Coronary artery calcification and changes in atheroma burden in response to established medical therapies.

Abstract

OBJECTIVES:

This study sought to determine the relationship between coronary calcification and plaque progression in response to established medical therapies.

BACKGROUND:

Coronary calcification correlates with the extent of atherosclerosis and predicts clinical outcome.

METHODS:

Atheroma volume was determined in serial intravascular ultrasound pullbacks in matched arterial segments of 776 patients with angiographic coronary artery disease. A calcium grade at baseline was assigned for each image (total 28,876) (0 = no calcium, 1 = calcium with acoustic shadowing <90 degrees and 2 = calcium with shadowing >90 degrees). Patients with a calcium index (average of calcium scores in a pullback) below versus above the median were compared with regard to plaque burden and progression.

RESULTS:

Patients with a high calcium index were older (59 vs. 54 years, p < 0.001), more likely to be male (80% vs. 68%, p < 0.001), and more likely to have a history of hypertension (71% vs. 64%, p = 0.03). These patients had a greater percentage atheroma volume (PAV) (45% vs. 34%, p < 0.001), total atheroma volume (TAV) (210 vs. 151 mm3, p < 0.001), and percentage of images with maximal plaque thickness >0.5 mm (93% vs. 72%, p < 0.001). The continuous rate of change in PAV (1.1 +/- 0.4% vs. 0.8 +/- 0.4%, p = 0.34) and TAV (1.7 +/- 2.1% vs. -0.1 +/- 2.2%, p = 0.37) was similar in patients with a lower and higher calcium index, respectively. A lower calcium index was associated with a higher rate of patients showing substantial change in atheroma burden (at least 5% change in PAV, 70% vs. 53%, p < 0.001).

CONCLUSIONS:

Calcific plaques are more resistant to undergoing changes in size in response to systemic interventions targeting atherosclerotic risk factors.

• Authors: Stephen J Nicholls, E Murat Tuzcu, Kathy Wolski, Ilke Sipahi, Paul Schoenhagen, Timothy Crowe, Samir R Kapadia, Stanley L Hazen, Steven E Nissen
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 49 Issue 2 Pg. 263-70 (Jan 16 2007) ISSN: 1558-3597 [Electronic] United States
• PMID: 17222740 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antihypertensive Agents
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Calcium

Topics

• Adult
• Aged
• Antihypertensive Agents (therapeutic use)
• Atherosclerosis (complications, drug therapy, pathology)
• Calcinosis (diagnostic imaging, drug therapy, etiology, pathology)
• Calcium (metabolism)
• Cohort Studies
• Coronary Artery Disease (complications, diagnostic imaging, drug therapy, pathology)
• Coronary Circulation (drug effects)
• Drug Therapy, Combination
• Female
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Male
• Middle Aged
• Probability
• Prognosis
• Retrospective Studies
• Risk Assessment
• Statistics, Nonparametric
• Treatment Outcome
• Ultrasonography, Interventional
• Vascular Patency (drug effects)