Vascular Calcification

Abstract

More than a century ago, Monckeberg1 was among the first to note that ectopic calcification may arise in the vasculature. Although this original description was of a specific form of sclerosing calcification that largely affects the vascular medial layer, we have since gone on to appreciate that generalized vascular calcification is a pervasive and likely inevitable program that is intimately entwined with aging, atherosclerosis, and cardiovascular disease. Global measures of coronary artery calcification were recently shown to independently predict both cardiovascular events and patient mortality.2,3 However, adding complexity, it would appear that arterial and coronary calcification serve only as markers of the overall burden of vascular disease, rather than identifying particular lesions that are likely to cause future events.4 A central conundrum in the field is the so-called calcification paradox: in many patients and rodent models, osteoporosis occurs simultaneously with advancing vascular calcification.5 Although it has become increasingly clear that the pathways that control skeletal bone formation and density are also operative in vascular calcification,5,6 the paradox leaves open the question of whether the 2 processes may diverge at key regulatory steps or whether the differing local milieu accounts for this …