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Aggressive and diffuse coronary calcification in South Asian angina patients compared to Caucasians with similar risk factors
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
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2013 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 167, no 6, 2472-2476 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Ethnic differences in prevalence and severity of coronary artery disease are well established and are usually attributed to risk factors variation. This study investigates the differences in coronary artery narrowing and coronary calcification between two age- and gender-matched cohorts of South Asian and Caucasian symptomatic angina patients.

METHODS: We identified 101 symptomatic angina patients of South Asian origin who had undergone CT angiography and calcium scoring, and compared them with 101 age and gender matched Caucasian patients.

RESULTS: South Asians had a greater mean number of arterial segments with both obstructive and non-obstructive plaque than Caucasians (p=0.006 and p=0.0003, respectively) and higher prevalence of triple-vessel disease (p=0.0004). Similarly, South Asians had a higher mean CAC score (p<0.0001) and the percentage of South Asians with CAC>0 and in all categories of CAC score 100-1000 were also higher, as was the number of arterial segments with calcified and non-calcified plaque. These results were more marked in patients aged >50 but in those ≤50, Caucasians showed a higher mean number of diseased segments (p=0.019), with non-obstructive plaque (p=0.02), possibly suggesting that Caucasians are likely to have more diffuse atherosclerosis at an earlier age. CAC prevalence and severity in this age-group were not significantly different between South Asians and Caucasians.

CONCLUSION: Despite similar conventional risk factors for CAD, symptomatic South Asians seem to have more aggressive and diffuse arterial calcification compared to Caucasians. These differences are more profound above the age of 50, suggesting potential genetic or other risk factors yet to be determined.

Place, publisher, year, edition, pages
Elsevier, 2013. Vol. 167, no 6, 2472-2476 p.
Keyword [en]
South Asians, Coronary artery calcification, Coronary CT scanning, Atherosclerosis risk factors
National Category
Cardiac and Cardiovascular Systems
Identifiers
URN: urn:nbn:se:umu:diva-65092DOI: 10.1016/j.ijcard.2012.05.102ISI: 000324478400030PubMedID: 22704877OAI: oai:DiVA.org:umu-65092DiVA: diva2:603334
Available from: 2013-02-05 Created: 2013-02-05 Last updated: 2017-12-06Bibliographically approved
In thesis
1. Investigation of the origin of the coronary artery calcification process and its relationship to the atherosclerotic cardiovascular disease
Open this publication in new window or tab >>Investigation of the origin of the coronary artery calcification process and its relationship to the atherosclerotic cardiovascular disease
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The objectives of this thesis are: a) To examine racial/ethnic differences in coronary artery calcification (CAC) and CAD, between symptomatic South Asians and Caucasians, matched for age, gender and conventional cardiovascular risk factors, b) To assess, using a meta-analysis model, the natural history of and stability of measurements of coronary artery calcium scoring (CACs) based on data collected from two large published trials: St Francis and EBEAT, c) To investigate the prevalence of coronary artery calcification in individuals with CT evidence for AVC, mitral valve calcification (MAC) or of both of them (AVC+MAC), d) To assess any potential association between premature CAD (<55 years in first-degree male relatives and <65 years in first-degree female relatives) and CAC in a large cohort of asymptomatic individuals.

We found that coronary artery calcification is more extensive and diffuse in symptomatic patients of South Asian ethnic origin as compared to Caucasians, despite similar conventional risk factors for CAD. This is more evident in those >50 years of age, suggesting potential genetic or other risk factors yet to be determined. The natural history of coronary artery calcification was overtime progression in the majority of subjects, irrespective of gender. The higher variability in RCA measurements could be related to the low baseline CACs or exaggerated movement of the right side atrioventricular ring, whereas those for LCA brances are influenced by the branch allocation of the CACs. Valve calcification is not isolated but involve also and the coronary arteries. The presence of calcification in the aortic valve or combined aortic and mitral valves predicted coronary artery calcification. Additionally patients in whom both valves have become calcified tend to have severe coronary artery calcification. And finally, there is no relationship between the prevalence and extent of coronary artery calcification and the presence of family history of coronary heart disease in asymptomatic individuals with none of the conventional risk factors for atherosclerosis.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2013. 90 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1619
Keyword
Coronary artery calcification, ethnicity, South Asians, Caucasians, reproducibility, aortic valve calcification, mitral valve calcification, family history of coronary artery disease, natural history, coronary artery calcium score, meta-analysis
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-83450 (URN)978-91-7459-774-5 (ISBN)
Public defence
2013-12-17, Sal D, unod T9, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2013-11-26 Created: 2013-11-26 Last updated: 2013-11-27Bibliographically approved

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Koulaouzidis, GeorgeNicoll, RachelCharisopoulou, DafniHenein, Michael Y

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