Abstract
BackgroundArterial 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.MethodsTo 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.ResultsThe 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).ConclusionsThe 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.
Highlights
Arterial calcification, the hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites
We quantified the volume of calcification as the volume above the threshold in the coronary arteries (CAC), the aortic arch (AAC), and the extracranial carotid arteries (ECAC) automatically, using specialized software (Syngo Calcium Scoring, Siemens, Forcheim, Germany)
As a quality control procedure, we examined the scree plot of eigenvalues of the different principal components and the total variance explained by the C-factor
Summary
The hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites. Kuiper et al BMC Cardiovasc Disord (2021) 21:317 burden of arterial calcification, it is important to realize that arterial calcification may develop anywhere in the arterial system In this light, the use of full-body scans has even been suggested to obtain information on the systemic burden of arterial calcification [7]. As there is a large variety in size of the different vessel beds, a calcification sum score or mean will be mostly dependent on the amount of calcification in the larger vessel beds, such as the aorta To take these differences into account, more advanced data reduction techniques are required to compose a single summary measure for the systemic component of arterial calcification
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