Relevance of Screening Symptom-Free Population for Coronary and Noncoronary Calcification Burden

Abstract

Early detection of arterial disease in the preclinical stage may improve cardiovascular disease sequelae, such as myocardial infarction and stroke.1 At present, the optimal imaging technique to detect subclinical arterial disease has not been determined.2 Calcium-based imaging by noncontrast computed tomography (CT) is widely used to detect noninvasively coronary calcification, an established surrogate of coronary atherosclerosis.3 In this issue of Hypertension , Jensky et al4 performed “whole body” noncontrast CT imaging of the arterial tree from the skull to the pubic symphysis in a large free-living, middle-aged, and mostly asymptomatic population to detect calcium deposit4 not only within the coronary bed but also in several noncoronary territories, including carotid, subclavian, and iliac arteries and the thoracic and abdominal aorta. The prevalence of any calcification ranged from 32% in the carotid and subclavian arteries to 57% in the coronary arteries.4 Other than expected associations of arterial calcium with aging, male sex, smoking, dyslipidemia, and diabetes mellitus, calcification was strongly and independently associated with hypertension in all of the vascular beds except the distal iliac and subclavian arteries.4 Association of calcification and hypertension was stronger in older than in younger subjects and in men than in women, and its magnitude was greater when pulsatile components of hypertension, that is, pulse and systolic pressures, were considered.4 Beyond the demonstration of the close link …