Severe Coronary Calcification Research Articles

Lipocalin-type prostaglandin D synthase is not a biomarker of atherosclerotic manifestations

Objective. Over the last decades Lipocalin-type prostaglandin D synthase (L-PGDS), Osteoprotegerin (OPG), Osteopontin (OPN) and Pregnancy associated plasma protein A (PAPP-A) have been reported to be associated with coronary artery disease, and L-PGDS has been proposed as a potential new diagnostic tool in the setting of stable coronary artery disease. We set out to investigate if measurement of concentrations of these biomarkers could be used to differentiate between four groups of individuals with different atherosclerotic manifestations. Methods. A total of 120 individuals from four equal gender- and age-matched groups were studied: (i) no previous cardiovascular disease (CVD) and no coronary calcifications [CAC-negative group], (ii) no previous CVD but evidence of severe coronary calcifications [CAC-positive group], (iii) acute coronary syndrome [ACS-group], and (iv) clinical stable patients with CVD, who were referred for cardiovascular surgery [CVD-group]. Concentrations of L-PGDS, OPG, OPN and PAPP-A were analyzed and compared between the four groups. Results. We did not find any significant differences in L-PGDS concentrations between the four groups (p = 0.32). OPG concentrations differed significantly (p = 0.003), with the highest concentration observed in ACS patients. Considering OPN (p = 0.12) and PAPP-A (p = 0.53) their concentrations between groups did not differ significantly. Conclusion. The main message from this study is the observation that L-PGDS based on a single blood test appears to be less valuable than previously proposed in identification of patients with coronary artery disease. However, ACS patients have higher OPG concentrations than patients with different manifestations of stable atherosclerosis. Neither OPN nor PAPP-A concentrations differed between groups.

Relationship Between Carotid Disease on Ultrasound and Coronary Disease on CT Angiography

The purpose of this study was to assess the relationship between carotid artery disease by ultrasound and coronary artery disease by coronary computed tomography angiography (CTA) and to identify carotid ultrasound parameters predictive of coronary artery disease. Carotid ultrasound and CTA are noninvasive modalities used to image atherosclerosis. Studies examining the relationship between the 2 tests, however, are lacking. We performed carotid ultrasound on predominantly nondiabetic subjects referred for CTA. Carotid intima media thickness (IMT) and plaque were assessed and compared with coronary artery calcification and the number of coronary arteries with any evidence of atherosclerosis on CTA. A total of 150 subjects underwent both CTA and carotid ultrasound on the same day. Carotid plaque was present in 71.3% (n = 107), whereas the presence of at least 1 coronary artery with disease on CTA was present in 57.1% (n = 84). Carotid plaque was present in 47.6% (30 of 63) of subjects with a calcium score of 0 and 88.5% (77 of 87) of subjects with a calcium score >0 (p = 0.0001). Similarly carotid plaque was present in 52.4% (33 of 63) of subjects with no CTA evidence of atherosclerosis versus 85.7% (72 of 84) of subjects with any CTA evidence of atherosclerosis (p < 0.0001). Carotid plaque, IMT ≥ 1.5 mm, or averaged mean IMT >0.75 mm were associated with a calcium score >0 (odds ratio: 5.4, p < 0.0001, 2.7, p < 0.001; 2.9, p = 0.011, respectively) and disease in at least 1 vessel on CTA (odds ratio: 2.8, p = 0.03, 2.19, p = 0.073; 2.22, p = 0.058, respectively) independent of age and sex. Carotid plaque and increased carotid IMT are associated with the presence and severity of coronary calcification and disease on CTA in ambulatory subjects.

Correlations Between Severity of Coronary Calcification and Impairment of Left Ventricular Ejection Fraction

Abstract Introduction: 64 multislice CT angiography is a recently introduced imaging technique, increasingly being used as a tool to show the coronary arteries in three-dimensional visualization. One of the advantages of this method is the ability to estimate the degree of calcification of atheromatous plaques via coronary calcium score calculation, which correlates with the severity score of ateromatous systemic burden. The aim of this study was to evaluate the relationship between the severity of coronary calcification, expressed by calcium score, and the left ventricular ejection fraction (LVEF). Material and methods: This retrospective study included 81 patients with symptoms of angina and ECG modifications (at rest or during exercise). Echocardiography and 64 multislice CT angiography were performed in all patients to assess the LVEF and Ca scoring. Results: Calcium score was lower than 100 in 62 patients (50.22%), between 100 and 400 in 11 patients (8.91%), and higher than 400 in 8 patients (6.48%). Mean LVEF was 53.52%, 17 patients having an LVEF of less than 50%. In patients with calcium score less than 100, the corresponding ejection fraction was normal: 55.29%, while in coronary arteries with extensive calcifications (calcium score &gt; 400), the LVEF was significantly lower, 50.5% (p = 0.004). Conclusions: High Calcium score is positively correlated with LVEF reduction, and a high value for calcium score indicates an increased probability of reduced left ventricular ejection fraction

TCT-205 One year outcomes of percutaneous coronary intervention with a modern drug-eluting stent in patients with moderate and severe coronary calcification: A pooled analysis from the Nobori-2 and e-Nobori all-comer registries

Percutaneous coronary intervention (PCI) of moderate and severely calcified lesions has been described as a predictor of worse outcomes when bare-metal stents or first-generation drug-eluting stents (DES) have been used. Little is known about the impact of coronary calcification on outcome after PCI

Impact of the Severity of Coronary Artery Calcification on Clinical Events in Patients Undergoing Coronary Artery Bypass Grafting (from the Acute Catheterization and Urgent Intervention Triage Strategy Trial)

The treatment of calcified coronary lesions by percutaneous coronary intervention has been shown to be associated with poor outcomes and an increased rate of complications. However, the impact of coronary calcification in patients undergoing coronary artery bypass grafting (CABG) is unknown. A total of 755 patients presenting with acute coronary syndrome in the Acute Catheterization and Urgent Intervention Triage Strategy trial underwent CABG. Patients were divided into 3 groups according to the presence and extent of coronary calcifications (lesion level: severe, moderate, none to mild) as assessed by an independent angiographic core laboratory. Major ischemic and bleeding outcomes were assessed at 30days and 1year. Severe calcification was found in 103 patients (13.6%), moderate calcification in 249 patients (33.0%), and none-to-mild calcification in 403 patients (53.4%). The presence of severe calcification compared with moderate or none to mild was associated with a significantly higher unadjusted rate of death (11.8% vs 3.7% vs 4.5%, p= 0.006), death or myocardial infarction (MI; 31.1% vs 19.7% vs 16.4%, p= 0.006), and major adverse cardiac event (MACE; 32.0% vs 22.6% vs 20.8%, p= 0.059) at 1year. By multivariate analysis, severe calcification (vs nonsevere calcification) was identified as an independent predictor of 1-year MACE (hazard ratio 1.49, 95% confidence interval 1.01 to 2.21, p= 0.04) and death or MI (hazard ratio 1.77, 95% confidence interval 1.18 to 2.66, p= 0.006). In conclusion, the presence of severe coronary calcification was associated with worse outcomes after CABG, including an increased risk of death. The presence of severe coronary calcification was identified as an independent predictor of MACE and death or MI 1year after CABG.

Low triiodothyronine: a pathway to coronary calcification in patients maintained on peritoneal dialysis

Low triiodothyronine: a pathway to coronary calcification in patients maintained on peritoneal dialysis

NEITHER SERUM VITAMIN D NOR CALCIUM LEVELS ARE ASSOCIATED WITH FLUORSOCOPIC SEVERITY OF CORONARY ARTERY CALCIFICATION AMONG PATIENTS UNDERGOING DIAGNOSTIC CORONARY ANGIOGRAPHY

Vitamin (Vit) D is a critical factor related to calcium (CA) absorption and metabolism, and Vit D levels are associated with serum CA levels, coronary artery disease (CAD) and major adverse CV events. Additionally, severity of coronary calcification has been used as a surrogate marker for CAD

The diabetes conundrum: despite increasing incidences of coronary disease in diabetic type II patients, their first cathlab presentation is later than expected

This editorial refers to ‘Severity of coronary atherosclerosis in patients with a first acute coronary event: a diabetes paradox’[†][1], by M. Niccoli et al. , on page 729 Niccoli et al . assessed the severity of coronary artery disease (CAD) in the culprit vessels of diabetic type II as well as non-diabetic patients ( n = 167) at the time of their first coronary event employing standard coronary angiography and intracoronary optical coherence tomography (OCT) imaging ( n = 72).1 To assess the severity of CAD, they applied the Bogarty, Gensini, and Sullivan scores, and to evaluate the development of collaterals they used the Rentrop score, all based on coronary angiography. Intracoronary imaging by OCT was performed to study coronary plaque morphology, more particularly to quantify the amount of lipids and calcification present in the plaques. This was assessed at the site of the minimal lumen area (MLA) and at the cross-section showing the largest arc of calcium in the culprit vessel. Furthermore, the OCT images were inspected for the presence of calcified nodules.2 The findings of the authors are: more collateral development towards the culprit vessel, less lipids at the MLA site, more severe calcified segments, and more superficial calcified nodules in diabetic type II patients as compared with non-diabetics at the time of their first event. As the author's state: despite more severe coronary calcification, including calcified nodules, potent pro-inflammatory, pro-oxidant, and pro-thrombotic stimuli in diabetic type II patients, these patients seem to experience their first event at a later stage in the process of CAD as compared with non-diabetic patients. This finding is seemingly at odds with general convention, i.e. that the first event for all patients happens at the same stage of CAD. The authors hypothesized that there might be, besides an increased presence … [1]: #fn-2

TCT-670 Impact of Moderate and Severe Coronary Calcification on 1-Year Outcomes after PCI with DES: A Pooled Analysis of 11,651 Patients from 14 Randomized Trials

TCT-670 Impact of Moderate and Severe Coronary Calcification on 1-Year Outcomes after PCI with DES: A Pooled Analysis of 11,651 Patients from 14 Randomized Trials

Diagnostic performance of coronary CT angiography for stenosis detection according to calcium score: systematic review and meta-analysis

A systematic review and meta-analysis to assess sensitivity and specificity of coronary CT angiography (CCTA) for significant stenosis at different degrees of coronary calcification. A literature search was performed including studies describing test characteristics of CCTA for significant stenosis, performed with at least 16-MDCT and according to calcium score (CS). Invasive coronary angiography was the reference standard. Pooled sensitivity and specificity of CCTA by CS categories and CT equipment were calculated. Of 14,121 articles, 51 studies reported on the impact of calcium scoring on diagnostic performance of CCTA and could be included in the systematic review. Twenty-seven of these studies (5,203 participants) were suitable for meta-analysis. On a patient-basis, sensitivity of CCTA for significant stenosis was 95.8, 95.6, 97.6 and 99.0% for CS 0-100, 101-400, 401-1,000 and >1,000 respectively. Specificity was 91.2, 88.2, 50.6 and 84.0% respectively. Specificity of CCTA was significantly lower for CS 401-1,000 due to lack of patients without significant stenosis. Sensitivity and specificity of 16-MDCT were significantly lower compared to more modern CT systems. Even in cases of severe coronary calcification, sensitivity and specificity of CCTA for significant stenosis are high. With 64-MDCT and newer CT systems, a CS cut-off for performing CCTA no longer seems indicated. Decisions about performing coronary CT angiography (CCTA) sometimes depend on calcium scoring. CCTA is highly sensitive for coronary stenosis. With 16-MDCT, however, heavy calcification reduces specificity for significant stenosis. For 64-MDCT (and above), CCTA has high specificity, even with severe coronary calcification.

Type I Interferons Are Associated with Subclinical Markers of Cardiovascular Disease in a Cohort of Systemic Lupus Erythematosus Patients

BackgroundSystemic lupus erythematosus (SLE) patients have a striking increase in cardiovascular (CV) comorbidity not fully explained by the Framingham risk score. Recent evidence from in vitro studies suggests that type I interferons (IFN) could promote premature CV disease (CVD) in SLE. We assessed the association of type I IFN signatures with functional and anatomical evidence of vascular damage, and with biomarkers of CV risk in a cohort of lupus patients without overt CVD.Methodology/Principal FindingsSerum type I IFN activity (induction of five IFN-inducible genes; IFIGs) from 95 SLE patient and 38 controls was quantified by real-time PCR. Flow mediated dilatation (FMD) of the brachial artery and carotid intima media thickness (CIMT) were quantified by ultrasound, and coronary calcification by computed tomography. Serum vascular biomarkers were measured by ELISA. We evaluated the effect of type I IFNs on FMD, CIMT and coronary calcification by first applying principal components analysis to combine data from five IFIGs into summary components that could be simultaneously modeled. Three components were derived explaining 97.1% of the total IFIG variation. Multivariable linear regression was utilized to investigate the association between the three components and other covariates, with the outcomes of FMD and CIMT; zero-inflated Poisson regression was used for modeling of coronary calcification. After controlling for traditional CV risk factors, enhanced serum IFN activity was significantly associated with decreased endothelial function in SLE patients and controls (p<0.05 for component 3), increased CIMT among SLE patients (p<0.01 for components 1 and 2), and severity of coronary calcification among SLE patients (p<0.001 for component 3).ConclusionsType I IFNs are independently associated with atherosclerosis development in lupus patients without history of overt CVD and after controlling for Framingham risk factors. This study further supports the hypothesis that type I IFNs promote premature vascular damage in SLE.

A Novel Approach to Facilitating Balloon Crossing Chronic Total Occlusions: The “Wire‐Cutting” Technique

Following successful guidewire passage, inability to cross the occluded lesion with a balloon is the most common cause of procedural failure for percutaneous recanalization of chronic total occlusions (CTOs). We sought to evaluate the efficacy of "wire-cutting" technique for facilitating the balloon passage through the lesion during CTO-percutaneous coronary intervention. Sixteen consecutive patients with CTOs were treated by "wire-cutting" technique when a lubricious balloon could not be passed through the lesion after successful guidewire crossing. The main process of the "wire-cutting" technique involved: inserting 2 percutaneous transluminal coronary angioplasty (PTCA) guidewires (A and B) into the distal true lumen; advancing a balloon over guidewire A to the site of the occlusion abutting the proximal cap, the balloon was then inflated and guidewire B was pressed between the balloon and the proximal cap; rapidly withdrawing guidewire B produced a cutting power that crushed the proximal cap thus facilitating balloon crossing. Technique success was defined as balloon having crossed CTO lesions successfully after performing wire-cutting procedure. Both technical success and procedural success were obtained in 10 (62.5%) cases. Technique failure occurred in 6 (37.5%) cases, of which 2 were due to the inability to place a second guidewire into the distal true lumen and the other 4 were due to severe coronary calcification. Of these 4 failures, 2 have final procedure success with the use of Rotablator and the remaining 2 patients were referred for bypass surgery. Major complication included severe coronary dissection that occurred in 1 (6.3%) patient, which was successfully treated by stenting. No other complications were observed. The wire-cutting technique may be considered as a simple and effective approach for facilitating balloon crossing resistant CTO lesions.

Diagnostische Wertigkeit der kontrastverstärkten MSCT-Koronarangiografie bei Patienten mit hochgradiger Koronarverkalkung im klinischen Alltag

Our aim was to evaluate the diagnostic accuracy of contrast-enhanced 64-MSCT coronary angiography (MSCT-CA) in patients with severe coronary calcification. 110 patients with an Agatston score > 400 were included in this retrospective analysis. Each patient underwent both conventional coronary angiography and MSCT-CA. No patient was excluded from the study because of coronary artery bypass grafting or coronary stenting. The results of MSCT-CA were compared with those of conventional coronary angiography and the diagnostic accuracy for detecting a hemodynamically significant stenosis was determined for coronary segments, vessels and patients. The average Agatston score for the study population was 1368 ± 1105. At least one significant stenosis was detected in 97 patients (88%) during conventional coronary angiography defining the gold standard. The sensitivity, specificity, positive and negative predictive values of MSCT-CA for detecting a significant stenosis were 54%, 83%, 52% and 85% for coronary segments (n = 1384), 80%, 70%, 74% and 77% for coronary vessels (n = 440), and 100%, 31%, 92% and 100% for patients (n = 110), respectively. No significant correlation could be observed between the degree of coronary calcification and the number of misclassified coronary segments. Artifacts caused by severe coronary calcification decrease the diagnostic accuracy of MSCT-CA. Performing MSCT-CA in patients with an Agatston score > 400 with the drawbacks of contrast media application and radiation exposure should be critically questioned and this decision should be made on an individual basis.

Unrequested information from routine diagnostic chest CT predicts future cardiovascular events

ObjectivesAn increase in the number of CT investigations will likely result in a an increase in unrequested information. Clinical relevance of these findings is unknown. This is the first follow-up study to investigate the prognostic relevance of subclinical coronary (CAC) and aortic calcification (TAC) as contained in routine diagnostic chest CT in a clinical care population.MethodsThe follow-up of 10,410 subjects (>40 years) from a multicentre, clinical care-based cohort of patients included 240 fatal to 275 non-fatal cardiovascular disease (CVD) events (mean follow-up 17.8 months). Patients with a history of CVD were excluded. Coronary (0–12) and aortic calcification (0–8) were semi-quantitatively scored. We used Cox proportional-hazard models to compute hazard ratios to predict CVD events.ResultsCAC and TAC were significantly and independently predictive of CVD events. Compared with subjects with no calcium, the adjusted risk of a CVD event was 3.7 times higher (95% CI, 2.7–5.2) among patients with severe coronary calcification (CAC score ≥6) and 2.7 times higher (95% CI, 2.0–3.7) among patients with severe aortic calcification (TAC score ≥5).ConclusionsSubclinical vascular calcification on CT is a strong predictor of incident CVD events in a routine clinical care population.

Systemic sclerosis is an independent risk factor for increased coronary artery calcium deposition

Endothelial dysfunction and inflammation are pathogenic mechanisms common to systemic sclerosis (SSc) and atherosclerosis. This study was undertaken to examine the relationship between coronary atherosclerosis, as assessed by the coronary artery calcium score (CACS), and conventional cardiovascular and disease-specific risk factors in SSc patients. The CACS was measured by computed tomography, and cardiovascular risk factors were examined in SSc patients and compared with controls matched for age, sex, and glycemic status. Disease activity score, antiphospholipid antibodies, high-sensitivity C-reactive protein level, and erythrocyte sedimentation rate were measured in SSc patients. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined. We recruited 53 SSc patients (50 women and 3 men) and 106 controls. The patients had a mean ± SD age of 53.1 ± 12.9 years and a median disease duration of 9 years. Compared to controls, SSc patients had significantly lower low-density lipoprotein (LDL) cholesterol levels (P = 0.001), high-density lipoprotein cholesterol levels (P = 0.01), diastolic blood pressure, waist circumference, and body mass index and were more likely to be receiving vasodilators (all P < 0.001). There was a significantly higher proportion of SSc patients among subjects with more severe coronary calcification (CACS ≥ 101) compared to those with lesser severity (CACS <100) (56.5% versus 29.4%; P = 0.01). Multiple logistic regression analysis revealed SSc to be an independent determinant for a CACS ≥ 101 (OR 10.89 [95% CI 2.21-53.75], P = 0.003) together with age and LDL cholesterol level after adjustment for other cardiovascular risk factors. Among disease-specific factors, only disease duration (OR 1.14 [95% CI 1.02-1.27], P = 0.02) was independently associated with more severe coronary calcification (CACS ≥ 101). Our findings indicate that SSc is an independent risk factor for coronary calcification, in addition to the conventional risk factors for coronary atherosclerosis, such as age and hypertension.

Involvement of Lipoprotein(a) in calcification of coronary arteries and thoracic aorta as detected by X-ray computed tomography

The authors compared the severity of coronary calcification and thoracic aortic calcification as detected by x-ray computed tomography (X-ray CT) with Lipoprotein(a) [Lp(a)], and investigated whether Lp(a) is more important than total cholesterol (TC) or HDL-cholesterol (HDLC) as a risk factor for arteriosclerosis. Subjects were 64 patients (47 males, mean age 57.1±8.4 years) comprising 43 cases of ischemic heart disease, 9 cases of chest pain syndrome, 7 of valvular heart disease, and 5 of dilated cardiomyopathy. Fasted blood samples were collected early in the morning and values before medication were used. Lp(a) was measured by ELISA. Evaluation of coronary calcification by X-ray CT was performed in accordance with the procedure described in the authors' previous reports. Coronary calcification was assessed in all slices (slice thickness: 1 cm; scoring system: no coronary calcification, 0 points; coronary calcification less than 1 cm in length, 1 point; 1–2 cm, 2 points; over 2 cm, 3 points). The total score was used as coronary calcification score. For the aortic calcification score, the total number of aorta (slice thickness: 1 cm) with calcification from the superior margin of the aortic arch to the inferior cardiac margin was used. Mean scores of coronary and aortic calcification were 6.1±7.9 and 4.5±5.2 points, and Lp(a), TC, and HDLC, 23.7±23.3, 213±37, and 49.9±15.1 mg/dl, respectively. No correlation was seen between the scores of both coronary calcification and aortic calcification and any of the three lipid parameters, but for cases without coronary calcification, Lp(a) (10.6±8.5 mg/dl) was significantly lower (p<0.1) than that for cases with coronary calcification (1 vessel, 29.4±24.4; 2 vessels, 26.5±16.7; 3 vessels, 32.6±31.0 mg/dl).

Interaction between oxidative stress and high‐density lipoprotein cholesterol is associated with severity of coronary artery calcification in rheumatoid arthritis

To test the hypothesis that oxidative stress is increased in patients with rheumatoid arthritis (RA) due to increased inflammation and contributes to the pathogenesis of atherosclerosis. The independent association between urinary F₂-isoprostane excretion, a measure of oxidative stress, and RA was tested using multiple linear regression models in 169 patients with RA and 92 control subjects, frequency matched for age, race, and sex. The relationship between F₂-isoprostane excretion and coronary calcium, a marker of atherosclerosis, was examined in multivariable proportional odds logistic regression models that also assessed the interactions between oxidative stress and low-density lipoprotein and high-density lipoprotein (HDL) cholesterol. F₂-isoprostane excretion was significantly higher in patients with RA (median 2.75 [interquartile range (IQR) 1.60-4.06] ng/mg creatinine) than in control subjects (median 1.86 [IQR 1.25-2.62] ng/mg creatinine; adjusted P = 0.006). In patients with RA, F₂-isoprostanes were positively correlated with body mass index (P < 0.001), but not with disease activity or mediators of inflammation such as the Disease Activity Score in 28 joints or serum tumor necrosis factor α, interleukin-6, and C-reactive protein concentrations in adjusted multivariable models (P > 0.05 for all). In patients with RA, F₂-isoprostanes significantly modified the effect of HDL cholesterol on coronary calcification (P = 0.02 for interaction) after adjustment for age, sex, and race. As F₂-isoprostane levels increased, HDL lost its protective effect against coronary calcification. Oxidative stress measured as F₂-isoprostane excretion was higher in patients with RA than in control subjects. Among patients with RA, higher F₂-isoprostane excretion and HDL cholesterol concentrations interacted significantly and were positively associated with the severity of coronary calcification.

Clinical significance of myocardial stress perfusion scintigraphy in patients with non-assessable severe coronary calcification by coronary CT angiography

Clinical significance of myocardial stress perfusion scintigraphy in patients with non-assessable severe coronary calcification by coronary CT angiography

Pseudoxanthoma elasticum and familial hypercholesterolemia: A deleterious combination of cardiovascular risk factors

Background and objectivePseudoxanthoma Elasticum (PXE), an autosomal recessive disease due to mutations in ABCC6 gene, is characterised by fragmentation of elastic fibres with involvement of the cardiovascular system. We investigated a 60-year-old female with angina pectoris found to have PXE, associated with elevated plasma LDL-C suspected to be due to autosomal-co-dominant hypercholesterolemia. MethodsABCC6, LDLR, PCSK9 and exon 26 of APOB genes were re-sequenced. Cardiovascular involvement was assessed by coronary angiography, single-photon emission computed tomography (SPECT) and ultrasound examination. Results and conclusionsThe patient was a compound heterozygous for two ABCC6 mutations (p.S317R and p.R1141X) and heterozygous for a novel LDLR mutation (p.R574H). She had severe coronary stenosis and calcification of the arteries of the lower limbs. Treatment with ezetimibe/simvastatin 10/60mg/day, maintained over a 4.5-year period, reduced of LDL-C and the myocardial ischemic area. In PXE patients LDL-lowering treatment might contribute to delay macrovascular complications.

Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis

Rheumatoid arthritis (RA) is an inflammatory disease associated with premature atherosclerosis. We hypothesized that mediators of inflammation associated with atherosclerosis in other populations (interleukin-6 [IL-6], tumor necrosis factor alpha [TNFalpha], serum amyloid A [SAA], vascular endothelial growth factor, neutrophil count, IL-1alpha, E-selectin, intercellular adhesion molecule 1 [ICAM-1], myeloperoxidase [MPO], matrix metalloproteinase 9, and vascular cell adhesion molecule 1) would be increased and associated with the severity of coronary atherosclerosis in patients with RA. Clinical variables, concentrations of inflammatory mediators, and coronary artery calcification were measured in 169 patients with RA and 92 control subjects. Differences in concentrations of inflammatory mediators were compared using median quantile regression. The relationship of inflammatory mediators with the severity of coronary calcification in RA and control subjects was examined using proportional odds logistic regression, allowing for interaction with disease status. Models were adjusted for traditional cardiovascular risk factors. Median serum concentrations of IL-6, SAA, ICAM-1, E-selectin, TNFalpha, and MPO and peripheral blood neutrophil count were higher in patients with RA than controls (all P < 0.05), independent of Framingham risk score and diabetes mellitus (DM). IL-6 (main effect odds ratio [OR] 1.72; 95% confidence interval [95% CI] 1.12, 2.66) and TNFalpha (main effect OR 1.49; 95% CI 1.16, 1.90) concentrations were significantly associated with higher amounts of coronary calcium, independent of Framingham risk score and DM, and such main effects significantly differed from controls (P = 0.001 and 0.03 for interaction, respectively). TNFalpha and IL-6 are significantly associated with the severity of subclinical atherosclerosis, independent of Framingham risk score, in RA.