Presence Of Coronary Calcification Research Articles

Diurnal Cortisol Decline is Related to Coronary Calcification: CARDIA Study

Chronic stress may be a risk factor for coronary heart disease and is associated with dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. We tested the hypotheses that two markers of HPA axis dysregulation, elevated average level (area under the curve, adjusted for time awake) and diurnal decline of salivary cortisol, were associated with presence of coronary calcification (CaC). Seven hundred eighteen black and white middle-aged adults enrolled in an ancillary study of Coronary Artery Risk Development in Young Adults provided six salivary cortisol samples throughout one full day and had measurements of CaC. The prevalence of any calcification was low, 8.1% in the participants of the ancillary study, with white men having the highest proportion. Average cortisol did not differentiate groups, means = 2.15 and 2.08. Those with any CaC declined approximately 6% per hour in cortisol over the course of the day, whereas those with no CaC declined more than 8% per hour (p < .003). Those persons with slope scores in the flattest quartile had a greater likelihood of any CaC than did those in the remaining quartiles adjusted for sex-race group, age, smoking, treatment for diabetes, systolic blood pressure, logged triglycerides, average cortisol, and educational attainment (odds ratio = 2.58; 95% confidence interval = 1.26-5.30). Our results are consistent with the hypothesis that HPA axis dysregulation may affect risk for atherosclerosis.

Blood Pressure Reactivity to Psychological Stress and Coronary Calcification in the Coronary Artery Risk Development in Young Adults Study

A longstanding hypothesis is that individuals who exhibit large increases in blood pressure during psychological stress are at risk for atherosclerosis. We tested whether blood pressure changes during psychological stress predict subsequent coronary calcification (CaC) in young healthy adults. We evaluated 2816 healthy black and white women, 20 to 35 years of age, from the Coronary Artery Risk Development in Young Adults Study, who were not using medication for hypertension or diabetes in 1987-1988. Participants completed video game and star tracing tasks while their blood pressure was recorded. Thirteen years later (2000-2001), they completed computed tomography measures of CaC. Overall 9.3% (261 of 2816) had CaC present at follow-up. Each 10 mm Hg change in systolic blood pressure during the video game was associated with a 24% increased odds of having CaC at follow-up (unadjusted odds ratio, 1.24; 95% CI, 1.06 to 1.46; P=0.008). This association persisted after adjustment for age, race, sex, education, smoking, alcohol, family history of myocardial infarction, smoking, daily alcohol consumption, body mass index, and resting or baseline blood pressure (odds ratio, 1.31; 95% CI, 1.08 to 1.58; P=0.006). Blood pressure changes during the star tracing task were not associated with subsequent CaC. Blood pressure changes during a video game predicted the presence of CaC 13 years later. To our knowledge, this is the first study that reports blood pressure reactivity to a stressor being related to calcification in the coronary arteries. Blood pressure reactivity may provide useful prognostic information about future risk beyond standard risk factors.

Lipoprotein(a) and Apolipoprotein(a) Isoforms

Elevated plasma levels of lipoprotein(a) [Lp(a)] are an independent risk factor for cardiovascular disease in whites. Blacks have 2- to 3-fold higher plasma levels of Lp(a) than whites and yet do not have a correspondingly higher rate of coronary events. It remains unclear whether elevated plasma levels of Lp(a) are an independent risk factor for coronary atherosclerosis in individuals of African descent. The relationship between plasma levels of Lp(a), apolipoprotein(a) isoform sizes, and the presence of coronary calcium was examined in 761 blacks and 527 whites (men aged >40 years, women aged >45 years) from a population-based sample. No relationship was found between plasma levels of Lp(a), apolipoprotein(a) isoform size, or a combination of these 2 variables and coronary artery calcium (CAC) in whites or blacks. No correlation was observed between plasma levels of Lp(a) and coronary calcium scores in any group, although all black men with very high plasma levels of Lp(a) (>300 micromol/L; n=7) were CAC-positive. Whites with high plasma levels of Lp(a) plus elevated plasma levels of LDL cholesterol (men) or reduced levels of HDL cholesterol (men and women) or who smoked (women) had a higher prevalence of CAC. In contrast, no joint effects between plasma levels of Lp(a) and other cardiovascular risk factors on coronary calcium were found in blacks. No consistent independent relationship between plasma levels of Lp(a) or apolipoprotein(a) isoform size and coronary calcium was found in whites or blacks.

Skin tissue cholesterol assay correlates with presence of coronary calcium

Background: Keratinocytes maintain cholesterol homoeostasis using LDL and HDL-scavenger receptor pathways implicated in atherosclerosis. We tested whether skin tissue cholesterol (SkTC) is associated with subclinical atherosclerosis, assessed using carotid intima-medial thickness (IMT) and coronary artery calcification (CAC). Methods: Two hundred and twenty two subjects were recruited from the Baltimore site of the Multi-Ethnic Study of Atherosclerosis (MESA). Baseline MESA examination included fasting blood collection, IMT measurement by B-mode ultrasound and CAC determination by helical CT. SkTC was measured using the Cholesterol 1, 2, 3 kit (IMI Inc., Canada). Results: SkTC was significantly higher if CAC was present in Caucasians ( p = 0.04) but not African–Americans. SkTC was not significantly correlated with IMT in either group. Using multiple logistic regression adjusting for age, sex and serum lipids, a 1-standard deviation higher SkTC was associated with 187% higher odds of the presence of CAC in Caucasians ( p < 0.01) but no significant difference in odds for African–Americans. In subjects in whom CAC was present, the extent of CAC was not related to the SkTC in multiple linear regressions. Conclusions: SkTC was associated with the presence of CAC independently of serum lipids/lipoproteins in Caucasians but not African–Americans. SkTC may provide a useful indicator of subclinical atherosclerosis in Caucasians.

Distinct Heritable Patterns of Angiographic Coronary Artery Disease in Families With Myocardial Infarction

Coronary artery disease (CAD) and myocardial infarction (MI) are significantly determined by genetic background. Whether distinct angiographic features of CAD are affected by inherited factors has never been investigated. Thus, we analyzed comprehensively the extent to which various aspects of CAD, including disease severity, distribution of lesions, presence of coronary calcification, morphology of stenoses, and anatomic characteristics, are under genetic control. We retrospectively studied the coronary angiograms of 882 siblings with CAD from 401 families. These families were ascertained through index patients defined by MI before the age of 60 years and at least 1 sibling with MI or coronary revascularization procedures. Heritability calculations were performed with variance-component analysis. Additionally, recurrence risks to siblings were analyzed. Traditional cardiovascular risk factors and age at the first coronary event displayed significant heritable components. After adjustment for age and sex, significant heritabilities were identified for proximal stenoses, in particular, left main CAD (h2=0.49+/-0.12; P=0.01), coronary calcification (h2=0.51+/-0.17; P=0.001), and ectatic coronary lesions (h2=0.52+/-0.07; P=0.001). In contrast, no heritability was found for distal disease (h2=0.05+/-0.19; NS), the pattern of coronary arterial blood supply, or the number of diseased vessels. Calculation of recurrence risks in siblings largely confirmed the heritability estimates. Distinct morphological characteristics associated with CAD show different degrees of heritability. Notably, the most hazardous localizations, like left main or proximal disease, display a high heritability. In contrast, some features of coronary morphology, such as distal disease, do not appear to be markedly influenced by heritable factors.

Parental history of stroke and myocardial infarction predicts coronary artery calcification: The Coronary Artery Risk Development in Young Adults (CARDIA) study

Few studies have examined the relationship between parental history of stroke and myocardial infarction (MI) and subclinical atherosclerosis, especially among young, asymptomatic individuals. This study investigates the association between coronary artery calcification (CAC) and parental history of stroke and MI in African-Americans and Caucasians from the CARDIA study. Parental history of stroke and MI was determined by self-administered family history questionnaire at baseline and Year 5 examinations. Presence of coronary calcification was determined by computed tomography on 3041 individuals, age 32 to 47, including 1375 African-Americans and 1666 Caucasians. Analyses were restricted to individuals free of clinically manifest coronary heart disease (CHD) and stroke. Parental history of stroke is associated with a two-fold greater risk of CAC in African-Americans, and this relationship is independent from established CHD risk factors (95% CI=1.14-3.43). There is no relationship between parental history of stroke and CAC status in Caucasians. Parental history of MI is associated with a two-fold greater risk of CAC in Caucasians (95% CI=1.38-2.92). The impact of parental history of MI in African-Americans is lower (OR=1.65; 95% CI=1.01-2.69) and no longer statistically significant after adjusting for known CHD risk factors. The identification of individuals with a parental history of stroke and MI provides important information for clinicians by which to target primary prevention efforts. Further characterization of familial factors, especially genetic factors, contributing to increased risk of CAC will shed light on the basis of the observed associations.

Association of Cardiovascular Risk Factors to Aortic Valve Calcification as Quantified by Electron Beam Computed Tomography

To analyze the association among aortic valve calcification, cardiovascular risk factors, and coronary artery calcification using electron beam computed tomography (EBCT). We analyzed cardiac EBCT data obtained for coronary calcium detection in 1000 consecutively enrolled patients (mean +/- SD age, 57.1 +/- 10 years; 69% men) between January 1, 1998, and July 23, 2001. In all patients, atherosclerotic risk factors (hyperlipidemia, hypertension, diabetes, smoking, and family history of coronary artery disease) were documented. With EBCT, the amount of coronary calcification was determined using the Agatston score, and the amount of aortic valve calcification was measured using a volumetric score. Aortic valve calcification was detected in 177 (17.7%) of the total patient group and was found more frequently in patients with coronary calcification (20.5% in patients with coronary calcium vs 3.8% in patients without coronary calcium; P < .001), hyperlipidemia (19.5% vs 6.5%; P < .001), hypertension (21.7% vs 13.9%; P = .01), or diabetes (30.7% vs 16.6%; P = .002). The volume of aortic valve calcification was significantly higher in patients with vs without hyperlipidemia (P < .001), hypertension (P = .002), and diabetes (P = .001). In a multivariable logistic regression analysis, adjusted for age and sex, hyperlipidemia (P = .001) and the presence of coronary calcification (P < .001) were significant predictors of aortic valve calcification. A significant association exists among atherosclerotic risk factors, coronary calcification, and the presence and amount of aortic valve calcification.

Multi-detector row computed tomographic angiography in pediatric heart transplant recipients: Initial observations.

The purpose of this study was to assess the feasibility and limitation of multi-detector row computed tomographic (MDCT) imaging for evaluating coronary arteries in pediatric heart transplant patients. Coronary MDCT angiography was performed in eight pediatric heart transplant recipients. The presence of coronary calcification was evaluated. Luminal changes of the visualized coronary segments on MDCT images were compared with catheter angiographic findings and intravascular ultrasound. Coronary calcification was present in one patient who had severe coronary arteriopathy documented by intravascular ultrasound. In 48 coronary segments visualized on MDCT images, 33, 7, and 4 segments each had normal, luminal irregularities, and moderate stenoses, respectively, which were confirmed by catheter angiography. Twelve coronary segments could not be assessed because of severe motion artifacts. Image quality degradation was more pronounced in patients with higher heart rates. Noninvasive MDCT angiography is promising but requires further technical improvement to evaluate coronary arteries in pediatric heart transplant patients.

Prognostic significance of coronary artery calcium in asymptomatic subjects with usual cardiovascular risk

Background Coronary calcium detected noninvasively is an attractive way to diagnose atherosclerosis before the development of symptoms. This study examines the prognostic value of coronary calcium in asymptomatic subjects with usual cardiovascular risk. Methods and Results In 425 asymptomatic subjects, 229 men (aged 45.1 ± 14 years) and 196 women (aged 42.7 ± 13 years), coronary calcium presence was studied by digital cinefluoroscopy. The majority (76%) had no or at most one risk factor. Subjects were followed up for 58.4 ± 12.7 months for cardiac events. Coronary calcium was present in 76 of 425 (17.9%) subjects. Cardiac events were observed in 21 subjects: 2 cardiac deaths, 7 acute myocardial infarctions, 3 coronary artery bypass grafts, 3 coronary angioplasty procedures, 3 events of unstable angina, and 10 events of stable angina pectoris. Survival curve analysis showed significant differences in all the studied end points between subjects with and those without calcium. Coronary calcium was an independent predictor of all events (3.6-fold increase, P < .008), cardiac death/myocardial infarction/revascularization (13.9-fold increase, P < .02), and stable angina (7.4-fold increase, P < .007). However, calcium did not independently predict cardiac death/myocardial infarction or acute coronary syndromes. Conclusions Coronary calcium in asymptomatic subjects with usual cardiovascular risk adds significant incremental information to risk factors information for the development of symptomatic coronary artery disease. (Am Heart J 2003;145:542-8.)

Counterpoint: Do people with diabetes benefit from coronary calcium scans?

Admission of ignorance is the first step toward knowledge . —Benjamin Disraeli Cardiovascular disease is responsible for most death and disability associated with diabetes. Those with diabetes suffer two to four times more myocardial infarctions, strokes, and sudden deaths than those without this condition (1–3). The medical community has recognized the increased vulnerability of these patients by assigning diabetes “coronary heart disease equivalent” status in its prevention guidelines (4). Since coronary syndromes tend to be clinically atypical and difficult to diagnose in diabetes, noninvasive approaches in asymptomatic or mildly symptomatic subjects have been proposed for screening and diagnosis (5,6). Pathologic studies have demonstrated a strong correlation between the presence of coronary calcium and the amount of atheromatous plaque (7). Since sensitive and noninvasive radiographic techniques are capable of detecting and quantitating calcium, calcium screening is an obvious candidate for screening for subclinical atherosclerosis. Morrison (8) has defined the purpose of screening for chronic diseases. “Screening for disease control can be defined as the examination of asymptomatic people in order to classify them as likely or not likely to have the disease that is the object of screening […]. The goal of screening is to reduce morbidity and mortality from disease among the people screened by early treatment of the cases discovered.” If one accepts this definition, one can then surmise that three distinct …

Computed tomography and magnetic resonance imaging for noninvasive coronary angiography and plaque imaging: current and potential future concepts.

Atherothrombosis is a systemic disease of the vessel wall that causes distinct clinical manifestations, depending on the affected circulatory bed and the characteristics of the individual lesions.1 These lesions may be quite heterogeneous.1 Thus, the clinical manifestations of atherothrombosis of the coronary arteries, of the arteries supplying the central nervous system, of the aorta, and of the peripheral circulation can be significantly different. Disruption-prone plaques in the coronary arteries, the so-called “vulnerable plaques,” tend to have a thin fibrous cap (cap thickness ≈65 to 150 μm) and a large lipid core (American Heart Association [AHA] plaque type IV-Va). Acute coronary syndromes often result from disruption of a modestly stenotic vulnerable plaque, not visible by x-ray angiography, which results in a thrombotic complication (AHA plaque type VI). During its evolution, a type Va plaque may also become fibrotic (AHA plaque type Vc) or calcified (AHA plaque type Vb).2,3⇓ In contrast to coronary artery vulnerable plaques characterized by high lipid content and a thin fibrous cap, high-risk plaques of the carotid arteries tend to be fibrotic and severely stenotic.3 ### Imaging of Atherothrombotic Disease Because there is striking heterogeneity in the composition of human atherothrombotic plaques, even within the same individual, reliable noninvasive imaging tools that can detect early atherothrombotic disease in the various regions and characterize the composition of the plaques are clinically desirable.3 Such imaging tools would improve our understanding of the pathophysiological mechanisms underlying atherothrombotic processes and allow us to better risk-stratify the disease. Additionally, such tools may permit optimal tailoring of treatment and allow direct monitoring of the vascular response. Presently, a number of imaging modalities are employed to study atherosclerosis; most identify luminal diameter or stenosis, wall thickness, and plaque volume.3 Two noninvasive imaging modalities, computed tomography and MRI, have been introduced to the study …

Combined coronary and mitral annulus calcium detection in the non-invasive diagnosis of coronary artery disease in patients with systemic hypertension.

Although the presence of coronary calcium (CC) on fast spiral computed tomography (FSCT) is a powerful predictor of coronary artery disease (CAD), both the specificity and positive predictive value (PPV) of CC in CAD diagnosis are modest. Since previous studies have shown an association between mitral annular calcification (MAC) and coronary atherosclerosis, we aimed to investigate whether combined coronary and MAC detection could improve the non-invasive diagnosis of CAD. Our study comprised 522 patients (284 men and 238 women, age ranged from 52-80 years, mean 65 +/- 6 years) who underwent FSCT of the coronaries as well as echo-Doppler examination. Among them, 97 patients had prior diagnosis of prevalent proven CAD (CAD group) while 425 patients were without clinically manifested CAD (the No CAD group). The prevalence of CC in the CAD group was 95 versus 68% in the No CAD group (P = 0.001). The prevalence of MAC in CAD group was 63 versus 51% in No CAD group (P = 0.03). Sensitivity and negative predictive value (NPV) of CC as a predictor of CAD were 95 and 96% respectively, but specificity and PPV were low: 32 and 24% respectively. Sensitivity and NPV of MAC as predictors of CAD were 63 and 85% respectively; specificity and PPV, 49 and 22% respectively. Using of combined CC and MAC evaluation in the prediction led to some specificity improvement at the expense of a similar sensitivity reduction, without a considerable gain in the total accuracy of the method. Coronary calcium detection on FSCT in hypertensive patients yields excellent sensitivity and NPV but relatively low specificity and PPV for clinically manifested CAD. Mitral annular calcification assessment yields a low sensitivity and specificity and its addition to CC evaluation does not improve non-invasive diagnosis of CAD.

High coronary artery calcium scores pose an extremely elevated risk for hard events

ObjectivesWe sought to assess the natural history of a cohort of asymptomatic individuals with very high (≥1,000) calcium scores (CSs) on a screening electron beam tomography (EBT) not submitted to further testing after the initial scan. We also compared the outcome of our prospective cohort with that of historical controls with severe abnormalities on myocardial perfusion imaging (MPI). BackgroundCoronary calcium detected on EBT imaging has been shown to correlate with the total plaque burden. However, there is still controversy as to the prognostic significance of calcium, as some investigators believe that the presence of coronary calcification may stabilize the atherosclerotic plaque. MethodsNinety-eight asymptomatic subjects (mean age: 62 ± 10) were followed for an average of 17 ± 11 months (range: 4 to 36 months) after undergoing EBT screening for the occurrence of hard coronary events (HCEs), defined as myocardial infarction or coronary death. All patients had an initial CS ≥1,000, and in none did the results of the EBT screening lead to further invasive or non-invasive testing. ResultsDuring the follow-up period, 35 patients (36%) suffered an HCE. All events were recorded in the first 28 months of follow-up. Subjects with HCEs had higher initial CSs than subjects not suffering HCEs (1,561 ± 270 vs. 1,199 ± 200, p < 0.001). The annualized event rate in subjects with a CS ≥1,000 was significantly greater than that of historical controls with severe perfusion abnormalities on MPI (25% vs. 7.4%, respectively; p < 0.0001). ConclusionsA high CS (≥1,000) on a screening EBT in an asymptomatic person portends a very high risk of an HCE in the short term. This risk appears to be greater than the risk associated with a severe perfusion abnormality on MPI.

PREDICTORS OF CORONARY DISEASE IN PATIENTS WITH END STAGE RENAL DISEASE

Patients with end stage renal disease have a high prevalence of cardiovascular disease and coronary arteriography is often routinely performed prior to kidney transplantation. However, the value of the conventional risk factors and non-invasive markers of coronary artery disease (CAD) in triaging patients for coronary arteriography has not been fully examined. 116 patients with end stage renal disease were evaluated. Coronary arteriography was performed in all patients either for a suspicion of CAD or as part of a routine pre-transplant evaluation. Lesions causing ≥ 50% luminal diameter stenosis in any of the three major coronary artery systems were considered significant. The mean age was 53.3 ± 9.3 years. Significant CAD was present in 69 patients (60%). Increasing age, family history of premature ischemic heart disease, the presence of angina, abnormal Q waves on the ECG or abnormal ST segment depression and the presence of coronary calcification were significant markers of coronary artery disease. However male gender, diabetes mellitus and obesity did not correlate with coronary disease. Even though hypertension, hypercholesterolemia and smoking were also not useful predictors these could have been modified by the renal failure. In conclusion increasing age, a family history of premature ischemic heart disease and some non-invasive markers were useful predictors of coronary disease.

Akumulasi Kalkulus Gigi yang Berlebihan pada Penderita Diabetes Tipe 2: Gejala Klnis Kemungkinan Menderita Penyakit Jantung Koroner

The relaive risk for Coronary Heart Disease (CHD) death in type 2 diabetics was 1.9-3.3 times higher, when compared to non-diabetics. Pathological studies have demonstrated a strong correlation between the presence of coronary calcium and CHD. Previous studies reported that the accumulation of dental plaque and dental calculus, and the severity of periodontal disease in type 2 diabetics were widely varied. A cross-sectional study on periodontal and CHD status of 36 non smoker type 2 diabetics was performed. The periodontal status was determined using Plaque Index of Sillness and Loe, Calculus Index of lingual anterior teeth, Papillary bleeding Index of Muleman, Periodontal Index of Russell, and dental panoramic rontgenogram. The CHD was determined by using standard ECG recording. Statistical analysis was using Fisher's exact test with the significant level of p 2) was not found in positive CHD diabetics, but found in 925 (36%) of negative CHD diabetics; a slight to moderate dental plaque accumulation was found in 11/11 (100%) of positive CHD diabetics, and 16/25 (64%) of negative CHD diabetics (p=.03). A heavy lingual calculus accumulaiton (score>2) was found in 11/11 (100%) of positive CHD diabetics and 10/25 (40%) of negative CHD diabetics (p=0.006). A severe generalized gingival bleeding (score>2) was not found in positive CHD diabetics, but found in 8/25 (32%) of negative CHD diabetics; a mild to moderate gingival bleeding was found in 11/11 (100%) of positive CHD diabetics and 17/25 (68%) of negative CHD diabetics (p=0.7). A severe generalized periodontal disease (score>5) was not found in positive CHD diabetics, but found in 9/25 (36%) of positive CHD diabetics; a mild to moderate periodontal disease (score<5) was found in 11/11 (100%) of positive CHD diabetics and 16/25 (64%) of negative CHD diabetics (p=.03). In conclusion, our data suggest that in type 2 diabetics, the presence of CHD is significantly correlated with the presence of a slight to moderate dental plaque accumulation, a heavy lingual calculus accumulation of anterior teeth, and a mild to moderate periodontal disease status. Although all the positive CHD diabetics have a mild to moderate gingival bleeding, the CHD status is not significantly correlated with the gingival bleeding status.

Improved Coronary Risk Assessment With Electron Beam Computed Tomography in an Asymptomatic Female With Familial Hypercholesterolemia

Improved Coronary Risk Assessment With Electron Beam Computed Tomography in an Asymptomatic Female With Familial Hypercholesterolemia

Improved Coronary Risk Assessment With Electron Beam Computed Tomography in an Asymptomatic Female With Familial Hypercholesterolemia

An asymptomatic 36-year-old woman had high cholesterol levels due to heterozygous familial hypercholesterolemia (FHC) and a family history of coronary artery disease (CAD) but no other risk factors. Exercise testing showed no signs of ischemia. Conventional drug therapy did not lower lipid levels adequately. However, low-density lipoprotein (LDL) apheresis, which effectively reduces cholesterol levels in patients with heterozygous FHC, was not indicated, according to current guidelines. Electron beam computed tomography demonstrated exceptionally high amounts of coronary calcium for the patient's age and sex. A subsequent coronary angiogram revealed advanced CAD, which justified the initiation of LDL apheresis to reduce her cholesterol levels. In patients with heterozygous FHC refractory to conventional lipid-lowering therapy, the presence of coronary calcium in the highest percentiles for age and sex (i.e., > 75th percentile) may warrant aggressive clinical management to improve prognosis, even if no symptoms or signs of ischemia are present.

Usefulness of electron beam tomography in adolescents and young adults with heterozygous familial hypercholesterolemia.

Because of the success of secondary prevention of coronary events by intense risk factor modification, a more precise measure of atherosclerosis in youth would have great clinical value both in the design of clinical trials for the demonstration of the usefulness of coronary disease prevention early in life and in guiding therapy. Identification of calcium in coronary arteries by electron beam tomography has been associated with severity of atherosclerosis in adults. Twenty-nine youths 11 to 23 years old with familial hypercholesterolemia (average LDL cholesterol, 5.95 mmol/L) underwent electron beam tomography as well as comprehensive risk factor assessment with measurement of total cholesterol, triglycerides, HDL cholesterol, lipoprotein (a), apolipoprotein E phenotype, blood pressure, body mass index, and history of tobacco use. Significant coronary calcium was identified in 7 of 29 subjects. Increased body mass index was significantly associated with the presence of coronary calcium (25.3 versus 20.6 kg/m2, P<0.03). No other risk factors were associated with the presence of coronary calcium. Coronary calcium, uncommonly identified before the fourth decade, was found in a significant percentage of adolescents and young adults with familial hypercholesterolemia. Overweight may increase the likelihood of coronary calcium being present in individuals already at high risk.

Detection of Coronary Calcification by Electron Beam Computed Tomography in Cardiac Transplant Recipients

622 Background. Graft atherosclerosis (GA) significantly limits survival in cardiac transplant recipients. Coronary calcification (CC) by electron beam computed tomography (EBCT) predicts coronary atherosclerotic plague burden and cardiac events in the non-transplant population. We sought to determine the relationship between CC and GA in cardiac transplant patients. Methods: In a cross sectional study 48 subjects underwent cardiac EBCT, using 100 ms exposure at 3 mm slice distance, soon after transplant or at time of routine annual coronary angiography. Positive CC was defined as an Agatston score ≥ 4. GA was defined by cardiac catheterization as focal luminal stenosis ≥25% or diffuse luminal narrowing ≥20% by quantitative angiography relative to the baseline study after transplant. Results: 41 male and 5 female patients underwent EBCT, mean age was 54 ± 16 years. Patients were 53 ± 49 months post transplant at time of EBCT. The mean donor heart age was 26 ± 12 years. Overall, 18 (39%) of 46 patients had positive CC; mean score of 38 ± 35. GA was present in 16 (40%) of 40 patients in which angiography was available. As a screening test, CC by EBCT predicted GA with a sensitivity of 57% and specificity of 64% (NPV= 66% and PPV= 40%). Of 11 patients who underwent EBCT≤ 12 months post transplant, 4 (36%) had CC. Conclusion: Significant coronary calcification may be present in approximately one-third of transplanted hearts at the time of transplant. Thirty-nine percent of cardiac transplant patients had coronary calcification(mean of 53 months post transplant). Coronary calcification by EBCT had a fair specificity with respect to graft atherosclerosis. The presence of coronary calcification and its relation to graft atherosclerosis in cardiac transplant patients warrants further longitudinal study.

Preclinical changes of extracoronary arterial structures as indicators of coronary atherosclerosis in men.

Carotid artery structure change was associated with coronary artery stenosis by angiography of subjects who were for the most part symptomatic. To determine whether structural changes at multiple extracoronary sites were associated with noninvasively detected coronary calcium for 94 asymptomatic high-risk men. B-mode ultrasonography allowed us to detect plaque at three sites (carotid, femoral, and abdominal aorta) and to measure intima-medial thickness both in common carotid and in femoral arteries. Ultrafast computed tomography determined the presence and amount of coronary calcification. After adjustment for age, plaques at two or three sites were associated with extensive amounts of coronary calcium [odds ratio 4.94 (95% confidence interval 1.08-23)], but not with the presence of coronary calcium; increase in carotid intima-medial thickness was not associated with presence and extent of coronary calcium; and increase in femoral intima-medial thickness was associated with presence of coronary calcium [odds ratio 1.44 (95% confidence interval 1.03-2)] and extensive coronary calcium [odds ratio 1.50 (95% confidence interval 0.97-2.33)]. Adjustment for cardiovascular risk factors attenuated these associations. Femoral intima-medial thickness predicted presence of coronary calcium whereas femoral intima-medial thickness and overall multiple plaques predicted extensive coronary calcium. Because coronary calcium is a marker of atherosclerosis and a predictor of coronary events, B-mode ultrasonography could be of clinical value for stratifying coronary risk.