Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study

Björn A Blomberg,Michael H Olsen,Werner Vach,Anders Thomassen,Marnix G E Lam,Poul F Høilund-Carlsen,Jagat Narula,Willem P T M Mali,Pim A De Jong,Abass Alavi

doi:10.1007/s00259-016-3552-9

Abstract

PurposeArterial inflammation and vascular calcification are regarded as early prognostic markers of cardiovascular disease (CVD). In this study we investigated the relationship between CVD risk and arterial inflammation (18F-FDG PET/CT imaging), vascular calcification metabolism (Na18F PET/CT imaging), and vascular calcium burden (CT imaging) of the thoracic aorta in a population at low CVD risk.MethodsStudy participants underwent blood pressure measurements, blood analyses, and 18F-FDG and Na18F PET/CT imaging. In addition, the 10-year risk for development of CVD, based on the Framingham risk score (FRS), was estimated. CVD risk was compared across quartiles of thoracic aorta 18F-FDG uptake, Na18F uptake, and calcium burden on CT.ResultsA total of 139 subjects (52 % men, mean age 49 years, age range 21 – 75 years, median FRS 6 %) were evaluated. CVD risk was, on average, 3.7 times higher among subjects with thoracic aorta Na18F uptake in the highest quartile compared with those in the lowest quartile of the distribution (15.5 % vs. 4.2 %; P < 0.001). CVD risk was on average, 3.7 times higher among subjects with a thoracic aorta calcium burden on CT in the highest quartile compared with those in the lowest two quartiles of the distribution (18.0 % vs. 4.9 %; P < 0.001). CVD risk was similar in subjects in all quartiles of thoracic aorta 18F-FDG uptake.ConclusionOur findings indicate that an unfavourable CVD risk profile is associated with marked increases in vascular calcification metabolism and vascular calcium burden of the thoracic aorta, but not with arterial inflammation.

Highlights

Adverse cardiovascular events and their sequelae are a major health concern in Western societies [1]
Our findings indicate that an unfavourable cardiovascular disease (CVD) risk profile is associated with marked increases in vascular calcification metabolism and vascular calcium burden of the thoracic aorta, but not with arterial inflammation
We recruited a heterogeneous population of subjects, including healthy volunteers and patients evaluated for chest pain syndromes. This allowed us to study the relationship between CVD risk and arterial inflammation, vascular calcification metabolism, and vascular calcium burden in a heterogeneous, but clinically relevant, group of subjects regarded to be at low CVD risk

Summary

Introduction

Adverse cardiovascular events and their sequelae are a major health concern in Western societies [1]. Efforts to prevent adverse cardiovascular events have focused on identifying asymptomatic individuals at high risk of cardiovascular disease (CVD), the so-called Bvulnerable^ patient [2, 3]. Identifying the vulnerable patient remains a major ongoing challenge [2]. Recent developments in cardiovascular imaging, aimed at visualizing key pathophysiological processes in CVD, offer new opportunities for assessing patient vulnerability. Arterial inflammation [4] and vascular calcification [5] have received attention as potent markers of increased CVD risk [6,7,8]. 18F-FDG PET/CT imaging can noninvasively assess arterial inflammation, whereas Na18F PET/ CT and CT imaging can noninvasively assess vascular calcification (Fig. 1) Arterial inflammation [4] and vascular calcification [5] have received attention as potent markers of increased CVD risk [6,7,8]. 18F-FDG PET/CT imaging can noninvasively assess arterial inflammation, whereas Na18F PET/ CT and CT imaging can noninvasively assess vascular calcification (Fig. 1)

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