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The natural history of coronary calcification: a meta-analysis from St Francis and EBEAT trials
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi. Umeå Heart Centre.
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.ORCID-id: 0000-0003-0081-1156
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
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2013 (Engelska)Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 168, nr 4, s. 3944-3948Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND AND AIM: Coronary artery calcium score (CACs) is an established quantitative tool for assessing subclinical atherosclerosis. The aim of this study was to assess in a meta-analysis model the natural history and reproducibility of CACs measurements obtained from St Francis and EBEAT trials.

METHODS: We analysed data from 649 individuals: 443 on placebo with 2year follow-up from St Francis trial (Study A) and 209 on 10mg atorvastatin with 1year follow-up of EBEAT trial (Study B). Total CACs and that in the left coronary artery (LCA) branches, left main stem (LMS), left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were analysed. In view of the wide CACs spectrum, data were logarithmically transformed before the analyses and mixed model analysis was used to evaluate the change of CACs over time.

RESULTS: The overall agreement between the two measurements was fairly good, showing a small but significant increase in CAC: 68% of the group as a whole presented an increase in CACs, 23% of the cohort had negligible change in CACs of <10% irrespective of the baseline CACs; and the remaining 10% showed a fall in CACs. Both studies showed similar patterns. The analysis of individual coronary arteries showed significantly higher variability of measurements in the RCA than in the LCA. Males had higher baseline CACs than females, but the rate of progression was not different between genders, irrespectively of age and baseline score.

CONCLUSION: The natural history of CACs 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 branches are influenced by the branch allocation of the CACs. Large changes to and from zero, might be related to technical limitations.

Ort, förlag, år, upplaga, sidor
Elsevier, 2013. Vol. 168, nr 4, s. 3944-3948
Nationell ämneskategori
Annan fysik Kardiologi
Forskningsämne
radiofysik
Identifikatorer
URN: urn:nbn:se:umu:diva-79929DOI: 10.1016/j.ijcard.2013.06.057ISI: 000326219600129PubMedID: 23870639OAI: oai:DiVA.org:umu-79929DiVA, id: diva2:645306
Tillgänglig från: 2013-09-04 Skapad: 2013-09-04 Senast uppdaterad: 2018-06-08Bibliografiskt granskad
Ingår i avhandling
1. Investigation of the origin of the coronary artery calcification process and its relationship to the atherosclerotic cardiovascular disease
Öppna denna publikation i ny flik eller fönster >>Investigation of the origin of the coronary artery calcification process and its relationship to the atherosclerotic cardiovascular disease
2013 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2013. s. 90
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1619
Nyckelord
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
Nationell ämneskategori
Kardiologi
Identifikatorer
urn:nbn:se:umu:diva-83450 (URN)978-91-7459-774-5 (ISBN)
Disputation
2013-12-17, Sal D, unod T9, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2013-11-26 Skapad: 2013-11-26 Senast uppdaterad: 2018-06-08Bibliografiskt granskad

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