Coronary Artery Calcium Score Progression Research Articles

Abstract P336: The Association of Coronary Artery Calcium Progression and Cognitive Function in Midlife - The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Background: Little is known about the impact of coronary artery calcium (CAC) and its progression on cognitive function in midlife, a time of importance for cognitive aging. Methods: In CARDIA, CAC was measured using computed tomography at years 15 (baseline), 20 and 25. CAC progression was defined as: (1) CAC>0 at follow-up among participants with baseline CAC=0; (2) an annualized change of ≥10 units at follow-up among those with 0<baseline CAC<100; or (3) an annualized percent change (annualized change in CAC score divided by baseline CAC score) ≥10% among those with baseline CAC≥100. Cognitive function was measured with Digit Symbol Substitution Test (DSST), Rey Auditory Verbal Learning Test (RAVLT), Stroop Interference, Montreal Cognitive Assessment (MoCA) and Verbal Fluency (Letter and Category Fluency) at year 35. We used linear regression to estimate the difference between marginal means with 95% confidence intervals (CIs) of each cognitive test by CAC score (0 vs >0) and CAC progression. Results: Among 2,341 participants (mean age 40.3 ± 3.6 years, 56% female, 43% Black at baseline), higher CAC score and CAC progression were associated with significantly lower cognitive performance in all cognitive tests. After adjustment for demographics, the association remained for CAC progression, compared to no progression, for most test scores: DSST (-2.70 95% CI: -4.05 to -1.36, p < 0.001), MoCA (-0.44 95% CI: -0.74 to -0.13, p = 0.005) and verbal fluency (-0.85 95% CI: -1.57 to -0.12, p = 0.02). Similar associations were observed for higher CAC score (>0 vs 0): DSST (-3.11 95% CI: -5.16 to -1.06, p = 0.003), MoCA (-0.81 95% CI: -1.28 to -0.34, p = 0.001) and RAVLT (-0.67 95% CI: -1.12 to -0.23, p = 0.003). Additional adjustment for physical activity, depressive symptoms, and APOE, and mutually for baseline CAC score and progression did not materially change the association. Conclusions: CAC score and progression were associated with lower cognitive function in midlife. CAC progression may be an independent risk factor for early cognitive aging, independent of baseline CAC score and other risk factors.

Impact of preserved ratio impaired spirometry on coronary artery calcium score progression: a longitudinal cohort study.

Preserved ratio impaired spirometry (PRISm) is associated with increased cardiovascular disease (CVD) risk and mortality. However, a causal relationship between PRISm and CVD remains unclear. We investigated the progression of coronary artery calcium (CAC) scores based on the presence of PRISm and reduced forced vital capacity (FVC). This retrospective cohort study included 11 420 participants aged ≥40 years with forced expiratory volume in 1 s (FEV1)/FVC ≥0.7 who underwent at least two health screening examinations with coronary computed tomography scan between 2003 and 2020, and were without a history of CVD or interstitial lung disease. Participants with PRISm, defined as FEV1/FVC ≥0.7 and FEV1 <80% predicted, were further divided by low FVC (FVC <80% predicted). We estimated the 5-year progression rates of CAC by comparing participants with and without PRISm at baseline using mixed linear models. Of the 11 420 participants, 8536 (75%), 811 (7%) and 2073 (18%) had normal spirometry, PRISm with normal FVC and PRISm with low FVC, respectively. During the mean (range) follow-up of 6.0 (0.5-17.2) years, the multivariable adjusted ratio of 5-year CAC progression rates comparing participants with PRISm to those with normal spirometry was 1.08 (95% CI 1.04-1.13). This rate was higher in participants with PRISm with low FVC (1.21 (95% CI 1.12-1.30)) than in those with normal FVC. In this longitudinal cohort study of subjects without a history of CVD, PRISm was significantly associated with CAC progression, which was more evident in the group with PRISm and low FVC.

#3775 PHOSPHATE BINDERS FOR PATIENTS WITH CHRONIC KIDNEY DISEASE UNDERGOING DIALYSIS: A NETWORK META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Abstract Background and Aims Phosphate binders (PBs) are essential for proper serum phosphorus control in patients with chronic kidney disease (CKD) requiring dialysis along with adequate dialysis and phosphorus restriction. To evaluate the clinical efficacy and safety of each PBs, we conducted a systematic review (SR) using a network meta-analysis (NMA) of randomised controlled trials (RCTs). Method We searched published RCTs in MEDLINE, EMBASE, the Cochrane Register of Controlled Trials (CENTRAL), and Clinical trial.gov databases using the search terms and text words relevant to this SR. We included RCTs involving adults (18 years and older) with at least 8 weeks of follow-up. Interventions and controls were the following: sevelamer-, bixalomer-, tenapanor-, iron- (ferric citrate, sucroferric oxyhydroxide), calcium-, magnesium-, lanthanum-, aluminium-, nicotinic acid-, and standard treatment or placebo). The outcomes were all-cause mortality, gastrointestinal adverse events (AEs), coronary artery calcium score (CACS), and serum calcium, phosphorus, and bicarbonate concentrations. Summary estimates were expressed as relative risk (RR) for binary outcomes and mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, respectively, with 95% confidence intervals (CI). The protocol of this study is registered in PROSPERO: CRD42022328388. Results All-cause mortality was identified and analysed in 29 trials involving 12,622 participants. Compared with calcium-containing PBs, sevelamer reduced the risk of all-cause mortality (RR 0.65, 95%CI 0.45 to 0.96). The risk of gastrointestinal AEs was higher for nicotinic acid (RR 3.79, 95%CI 1.29 to 11.12), sucroferric oxyhydroxide (RR 1.96, 95%CI 1.47 to 2.63), sevelamer (RR 1.47, 95%CI 1.14 to 1.88), and lanthanum (RR 1.36, 95%CI 1.14 to 1.64) than calcium-containing PBs. Lanthanum had an inhibitory effect on CACS progression compared to calcium-containing PBs (SMD -0.63, 95% CI -1.05 to -0.22). Serum calcium was lower than calcium-containing PBs in the following order: magnesium (MD -0.67, 95% CI -1.12 to -0.22), placebo (MD -0.64, 95% CI -1.22 to -0.67), nicotinic acid (MD -0.56, 95% CI -1.11 to -0.005), sevelamer (MD -0.35, 95% CI -0.47 to -0.23), and lanthanum (MD -0.24, 95% CI -0.38 to -0.095). No significant difference was observed in serum phosphorus decrease between any PBs and calcium-containing PBs. Serum bicarbonate concentration increased with ferric citrate (MD 1.16, 95% CI 0.36 to 1.96) and sucroferric oxyhydroxide (MD 1.06, 95% CI 0.29 to 1.82) but decreased with sevelamer (MD -1.24, 95% CI -1.71 to -0.77). Conclusion Our findings from SR based on NMA suggest that lanthanum may attenuate CACS and sevelamer may reduce the risk of all-cause mortality compared to calcium-containing PBs in patients with CKD requiring dialysis.

Dietary patterns and subclinical atherosclerosis incidence and progression: Results from ELSA-Brasil

Background and aimsCardiovascular disease (CVD) is the main cause of disease burden worldwide. Coronary artery calcification (CAC) score is a subclinical atherosclerosis marker able to predict the risk of CVD in asymptomatic patients, and few studies have investigated the association between dietary patterns (DP) and CAC score prospectively. Thus, the aim of this study was to estimate the association between baseline DP and CAC score incidence and progression on the ELSA-Brasil cohort. Methods and resultsThis study is a longitudinal prospective analysis of the ELSA-Brasil participants who underwent a CAC exam on baseline and follow-up (n = 2,824). CAC incidence was defined as a baseline CAC score equal to zero (n = 2,131) and subsequent follow-up CAC score greater than zero. CAC progression was defined according to the Hokanson method for the individuals who presented a CAC score greater than zero at the baseline (n = 639). Dietary data were assessed at the baseline using a food frequency questionnaire (FFQ), and factor analysis was applied to identify DP. Poisson regression models with robust variance and linear regression models were applied to estimate the association between baseline DP and CAC incidence and progression. The incidence of CAC was 14.6%, while 60.3% of the individuals presented CAC progression. Three DP were identified: convenience, Brazilian traditional, and prudent. We did not find a significant association between baseline DP and CAC incidence or progression. ConclusionOur findings from this longitudinal prospective analysis showed that baseline DP are not associated with CAC incidence or progression.

Coronary Artery Calcification Score and the Progression of Chronic Kidney Disease.

An elevated coronary artery calcification score (CACS) is associated with increased cardiovascular disease risk in patients with CKD. However, the relationship between CACS and CKD progression has not been elucidated. We studied 1936 participants with CKD (stages G1-G5 without kidney replacement therapy) enrolled in the KoreaN Cohort Study for Outcome in Patients With CKD. The main predictor was Agatston CACS categories at baseline (0 AU, 1-100 AU, and >100 AU). The primary outcome was CKD progression, defined as a ≥50% decline in eGFR or the onset of kidney failure with replacement therapy. During 8130 person-years of follow-up, the primary outcome occurred in 584 (30.2%) patients. In the adjusted cause-specific hazard model, CACS of 1-100 AU (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.04 to 1.61) and CACS >100 AU (HR, 1.42; 95% CI, 1.10 to 1.82) were associated with a significantly higher risk of the primary outcome. The HR associated with per 1-SD log of CACS was 1.13 (95% CI, 1.03 to 1.24). When nonfatal cardiovascular events were treated as a time-varying covariate, CACS of 1-100 AU (HR, 1.31; 95% CI, 1.07 to 1.60) and CACS >100 AU (HR, 1.46; 95% CI, 1.16 to 1.85) were also associated with a higher risk of CKD progression. The association was stronger in older patients, in those with type 2 diabetes, and in those not using antiplatelet drugs. Furthermore, patients with higher CACS had a significantly larger eGFR decline rate. Our findings suggest that a high CACS is associated with significantly increased risk of adverse kidney outcomes and CKD progression.

MO750: Dialysate Magnesium Impact on Progression of Coronary Artery Calcification

Abstract BACKGROUND AND AIMS The development of vascular calcifications is accelerated in dialysis patients and is associated with an increased risk of cardiovascular morbidity and mortality. Studies have shown that magnesium (Mg) reduces mineral deposit formation, thus potentially abating the process of vascular calcification. Therefore, the use of higher dialysate-Mg might present a promising tool to reduce vascular calcification. Many in vitro studies have investigated effects of Mg on vascular calcification, but prospective clinical trials are lacking. This study evaluated the difference in coronary artery calcification progression over 12 months based on different concentrations of routinely used dialysate-Mg. METHOD This prospective randomized, multicentre study included 60 angina-free chronic haemodialysis (HD) patients distributed into two equal groups based on dialysate-Mg level (0.5 versus 1.0 mmol/L) used routinely before and throughout the study period. Laboratory measurements, including total serum Mg level and coronary artery calcium score (CACS) determined by cardiac computed tomography, were performed in all patients at baseline and after 12 months of follow-up. RESULTS Total serum Mg was significantly higher in patients on higher dialysate-Mg, both at baseline and after 12 months of follow-up (P &amp;lt; 0.001). Nevertheless, in both study groups, total serum Mg decreased after 12 months of follow-up; from 1.13 ± 0.15 mmol/L to 0.99 ± 0.14 mmol/L (P &amp;lt; 0.001) in the lower dialysate-Mg group and from 1.39 ± 0.22 mmol/L to 1.29 ± 0.21 mmol/L (P &amp;lt; 0.001) in the higher dialysate-Mg group. CACS increased significantly in both study groups after 12 months: from 361.90 ± 725.67 to 480.00 ± 783.53 (P &amp;lt;0.001) in the lower dialysate-Mg group and from 437.71 ± 573.77 to 589.07 ± 682.82 (P &amp;lt; 0.001) in the higher dialysate-Mg. Still, the mean change in CACS (ΔCACS) did not differ significantly between the study groups (109.29 ± 181.99 versus 151.86 ± 211.22; P = 0.321). In patients with CACS = 0 at the beginning of the study (4 in the lower and 5 in the higher dialysate-Mg group), the mean ΔCACS was 21.25 ± 3.96 and 0 (P = 0.180), respectively. CONCLUSION Routine use of higher dialysate-Mg (1.0 mmol/L) increases total serum Mg level compared with standard dialysate-Mg solutions (0.5 mmol/L). However, this was not associated with lower CACS progression over 12 months of follow-up. Further research is needed to assess if patients with CACS = 0 may benefit from higher dialysate-Mg in terms of reduced calcification progression compared with standard dialysate-Mg solutions.

Nonlinear relationship between HbA1c and coronary artery calcium score progression: a secondary analysis based on a retrospective cohort study

ObjectiveCoronary artery calcium score and glycated hemoglobin(HbA1c) are both considered risk factors for coronary heart disease. However, the relationship between coronary artery calcium score and HbA1c is still unclear. Consequently, the present study was undertaken to explore HbA1c association with coronary artery calcium score progression in South Korea.MethodsThis study is a secondary analysis based on a retrospective cohort study in which 8151 participants received Health examination kits at the Health Promotion Center, Samsung Medical Center in Seoul, South Korea, from March 1, 2003–December 31, 2013. Cox proportional-hazards regression model was then used to evaluate the independent relationship between HbA1c and coronary artery calcium score progression.ResultsAfter adjusting potential confounding factors (age, sex, BMI, height, weight, SBP, DBP, TC, LDL-C, HDL-C, triglycerides, smoking status, alcohol consumption, reflux esophagitis status, hypertension, diabetes, dyslipidemia, ischemic heart disease and cerebrovascular disease), it was revealed that there was a nonlinear relationship between HbA1c and coronary artery calcium score progression, while the scoring point was 5.8%. The effect size was 2.06 to the left of the inflection point, while the 95% CI was 1.85 to 2.29. Whereas, the effect size was 1.04, on the right side of the inflection point while 95% CI was 0.99 to1.10.ConclusionThe relationship between HbA1c and coronary artery calcium score progression is nonlinear. HbA1c is positively related to coronary artery calcium score progression when HbA1c level was less than 5.8%.

Abstract 14392: Progression of Coronary Artery Calcium Score Predicts Higher Risk for Coronary Revascularization

Introduction: The Coronary artery calcium (CAC) score is a powerful independent screening tool for coronary artery disease (CAD). Elevated CAC score has been significantly associated with increased rates of revascularization, however monitoring the progression of disease with a serial CAC score remains controversial. Hypothesis: The progression of the CAC score predicts the need for coronary revascularization. Methods: Data were analyzed retrospectively of patients who underwent two calcium scans between February 2008 and April 2021 as part of the Sanford Cardiovascular Prevention Program and were categorized into low (&lt;100), moderate (100-399), or high ≥400) CAC groups. Progression of the CAC score between two scans was analyzed and the need for clinically indicated revascularization (PCI vs CABG) was evaluated by the chi-square test. Results: A total of 5809 subjects were screened for CAC score. 54.3% were females and the mean age was 55.6 ±10.35 years. Progression of CAC score (Low to moderate/high, moderate to high) and need for revascularization was statistically significant (P&lt;0.001). In our study, patients who progressed from low to high and moderate to high CAC score category were found to have the highest rates of coronary revascularization, 11.92%, and 13.36 % respectively. Conclusions: In our study, patients who progressed to a high CAC score category were found to have a significantly increased need for revascularization. Repeating a CAC score in low to moderate risk patients may have clinical benefit and needs further investigation.

Coronary artery calcification progression and long-term cardiovascular outcomes in renal transplant recipients: an analysis by the joint model.

ABSTRACTBackground Compared with the general population, the risk of death is substantially higher in renal transplant recipients than in age- and sex-matched individuals in the general population. In the general population, coronary artery calcification (CAC) predicts all-cause and cardiovascular mortality. In this study we aimed to analyse these relationships in renal transplant recipients.MethodsWe examined 178 renal transplant patients in this prospective observational cohort study. We measured CAC with multidetector spiral computed tomography using the Agatston score at multiple time points. Overall, 411 scans were performed in 178 patients over an average 12.8 years follow-up. The clinical endpoint was a composite including all-cause death and non-fatal cardiovascular events. Data analysis was performed by the joint model.ResultsDuring a follow-up of 12.8 ± 2.4 years, coronary calcification progressed over time (P < 0.001) and the clinical endpoint occurred in 54 patients. In the analysis by the joint model, both the baseline CAC score and the CAC score progression were strongly associated with the incidence rate of the composite event [hazard ratio 1.261 (95% confidence interval 1.119–1.420), P = 0.0001].ConclusionsCAC at baseline and coronary calcification progression robustly predict the risk of death and cardiovascular events in renal transplant recipients. These findings support the hypothesis that the link between the calcifying arteriopathy of renal transplant patients and clinical end points in these patients is causal in nature.

Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: a 3-year serial hybrid [15O]H2O PET/CT imaging study

Abstract Funding Acknowledgements Type of funding sources: None. Background. The value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented. Purpose. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion. Methods. Fifty-three patients with single-vessel coronary artery disease (CAD) underwent [15O]H2O Positron Emission Tomography/Computed Tomography at 1 month (baseline), 1 year, and 3 years after percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH (Impact of Vascular Reparative Therapy on Vasomotor Function and Myocardial Perfusion) trial. Relationships between baseline CAC score and evolution of perfusion indices were explored with a mixed model-analysis. Results. Baseline CAC score was 0 in 9%, 0.1-99.9 in 40%, 100-399.9 in 36% and ≥400 in 15% of patients, respectively. In higher baseline CAC groups, scores increased more over time (overall p &amp;lt; 0.01). Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL·min-1·g-1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p &amp;lt; 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time were not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years follow-up. Conclusions. Higher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.

Triglyceride Glucose-Waist Circumference Better Predicts Coronary Calcium Progression Compared with Other Indices of Insulin Resistance: A Longitudinal Observational Study.

The triglyceride glucose (TyG) index, a product of triglyceride and fasting glucose, is a reliable marker for insulin resistance. We aimed to investigate the association between the TyG-related markers and coronary artery calcification (CAC) progression. We enrolled 1145 asymptomatic participants who underwent repeated CAC score measurements during routine health examinations. Homeostasis model assessment of insulin resistance (HOMA-IR), TyG index, TyG-BMI (body mass index), and TyG-WC (waist circumference) were calculated. Progression of CAC was defined as (1) incident CAC in a CAC-free population, or an (2) increase of ≥2.5 units between the baseline and final square root of the CAC scores in participants with detectable CAC. According to the quartiles of parameters, we stratified the subjects into four groups. The prevalence of progression increased with the TyG-WC quartile (15.0%, 24.1%, 31.0%, and 32.2% for each of the groups; p < 0.001). The multivariate-adjusted odds ratio (95% confidence interval) for CAC score progression was 1.66 (1.01–2.77) when the highest and lowest TyG-WC index quartiles were compared. Furthermore, the predictability of TyG-WC for CAC progression was better than the other indices in terms of the area under the curve. The TyG-WC index predicted CAC progression better than other indices and could be a potential marker of future coronary atherosclerosis.

Evolution of coronary artery calcium and absolute myocardial perfusion after percutaneous revascularization: A 3-year serial hybrid [15O]H2O PET/CT imaging study

Background and aimsThe value of serial coronary artery calcium (CAC) scores to predict changes in absolute myocardial perfusion and epicardial vasomotor function is poorly documented. This study explored the association between progression of CAC score and changes in absolute myocardial perfusion. MethodsFifty-three patients (26% female) with de novo single-vessel coronary artery disease underwent [15O]H2O positron emission tomography/computed tomography at 1 month (baseline), 1 year, and 3 years after complete revascularization with percutaneous coronary intervention (PCI) to assess CAC scores, hyperemic myocardial blood flow (hMBF), coronary flow reserve (CFR) and cold pressor test MBF (CPT-MBF), within the context of the VANISH trial. ResultsBaseline CAC score was 0 in 9%, 0.1–99.9 in 40%, 100–399.9 in 36% and ≥400 in 15% of patients, respectively. Mixed model-analysis allowed for averaging perfusion indices over all time points: hMBF (3.74 ± 0.83; 3.33 ± 0.79; 3.08 ± 0.78 and 2.44 ± 0.74 mL min−1·g−1) and CFR (3.82 ± 1.12; 3.17 ± 0.80; 3.19 ± 0.81; 2.63 ± 0.92) were lower among higher baseline CAC groups (p < 0.01; p = 0.03). However, no significant interaction was found between baseline CAC groups and time after PCI for all perfusion indices, denoting that evolution of perfusion indices over time was not significantly different between CAC groups. Furthermore, CAC progression was not correlated with evolution of hMBF (r = 0.08, p = 0.57), CFR (r = 0.09, p = 0.53) or CPT-MBF (r = 0.03, p = 0.82) during 3 years of follow-up. ConclusionsHigher baseline CAC was associated with lower hMBF and CFR. However, both baseline CAC and its progression were not associated with evolution of absolute hMBF, CFR and CPT-MBF over time, suggesting that CAC score and progression of CAC are poor indicators of change in absolute myocardial perfusion.

Association of type D personality and level of coronary artery calcification

ObjectiveTo evaluate the association of the type D personality and the level of coronary arteries calcification in population-based sample. Methods1595 residents aged 25 to 64 years were recruited in a observational cross-sectional study in the period from 2012 to 2013. In addition to the ESSE-RF study protocol, we assessed the presence of a Type D personality and quantified coronary artery calcium (CAC) using multispiral computed tomography. The obtained data was analyzed by the Agatston method. The patients were divided into two groups: patients with type D personality (n = 231) and without type D (n = 1379). ResultsCAC score differed significantly between the groups: 689.3 ± 53.7 in patients with type D and 546.5 ± 47 without type D (p = 0.04). The greatest differences of calcium score were found in the left coronary artery system, namely left anterior descending artery (p = 0.01) and circumflex artery (p = 0.03). Patients with type D had higher levels of clinically significant anxiety (p = 0.04) and depression (p = 0.02). Type D personality is associated with high levels of CAC score independently from age, sex, diabetes mellitus status, smoking, alcohol consumption, body mass index, arterial hypertension status, cholesterol level, history of brain stroke, myocardial infarction, coronary artery disease, HADS-A and HADS-D scores. ConclusionsType D personality is associated with higher average values of the CAC score, and type D may represent a potentially modifiable risk factor CAD. But it is unclear whether type D can affect the progression of CAC score.

Hypoxemia During Sleep and the Progression of Coronary Artery Calcium.

The aim of this study was to evaluate the associations between objective sleep parameters of obstructive sleep apnea (OSA) and progression of subclinical cardiovascular disease as measured by the coronary artery calcium (CAC) score. We reviewed the medical records of 196 patients who underwent both polysomnography (PSG) and repeated coronary artery computed tomography (CT) for screening purposes. For each participant, the first coronary CT scan was conducted within 12months of PSG. Follow-up CT was performed voluntarily. The CAC score was log-transformed to obtain normally distributed data. We evaluated potential associations between various sleep parameters by analyzing overnight-attended PSG and CAC score progression over time. ST90 (total sleep time of SaO2 < 90%), CT90 (percentage of time of SaO2 < 90%), and degree of mean oxygen desaturation were significantly correlated with CAC score progression even after adjustment for confounders (age, sex, DM, HTN, hypercholesterolemia, BMI, and smoking status) (estimate = 0.004, p = .010; estimate = 0.009, p < .001; estimate = 0.027, p = .001; respectively). We also performed subgroup analysis and found that the progression of CAC score over time showed higher tendency when CT90 value was 2.73 or more (CT90 ≥ 2.73 group; estimate = 0.336, CT90 < 2.73 group; estimate = 0.194, p < .001 each). ST90, CT90 and mean oxygen desaturation are significant predictors of cardiovascular disease progression. Coronary artery status should be monitored repetitively in patients with hypoxemia during sleep.

Differential association between the progression of coronary artery calcium score and coronary plaque volume progression according to statins: the Progression of AtheRosclerotic PlAque DetermIned by Computed TomoGraphic Angiography Imaging (PARADIGM) study.

Coronary artery calcium score (CACS) is a strong predictor of major adverse cardiac events (MACE). Conversely, statins, which markedly reduce MACE risk, increase CACS. We explored whether CACS progression represents compositional plaque volume (PV) progression differently according to statin use. From a prospective multinational registry of consecutive patients (n = 2252) who underwent serial coronary computed tomography angiography (CCTA) at a ≥ 2-year interval, 654 patients (61 ± 10 years, 56% men, inter-scan interval 3.9 ± 1.5 years) with information regarding the use of statins and having a serial CACS were included. Patients were divided into non-statin (n = 246) and statin-taking (n = 408) groups. Coronary PVs (total, calcified, and non-calcified; sum of fibrous, fibro-fatty, and lipid-rich) were quantitatively analysed, and CACS was measured from both CCTAs. Multivariate linear regression models were constructed for both statin-taking and non-statin group to assess the association between compositional PV change and change in CACS. In multivariate linear regression analysis, in the non-statin group, CACS increase was positively associated with both non-calcified (β = 0.369, P = 0.004) and calcified PV increase (β = 1.579, P < 0.001). However, in the statin-taking group, CACS increase was positively associated with calcified PV change (β = 0.756, P < 0.001) but was negatively associated with non-calcified PV change (β = -0.194, P = 0.026). In the non-statin group, CACS progression indicates the progression of both non-calcified and calcified PV progression. However, under the effect of statins, CACS progression indicates only calcified PV progression, but not non-calcified PV progression. Thus, the result of serial CACS should be differently interpreted according to the use of statins.

Bariatric surgery and the coronary artery calcium score.

to investigate the impact of bariatric surgery on the coronary artery calcium score (CACS), and to establish predictors of progression of this score in patients with obesity. prospective study that evaluated 18 obese patients before and after bariatric surgery. All patients were submitted to computed tomography scans and blood tests (total cholesterol, LDL, HDL, triglycerides, fasting plasma glucose, A1C, insulin, serum calcium, C-peptide and C-Reactive Protein) in order to determine CACS and Framingham risk score (FRS). the FRS decreased 50% between the pre and postoperative evaluations. The mean CACS increased significantly at the late postoperative period, going from 8.5 to 33.1. HDL levels had also increased between the pre and postoperative periods. All of the other quantitative variables reduced significantly at the postoperative evaluation. When dividing CACS into four degrees, it was observed that 22.2% presented CACS=0 at the postoperative evaluation. The prevalence of mild CACS decreased from 77.8% to 50%, while moderate CACS remained the same (11.1%). Severe CACS increased from 11.1% to 16.7%. Older ages were linked to CACS progression, and this was the only variable that presented statistical association with progression. bariatric surgery leads to positive cardiovascular outcomes, apparently regardless of CACS.

The impact of non-alcoholic fatty liver disease and metabolic syndrome on the progression of coronary artery calcification

It is unclear whether non-alcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease. We examined the independent impact of NAFLD on the progression of the coronary artery calcification (CAC) score, a well-known marker of atherosclerosis progression. We examined 1,173 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. The subjects were categorised into four groups based on the presence (+) or absence (−) of NAFLD and metabolic syndrome (MetS). The progression of CAC score was defined as either incident CAC in a CAC-free population at baseline or an increase of ≥2.5 units between the baseline and the final square roots of the CAC scores of participants with detectable CAC at baseline. CAC progression was seen in 18.6% (98/526), 28.3% (77/272), 29.1% (30/103) and 32.0% (87/272) of the subjects with NAFLD(−)/MetS(−), NAFLD(+)/MetS(−), NAFLD(−)/MetS(+) and NAFLD(+)/MetS(+), respectively. The subjects with NAFLD(+)/MetS(+) and NAFLD(+)/MetS(−) had a significantly higher risk of CAC progression than those with NAFLD(−)/MetS(−) (multivariate-adjusted odds ratio [OR]: 1.76; 95% confidence interval [CI]: 1.18–2.62 and multivariate-adjusted OR: 1.53, 95% CI: 1.05–2.23, respectively). NAFLD is an independent risk factor for CAC progression, irrespective of the presence of MetS.

The Impact of Fatty Liver Disease and Metabolic Syndrome on the Progression of Coronary Artery Calcification

Objectives: Fatty liver disease (FLD) is a well-known risk factor for cardiovascular disease (CVD). However, it is unclear whether FLD per se is an independent risk factor of CVD or combined unfavorable metabolic components with metabolic syndrome (MetS). In this study, we examined the independent impact of FLD on the coronary artery calcification (CAC) score progression. Methods: We examined 1,173 asymptomatic participants who underwent repeated CAC score measurement during routine health examinations. Subjects were categorized into 4 groups according to the presence (+) or absence (-) of FLD and MetS. The CAC score progression was defined as either incident CAC in a population free of CAC at baseline or increase ≥ 2.5 units between the baseline and final square root of CAC scores participants who had detectable CAC at baseline examination. Results: Among the participants, 44.8% (526), 23.2% (272), 8.8% (103) and 23.2% (272) were classified as FLD(-)/MetS(-), FLD(+)/MetS(-), FLD(-)/MetS(+), and FLD(+)/MetS(+), respectively. The proportions of subjects who developed CAC progression was 18.6% (98), 28.3% (77), 29.1% (30) and 32.0% (87) in FLD(-)/Mets(-), FLD(+)/Mets(-), FLD(-)/MetS(+), and FLD(+)/MetS(+), respectively. In logistic regression analysis, FLD(+)/MetS(+) were at significantly higher risk of CAC progression compared to FLD(-)/MetS(-) [multivariate adjusted-odds ratio (OR) 1.76, 95% confidence interval (CI) 1.18-2.62]. FLD(+)/MetS(-) also demonstrated higher risk of CAC progression [multivariate adjusted-OR 1.53, 95% CI 1.05-2.23]. Conclusions: FLD is an independent risk factor for CAC progression irrespective of the presence of metabolic syndrome. Special attention should be paid to subjects with FLD for the prevention of future cardiovascular events, even though MetS does not coexist. Disclosure Y. Cho: None. Y. Kang: None. C. Park: None. S. Park: None. W. Lee: None. J. Park: None. C. Jung: None.

The annual rate of coronary artery calcification with combination therapy with a PCSK9 inhibitor and a statin is lower than that with statin monotherapy

Statins and/or PCSK9 inhibitors cause the regression of coronary atheroma and reduce clinical events. However, it currently remains unclear whether these drugs modulate coronary atheroma calcification in vivo. Coronary artery calcium (CAC) scores (Agatston Units, AUs) were estimated in 120 patients receiving coronary computed tomographic angiography (CCTA) (63% males; median age 56 years). The CAC scores were compared among the three groups: (1) neither statin nor PCSK9 inhibitor therapy, (2) statin monotherapy, and (3) statin and PCSK9 inhibitor combination therapy in an unpaired cross-sectional study. Additionally, CCTA was performed twice at an interval in 15 patients undergoing statin monotherapy to compare the previous (baseline) and subsequent (follow-up) CAC scores in a paired longitudinal study. In addition, a PCSK9 inhibitor was administered to 16 patients undergoing statin therapy. Before and after that, CCTA was performed twice to compare the previous and subsequent CAC scores in a paired longitudinal study. The unpaired cross-sectional study and paired longitudinal study consist of completely different patients. Among 120 patients, 40 (33%) had a CAC score >100 AUs. The median CAC score increased in the following order: statin group, statin and PCSK9 group, and no-statin-no-PCSK9 group. Annual CAC score progression was 29.7% by statin monotherapy and 14.3% following the addition of the PCSK9 inhibitor to statin therapy. The annual rate of CAC with the combination therapy with a PCSK9 inhibitor and a statin is lower than that with statin monotherapy. CAC may be prevented with PCSK9 Inhibitor.

Fatty liver disease determines the progression of coronary artery calcification in a metabolically healthy obese population.

ObjectivesMetabolically healthy obese (MHO) phenotype describes an obese state with a favorable metabolic profile. However, the prognosis of this subpopulation remains controversial. We aimed to examine whether MHO phenotype is associated with progression of atherosclerotic activity, reflected as the changes in coronary artery calcification (CAC) over time. If so, we sought to determine the role of fatty liver disease (FLD), the hallmark of hepatic steatosis, in this progression.MethodsWe enrolled 1,240 asymptomatic subjects who underwent repeated CAC score measurement during routine health examinations. CAC score progression was defined as either incident CAC in a population free of CAC at baseline, or an increase by ≥2.5 units between the baseline and final square root of CAC scores in participants with detectable CAC at baseline. Subjects were stratified by body mass index (cut-off, 25.0 kg/m2) and metabolic health state using Adult Treatment Panel-III criteria. FLD was assessed via ultrasonography.ResultsOver 2.9 years of follow-up, 25.2% of total subjects exhibited CAC score progression. The MHO phenotype was not significantly associated with CAC score progression (multivariate adjusted-odds ratio [OR], 1.45; 95% confidence interval [CI], 0.93–2.25), as compared to the metabolically healthy non-obese (MHNO) phenotype. However, subgroup analysis indicated that the MHO/FLD phenotype was significantly associated with CAC score progression (multivariate adjusted-OR, 2.37; 95% CI, 1.34–4.16), as compared to the MHNO/no FLD phenotype, whereas the MHO/no FLD phenotype was not (multivariate adjusted OR, 1.25; 95% CI, 0.71–2.24).ConclusionsObese individuals with FLD have an increased risk of atherosclerosis progression, despite their healthy metabolic profile. Preventive interventions targeting cardiometabolic risk factors should be considered in such individuals, regardless of the weight status.