The impact of coronary calcium score and cardiac risk factors on coronary endothelial function

Abstract Background Understanding determinants of coronary calcium score could lead to the development of new preventive actions for reducing cardiovascular risk. Our hypothesis is that major cardiovascular risk factors are linked with coronary calcium score, but the parameters associated with moderate or high scores could be different. Purpose The aim of our study was to explore the potential determinants of moderate and high elevation of coronary calcium score in a population of patients at intermediate cardiovascular risk. Methods We conducted a cross-sectional analysis, using data from a prospective cohort. Our study population was composed of people presenting with cardiovascular risk factors, who were referred by their attending physician for a complete assessment of their risk factors and for screening for silent cardiovascular disease. People in secondary prevention could also be referred. Coronary calcium score was assessed by cardiac CT scan. We used the following categories for classifying patients according to their coronary calcium score: low (0–100 AU (Agatston units)); moderate (101–300 AU) and high calcium score (greater than 300 AU). We performed a descriptive analysis and then we built a multinomial logistic regression model, using the low calcium score category as reference. Results Among the 1585 patients included in the database, we analyzed data from 1402 individuals who beneficiated from coronary calcium scoring. The sample included 714 (51%) men, and 144 (10%) people with a history of cardiovascular disease. Mean age was 59 yrs. Data from the multivariate analysis showed that age (OR=1.07; 95% CI [1.054–1.091] for 1-year increase), gender (OR=0.461; 95% CI [0.330–0.643] for women versus men) and smoking more than 20 cigarettes per day (OR=2.893; 95% CI [1.207–6.935]) were associated with a moderate calcium score. Variables associated with a high calcium score were: age (OR=1.097; 95% CI [1.076–1.119] for 1-year increase), gender (OR=0.221; 95% CI [0.151–0.323] for women vs men), treated dyslipidemia (OR=2.108; 95% CI [1.467–3.027]), treated hypertension (OR=2.199; 95% CI [1.523–3.175]), and history of cardiovascular disease (OR=4.138; 95% CI [2.510–6.823]). Conclusions In this study, well-known and modifiable cardiovascular risk factors are associated with calcium score. However, our results highlight that determinants of moderate and high scores may be different. While tobacco is associated with a higher risk of moderate calcium score, hypertension and dyslipidemia appear to be preferentially linked with the highest scores. It is thus appropriate that the 2019 ESC/EAS guidelines for dyslipidemias have classified patients with hypertension and dyslipidemia in the high risk category. Funding Acknowledgement Type of funding source: None

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Carotid artery stiffness, digital endothelial function, and coronary calcium in patients with essential thrombocytosis, free of overt atherosclerotic disease

Radiology and Oncology ◽

10.1515/raon-2017-0006 ◽

2017 ◽

Vol 51 (2) ◽

pp. 203-210 ◽

Cited By ~ 1

Author(s):

Matjaz Vrtovec ◽

Ajda Anzic ◽

Irena Preloznik Zupan ◽

Katja Zaletel ◽

Ales Blinc

Keyword(s):

Carotid Artery ◽

Endothelial Function ◽

Carotid Plaque ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Plaque Burden ◽

Essential Thrombocytosis ◽

Control Subjects ◽

Artery Stiffness

Abstract Background Patients with myeloproliferative neoplasms (MPNs) are at increased risk for atherothrombotic events. Our aim was to determine if patients with essential thrombocytosis (ET), a subtype of MPNs, free of symptomatic atherosclerosis, have greater carotid artery stiffness, worse endothelial function, greater coronary calcium and carotid plaque burden than control subjects. Patients and methods 40 ET patients without overt vascular disease, and 42 apparently healthy, age and sex-matched control subjects with comparable classical risk factors for atherosclerosis and Framingham risk of coronary disease were enrolled. All subjects were examined by physical and laboratory testing, carotid echo-tracking ultrasound, digital EndoPat pletysmography and CT coronary calcium scoring. Results No significant differences were found between ET patients and controls in carotid plaque score [1 (0-1.25) vs. 0 (0-2), p=0.30], β- index of carotid stiffness [7.75 (2.33) vs. 8.44 (2,81), p=0.23], pulse wave velocity [6,21 (1,00) vs. 6.45 (1.04) m/s; p=0.46], digital reactive hyperemia index [2.10 (0.57) vs. 2.35 (0.62), p=0.07], or augmentation index [19 (3-30) vs. 13 (5-22) %, p=0.38]. Overall coronary calcium burden did not differ between groups [Agatston score 0.1 (0-16.85) vs. 0 (0-8.55), p=0.26]. However, significantly more ET patients had an elevated coronary calcium score of >160 [6/40 vs. 0/42, p < 0.01]. Conclusions No significant differences between groups were found in carotid artery morphology and function, digital endothelial function or overall coronary calcium score. Significantly more ET patients had an elevated coronary calcium score of >160, indicating high cardiovascular risk, not predicted by the Framingham equation.

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Coronary Calcium Score May Replace Cardiovascular Risk Factors as Primary Risk Stratification Tool Before Kidney Transplantation

Transplantation Journal ◽

10.1097/tp.0000000000000992 ◽

2016 ◽

Vol 100 (10) ◽

pp. 2177-2187 ◽

Cited By ~ 7

Author(s):

Simon Winther ◽

Morten Bøttcher ◽

Hanne S. Jørgensen ◽

Kirsten Bouchelouche ◽

Lars C. Gormsen ◽

...

Keyword(s):

Risk Factors ◽

Kidney Transplantation ◽

Cardiovascular Risk ◽

Risk Stratification ◽

Cardiovascular Risk Factors ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Risk Stratification Tool

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Performance of coronary calcium score and epicardial fat volume in early diagnostic of coronary artery disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.0177 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

L Agoston Coldea ◽

A Zlibut ◽

C Cionca ◽

I Muresan ◽

D Horvat ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Calcium Score ◽

Coronary Calcium ◽

Coronary Calcium Score ◽

Epicardial Fat Volume ◽

Artery Disease ◽

Fat Volume

Abstract Background Coronary artery disease (CAD) remains a world leading cause of death, despite the development of traditional risk scores based on the quantification of cardiovascular risk factors. Coronary calcium score (CCS) determined by cardiac computed tomography (CCT) is a noninvasive tool with major implications in early diagnosis and in outcome prediction in CAD patients. Epicardial fat volume (EFV) is a recently described CCT-based diagnostic and prognostic tool of CAD and outcome. Purpose This study sought to investigate the performance of coronary calcium score and EFV in early diagnosing CAD. Methods We conducted a prospective, single-center, cross-sectional study on patients suspected of CAD. All patients were submitted to detailed clinical data, 12-lead electrocardiogram, estimating pretest probability, stress test, echocardiography, CCT imaging. In the study subjects was assessed CCS, EFV and the number of calcified plaques (NoP). The total CCS load was then ranked in the following scoring groups: 0 (no evidence of coronary calcium; reference group), 1–99 (minimal to mild), 100–399 (moderate), and 400–999 (extensive) and ≥1000 (very extensive). The subjects in the study were classified according to the NoP derived from their CCS scans (no plaques, 1–5, 6–10 and more than 10 calcified plaques). CAD was defined as coronary stenosis over 50% of the vessel. Results Among 540 patients (55.8±11.2 years of age; 52% women) met the enrollment criteria, 98 patients presented CAD. Spearman correlation analysis revealed strong correlations between EFV index and CCS (r=0.45; p<0.0001) and between EFV index and NoP (r=0.44; p<0.0001), after adjustment for age, sex, body mass index, hypertension, diabetes and low-density lipoprotein cholesterol. The area under the curve of the receiver-operator curve for CAD prediction by CCS >70.3 UH (cut-off value) was significantly higher (AUC=0.927; p<0.0001) by comparison with EFV index >40.8 ml/m2 (AUC=0.816; p<0.0001) and NoP >4 (AUC=0.928; p<0.0001). The association of all three parameter, CCS, EFV and NoP, increases the prediction power of CAD, providing an AUC of 0.969 with a 0.70 sensibility and 0.95 specificity. Conclusion The combined use of EPV, CCS and NoP has a very high predictive capacity for CAD, regardless of the classic cardiovascular risk factors. This increases the diagnostic capacity of CAD beyond every parameter used alone. Funding Acknowledgement Type of funding source: None

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