Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study
Introduction
Coronary artery calcification (CAC) is an independent predictor of cardiovascular (CV) events and all-cause mortality in both CV and renal patients1., 2. and is known as ‘sub-clinical atherosclerosis’ in asymptomatic individuals.3 Severe CAC can cause hardening of the arteries (arteriosclerosis), which may result in exertional angina even in the absence of significant flow limiting lesions.4 The conventional CV risk factors (hypertension, diabetes mellitus, dyslipidemia, family history of coronary artery disease (CAD), obesity and smoking), which have proved to be predictive of the estimated 10-year coronary event risk,5 may also predict CAC. We have previously investigated the risk factor correlates of CAC presence and shown them to be principally dyslipidemia and diabetes in males and diabetes and smoking in females.6 Although a few, such as Mayer et al.7 and Mitsutake et al.,8 have studied risk factors for CAC extent in symptomatic patients, their cohorts were relatively small. Using the 6309 symptomatic patients from the European Calcific Coronary Artery Disease (Euro-CCAD) study, an international platform established in 2009 in Umeå, Sweden, we intended to investigate correlates of CAC extent in a larger cohort and compare them with the correlates of CAC presence in the same cohort in a cross-sectional retrospective study.
Section snippets
Methods
Retrospective data were collected from seven heart centers in six countries on symptomatic patients with intermediate risk.9 Some data were collected from registries. Patients may have typical or atypical angina symptoms; data allowing classification of chest pain as typical angina, atypical angina or non-cardiac chest pain as defined by Diamond10 were not available although it was estimated that the majority had typical angina. Patients received a thorough clinical examination and assessment
Results
The overall Euro-CCAD cohort consists of data from 6309 symptomatic patients, among whom 600 (9.5%) had no risk factors, while among the 4177 patients with CAC, 7% had no risk factors. Table 1 describes the prevalence of individual risk factors categorized according to the CAC scores 0, 1–99, 100–399, 400–999 and ≥ 1000. Age and number of risk factors increased with the CAC score, as did the percentage of patients with HT, DL, and DM (p < 0.001 for all), while the percentage of patients with no
Summary of findings
Among 6309 symptomatic patients, 9.5% of the total and 7% of those with CAC had no risk factors. With the exception of smoking and family history of CAD, the prevalence of all risk factors increased with the CAC score, although the proportion of patients with no risk factors decreased. The number of risk factors increased fairly uniformly with the CAC score. In ordinal logistic regression, age, male sex, DM, HT, DL and smoking were associated with an increasing CAC score in the patient cohort
Conclusion
In this cohort of symptomatic patients with CAC, age, DM, HT, DL and number of risk factors correlated with an increasing CAC score in both sexes, with DM being the most important dichotomous risk factor in every quantile in both sexes. A small proportion of patients with CAC had no risk factors, while some of those with risk factors had zero CAC. These findings support the important role of CAC assessment in the management of symptomatic patients, particularly diabetics.
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We declare that none of the authors have any financial or any other conflict of interest.