Abstract
PurposeTo assess specific risk factors and biomarkers associated with intimal arterial calcification (IAC) and medial arterial calcification (MAC).MethodsWe conducted a cross-sectional study in patients with or at risk of vascular disease from the SMART study(n = 520) and the DCS cohort(n = 198). Non-contrast computed tomography scanning of the lower extremities was performed and calcification in the femoral and crural arteries was scored as absent, predominant IAC, predominant MAC or indistinguishable. Multinomial regression models were used to assess the associations between cardiovascular risk factors and calcification patterns. Biomarkers for inflammation, calcification and vitamin K status were measured in a subset of patients with IAC(n = 151) and MAC(n = 151).ResultsFemoral calcification was found in 77% of the participants, of whom 38% had IAC, 28% had MAC and 11% were scored as indistinguishable. The absolute agreement between the femoral and crural arteries was high(69%). Higher age, male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC compared to absence of calcification. Smoking and low ankle-brachial-index (ABI) were associated with higher prevalence of IAC and high ABI was associated with less IAC. Compared to patients with IAC, patients with MAC more often had diabetes, have a high ABI and were less often smokers. Inactive Matrix-Gla Protein was associated with increased MAC prevalence, while osteonectin was associated with decreased risk of MAC, compared to IAC.ConclusionsWhen femoral calcification is present, the majority of the patients have IAC or MAC throughout the lower extremity, which have different associated risk factor profiles.
Highlights
Arterial calcification is associated with increased cardiovascular risks [1]
Femoral calcification was found in 77% of the participants, of whom 38% had Intimal arterial calcification (IAC), 28% had medial arterial calcification (MAC) and 11% were scored as indistinguishable
Male sex, statin use and history of coronary artery disease were associated with higher prevalences of femoral IAC and MAC
Summary
Arterial calcification is associated with increased cardiovascular risks [1]. Based on radiology-pathology correlation studies, IAC is thought to have a spotty/patchy picture on radiographs, whereas MAC and internal elastic lamina calcification tend to outline the artery with a smooth layer of calcium, resulting in linear or annular calcifications on radiographs [3,4]. These calcification patterns may represent different pathophysiological mechanisms driven by separate risk factors, subsequently leading to different forms of cardiovascular disease (CVD). While IAC is thought to be characterized by inflammation and lipid deposition in plaques, MAC is suggested to reflect a process of active calcification resembling bone formation [5,6,7,8]
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