窄段有无钙化,并与冠状动脉内超声（ICUS）检查结果进行比较分析,进一步评价在冠状动脉介入治疗前应用ICUS确定钙化的范围和严重程度的价值作进一步的评价。方法 对150例拟行冠状动脉介入治疗的患者行CAG同时行ICUS检查,评价靶血管狭窄处的钙化情况。结果有113例（75.3％）靶血管狭窄处被ICUS检出钙化。而CAG检出52例有钙化。两种方法的检查结果有75例相符,75例不相符合。CAG对钙化检出的敏感性为38.9％,特异性为86.5％。在靶血管狭窄段CAG检出钙化的平均弧度（n=52）较ICUS检出的（n=113）要大。CAG判定表浅型钙化的敏感性和特异性分别为35.3％和95.2％。在98例靶血管狭窄处CAG判定为无钙化的患者中,68例患者ICUS检出有不同程度的钙化。而CAG在非靶血管狭窄段检出钙化是ICUS在98例患者中检出钙化惟一的预期值（P=0.003,OR=1.16,95％可信区间为1.1～1.3）。有73例CAG在冠状动脉丛任何处均未见钙化,而ICUS检出44例（60.3％）有钙化,其中>90弧度的表浅型钙化仅9例（12.3％）。结论CAG检出靶血管狭窄段有钙化存在提示可能为弧度较大的表浅型钙化。在CAG检不出靶血管狭窄处钙化的病例中,若患者的年龄较大,旦发     

骨保护素与动脉粥样硬化和血管钙化

骨保护素(OPG)作为肿瘤坏死因子受体超家族成员,不仅是骨代谢的一个重要调节因子,还是重要的血管调节因子,能够保护血管内皮细胞,抑制血管钙化和动脉粥样硬化。冠状动脉粥样硬化性心脏病(冠心病)及外周动脉硬化疾病血清OPG水平及动脉壁中OPG含量明显升高,OPG在动脉粥样硬化的发生发展中可能起着重要的调节作用。但其确切的机制尚不清楚,可能是一种自我防御代偿机制,以对抗促动脉粥样硬化、血管钙化及血管损伤的其它因子。     

他汀类药物与冠状动脉粥样硬化性心脏病的一级预防及其作用机制

一级预防也称病因预防或初级预防,主要是针对心血管病致病因子采取的措施,达到预防疾病发生的目的：主要是面向人群,为没有或虽有危险因素存在,但疾病尚未发生者进行的预防。自20世纪70年代首次由Endo等研究提出他汀类药物的降脂作用与在心血管疾病的治疗中扮演着重要角色以来,对他汀类药物的研究逐渐深入。     

Current understanding of coronary artery calcification

Coronary artery calcification (CAC) is highly prevalent in patients with coronary heart disease (CHD) and is associated with major ad-verse cardiovascular events. There are two recognized type of CAC—intimal and medial calcification, and each of them have specific risk factors. Several theories about the mechanism of vascular calcification have been put forward, and we currently believe that vascular calcifi-cation is an active, regulated process. CAC can usually be found in patients with severe CHD, and this asymptomatic phenomenon make early diagnosis of CAC important. Coronary computed tomographic angiography is the main noninvasive tool to detect calcified lesions. Measurement of coronary artery calcification by scoring is a reasonable metric for cardiovascular risk assessment in asymptomatic adults at intermediate risk. To date, effective medical treatment of CAC has not been identified. Several strategies of percutaneous coronary interven-tion have been applied to CHD patients with CAC, but with unsatisfactory results. Prognosis of CAC is still a major problem of CHD patients. Thus, more details about the mechanisms of CAC need to be elucidated in order to improve the understanding and treatment of CAC.     

cystatin C与冠状动脉钙化的相关性研究

目的 探讨胱抑素C（Cys C）与冠状动脉钙化的相关性。方法 选择2014年5月至2015年2月在青岛市市立医院就诊,有胸痛、胸闷症状,有中度心血管风险,既往无冠心病病史的患者,共201例,检测Cys C等生化指标,行冠脉CT检查。按Cys C是否升高分为两组,Cys C≤0.95组121例,Cys C＞0.95组80例。比较两组临床及生化指标是否有统计学意义,并进一步分析Cys C与冠状动脉钙化及冠脉多支病变的关系。结果 与Cys C≤0.95组相比,Cys C升高组Cr（P=0.002）、BNP（P=0.003）、CRP（P=0.03）水平明显升高,钙化程度（P＜0.01）及多支病变（P＜0.005）发生率显著升高;Cys C水平与冠状动脉钙化独立相关（OR=0.319,95%CI：0.265-0.467,P＜0．01）,Cys C水平与多支病变独立相关（OR=9.863,95%CI：3.157-217.571,P＜0.01）。结论 Cys C与冠状动脉钙化及冠脉多支病变存在密切的关联。     

血管内超声诊断冠状动脉钙化斑块优势

目的比较冠状动脉造影（ＣＡＧ）和冠状动脉内超声（ＩＶＵＳ）对冠状动脉钙化斑块检出率。方法１００例临床疑冠心病患者行ＣＡＧ和ＣＵＳ检查。结果ＣＡＧ对冠状动脉钙化斑块的检出率虽然较低（２８％）,但特异性高达９７％。ＩＶＵＳ不但检出率高（６４％）,而且能显示冠状动脉的结构,钙经斑块特点,对介入治疗有很好的指导作用。结论对冠状动脉钙化斑块的检出优势ＩＶＵＳ明显强于ＣＡＧ。     

数字荧光透视检出冠状动脉钙化与冠状动脉造影的对比研究

目的　评价数字荧光透视检出冠状动脉钙化 (CAC)对诊断冠心病的价值。方法　 114例患者于冠状动脉造影前经数字荧光透视检查 CAC,以冠状动脉造影存在 1支以上的管径狭窄≥ 5 0 %为诊断冠心病的标准。结果　 114例患者中 ,冠心病患者 63例 ,无冠心病患者 5 1例。冠心病组 CAC阳性率明显高于造影无冠心病组 (71.4%对13 .7% ) ,P<0 .0 1;以数字荧光透视有无 CAC判断冠心病与冠状动脉造影对比 ,总符合率为 78.1% ;不同年龄、性别患者以及不同类型冠心病之间其符合率无明显差异 ,P>0 .0 5。结论　数字荧光透视检出 CAC简便易行 ,无创伤性 ,与冠状动脉造影对比符合率高 ,可广泛用于临床预测及诊断冠心病     

冠状动脉钙化积分相关临床因素分析

目的 评价冠状动脉(冠脉)钙化积分(CACS)的相关因素.方法 入选疑诊冠心病的患者141例,3个月内完成多层螺旋CT、脉搏波传导速度(PWV)、超声心动图及血生化检查,MDRD方程计算患者入院时估算肾小球滤过率(eGFR).根据冠脉钙化程度将病例分为3组:A组(CACS=0～10),B组(CACS=11～400),C组(CACS>400).结果 3组比较年龄、高血压病史、糖尿病史、二尖瓣钙化、主动脉瓣钙化、两侧臂踝指数低值、臂到踝的PWV高值、臂及踝平均动脉压高值、波形上升支时间高值差异均有统计学意义(P值均<0.05).多因素logistic回归分析显示:主动脉瓣钙化(P=0.000)、二尖瓣钙化(P=0.002)、波形上升支时间高值(P=0.009)和糖尿病(P=0.032)是严重冠脉钙化的独立相关因素.结论 疑诊冠心病的患者行多层螺旋CT检查前可行PWV和超声心动图检查,结合病史评估患者冠脉钙化的可能性及严重程度.     

Incidental coronary calcifications on routine chest CT: Clinical implications

Coronary artery calcification (CAC) is a marker of atherosclerosis and an independent risk factor for cardiac-related mortality, with much of the 50% decline in mortality over the past 30 years being attributed to early detection of coronary disease and intervention of modifiable risk factors. With over 10 million computed tomography (CT) examinations of the chest performed in the United States yearly, CAC can be identified in a very large number of patients. In this review, we discuss the clinical evidence underlying the relationship between radiologic identification of CAC, atherosclerosis, and cardiac outcomes and the implications of its assessment on standard chest CT. We conclude that reporting of incidental coronary calcification found on non-gated chest CT would have a great impact on both management and mortality and thus, in the appropriate setting, should be noted in the impression of the radiologic report when identified.     

血浆白介素-37水平与冠状动脉钙化相关性研究

目的:探讨冠状动脉钙化患者血浆白介素(IL)-37水平的变化。方法:入选行冠状动脉CT检查发现冠状动脉钙化的患者48例,无冠状动脉钙化的30例患者为对照组。采用夹心酶联免疫法(ELISA)测定血浆IL-37和肿瘤坏死因子(TNF)-α,采用乳胶凝集比浊法检测超敏C反应蛋白(hs-CRP)水平。结果:冠状动脉钙化患者血浆IL-37(80.81±26.21)ng/L、TNF-α(12.53±3.44)ng/L和hs-CRP(2.66±3.89)mg/L水平高于对照组[IL-37(65.91±20.55)ng/L,P=0.010;TNF-α(10.51±3.73)ng/L,P=0.017;hs-CRP(1.12±0.81)mg/L,P=0.035]。相关性分析显示冠状动脉钙化患者血浆IL-37与TNF-α、hs-CRP水平、冠状动脉钙化Agatston积分正相关(分别r=0.410,P=0.004;r=0.481,P=0.001;r=0.354,P=0.013)。结论:新型抗炎因子IL-37可能与冠状动脉钙化的发生、发展密切相关。