nach oben

The International Journal of Cardiovascular Imaging

Erschienen in:

06.03.2019 | Original Paper

Predictive value of coronary calcifications for future cardiac events in asymptomatic patients: underestimation of risk in asymptomatic smokers

verfasst von: Gregor S. Zimmermann, Tobias Rüther, Franz v. Ziegler, Martin Greif, Christoph Becker, Alexander Becker

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 7/2019

Einloggen, um Zugang zu erhalten

Abstract

Coronary calcification (CAC) is an established marker for coronary atherosclerosis and has a highly specific predictive value for cardiovascular events. This study aimed to determine the predictive value in the specific group of asymptomatic smokers in comparison to non-smokers. We included 1432 asymptomatic individuals (575 women, 857 men, age 59.2 ± 7.7 years.) in this study. Coronary calcification was calculated by multi-slice computed tomography following a standardized protocol including calcium score (CS). Coronary risk factors were determined at inclusion. After mean observation time of 76.3 ± 8.5 months the patients were contacted and evaluated for cardiovascular events (myocardial infarction, cardiac death and revascularisation). Mean CS was 231 ± 175 in smokers and 239 ± 188 in non-smokers. Cardiovascular events were found in 14.9% of our patients and there were significantly more events in smokers (119 events, 8.3%) than in non-smokers (94 events, 6.6%, p = 0.001). CS > 400 showed a hazard ratio for future cardiac events of 5.1 (95% CI 4.3–7.6) in smokers and 4.4 (95% CI 3.4–6.2) in non-smokers, p = 0.01. Also in smokers determination of CAC is a valuable predictor of future cardiovascular events. In our study smokers showed throughout all score groups a significantly higher risk compared to non-smokers with equal CS. Therefore, CS may underestimate the risk for future cardiac events in smokers compared to non-smokers.

Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jimenez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P, American Heart Association Statistics C, Stroke Statistics S (2017) Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 135(10):e146–e603. https://doi.org/10.1161/CIR.0000000000000485 CrossRefPubMedPubMedCentral

Becker A, Leber A, Becker C, Knez A (2008) Predictive value of coronary calcifications for future cardiac events in asymptomatic individuals. Am Heart J 155(1):154–160. https://doi.org/10.1016/j.ahj.2007.08.024 CrossRefPubMed

Achenbach S, Nomayo A, Couturier G, Ropers D, Pohle K, Schlundt C, Schmermund A, Matarazzo TJ, Hoffmann U, Daniel WG, Killip T (2003) Relation between coronary calcium and 10-year risk scores in primary prevention patients. Am J Cardiol 92(12):1471–1475CrossRefPubMed

Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92(8):2157–2162CrossRefPubMed

Schmermund A, Baumgart D, Adamzik M, Ge J, Gronemeyer D, Seibel R, Sehnert C, Gorge G, Haude M, Erbel R (1998) Comparison of electron-beam computed tomography and intracoronary ultrasound in detecting calcified and noncalcified plaques in patients with acute coronary syndromes and no or minimal to moderate angiographic coronary artery disease. Am J Cardiol 81(2):141–146CrossRefPubMed

Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, Kondos G, Kronmal RA (2009) Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 53(4):345–352. https://doi.org/10.1016/j.jacc.2008.07.072 CrossRefPubMedPubMedCentral

von Ziegler F, Greif M, Tittus J, Schenzle J, Becker C, Becker A (2014) Distribution of coronary calcifications in patients with suspected coronary heart disease. Am Heart J 167(4):568–575. https://doi.org/10.1016/j.ahj.2013.12.011 CrossRef

Messner B, Bernhard D (2014) Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol 34(3):509–515. https://doi.org/10.1161/ATVBAHA.113.300156 CrossRefPubMed

Lavi S, Prasad A, Yang EH, Mathew V, Simari RD, Rihal CS, Lerman LO, Lerman A (2007) Smoking is associated with epicardial coronary endothelial dysfunction and elevated white blood cell count in patients with chest pain and early coronary artery disease. Circulation 115(20):2621–2627. https://doi.org/10.1161/CIRCULATIONAHA.106.641654 CrossRefPubMed

10.

Nordskog BK, Blixt AD, Morgan WT, Fields WR, Hellmann GM (2003) Matrix-degrading and pro-inflammatory changes in human vascular endothelial cells exposed to cigarette smoke condensate. Cardiovasc Toxicol 3(2):101–117CrossRef

11.

Bauer M, Fink B, Thurmann L, Eszlinger M, Herberth G, Lehmann I (2015) Tobacco smoking differently influences cell types of the innate and adaptive immune system-indications from CpG site methylation. Clin Epigenetics 7:83. https://doi.org/10.1186/s13148-016-0249-7 CrossRefPubMed

12.

Expert Panel on Detection E, Adults ToHBCi (2001) Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). JAMA 285 (19):2486–2497. https://doi.org/10.1001/jama.285.19.2486 CrossRef

13.

Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832CrossRefPubMed

14.

Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG (2005) Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol 46(5):807–814. https://doi.org/10.1016/j.jacc.2005.05.049 CrossRefPubMed

15.

Shemesh J, Henschke CI, Shaham D, Yip R, Farooqi AO, Cham MD, McCauley DI, Chen M, Smith JP, Libby DM, Pasmantier MW, Yankelevitz DF (2010) Ordinal scoring of coronary artery calcifications on low-dose CT scans of the chest is predictive of death from cardiovascular disease. Radiology 257(2):541–548. https://doi.org/10.1148/radiol.10100383 CrossRefPubMed

16.

Raggi P, Gongora MC, Gopal A, Callister TQ, Budoff M, Shaw LJ (2008) Coronary artery calcium to predict all-cause mortality in elderly men and women. J Am Coll Cardiol 52(1):17–23. https://doi.org/10.1016/j.jacc.2008.04.004 CrossRefPubMed

17.

Leber AW, von Ziegler F, Becker A, Becker CR, Reiser M, Steinbeck G, Knez A, Boekstegers P (2008) Characteristics of coronary plaques before angiographic progression determined by multi-slice CT. Int J Cardiovasc Imaging 24(4):423–428. https://doi.org/10.1007/s10554-007-9278-9 CrossRefPubMed

18.

Silverman MG, Blaha MJ, Krumholz HM, Budoff MJ, Blankstein R, Sibley CT, Agatston A, Blumenthal RS, Nasir K (2014) Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the Multi-Ethnic Study of Atherosclerosis. Eur Heart J 35(33):2232–2241. https://doi.org/10.1093/eurheartj/eht508 CrossRefPubMed

19.

Becker A, Leber AW, Becker C, von Ziegler F, Tittus J, Schroeder I, Steinbeck G, Knez A (2008) Predictive value of coronary calcifications for future cardiac events in asymptomatic patients with diabetes mellitus: a prospective study in 716 patients over 8 years. BMC Cardiovasc Disord 8:27. https://doi.org/10.1186/1471-2261-8-27 CrossRefPubMedPubMedCentral

20.

Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O’Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358(13):1336–1345. https://doi.org/10.1056/NEJMoa072100 CrossRef

21.

Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, Dardari Z, Sibley CT, Burke GL, Kronmal RA, Szklo M, Blumenthal RS, Nasir K (2016) Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 133(9):849–858. https://doi.org/10.1161/CIRCULATIONAHA.115.018524 CrossRefPubMedPubMedCentral

22.

Anand DV, Lim E, Hopkins D, Corder R, Shaw LJ, Sharp P, Lipkin D, Lahiri A (2006) Risk stratification in uncomplicated type 2 diabetes: prospective evaluation of the combined use of coronary artery calcium imaging and selective myocardial perfusion scintigraphy. Eur Heart J 27(6):713–721. https://doi.org/10.1093/eurheartj/ehi808 CrossRefPubMed

23.

Schmermund A, Erbel R, Silber S, Health MRSGMNIoC (2002) Age and gender distribution of coronary artery calcium measured by four-slice computed tomography in 2,030 persons with no symptoms of coronary artery disease. Am J Cardiol 90(2):168–173CrossRefPubMed

24.

Zagaceta J, Bastarrika G, Zulueta JJ, Colina I, Alcaide AB, Campo A, Divo M, Casanova C, Marin JM, Pinto-Plata VM, Celli BR, de -Torres JP (2017) Prospective comparison of non-invasive risk markers of major cardiovascular events in COPD patients. Respir Res 18(1):175. https://doi.org/10.1186/s12931-017-0658-y CrossRefPubMedPubMedCentral

25.

Williams MC, Murchison JT, Edwards LD, Agusti A, Bakke P, Calverley PM, Celli B, Coxson HO, Crim C, Lomas DA, Miller BE, Rennard S, Silverman EK, Tal-Singer R, Vestbo J, Wouters E, Yates JC, van Beek EJ, Newby DE, MacNee W, Evaluation of CLtIPSEi (2014) Coronary artery calcification is increased in patients with COPD and associated with increased morbidity and mortality. Thorax 69 (8):718–723. https://doi.org/10.1136/thoraxjnl-2012-203151 CrossRefPubMed

26.

McClelland RL, Jorgensen NW, Budoff M, Blaha MJ, Post WS, Kronmal RA, Bild DE, Shea S, Liu K, Watson KE, Folsom AR, Khera A, Ayers C, Mahabadi AA, Lehmann N, Jockel KH, Moebus S, Carr JJ, Erbel R, Burke GL (2015) 10-year coronary heart disease risk prediction using coronary artery calcium and traditional risk factors: derivation in the MESA (Multi-Ethnic Study of Atherosclerosis) with validation in the HNR (Heinz Nixdorf Recall) Study and the DHS (Dallas Heart Study). J Am Coll Cardiol 66(15):1643–1653. https://doi.org/10.1016/j.jacc.2015.08.035 CrossRefPubMedPubMedCentral

27.

United States. Public Health Service. Office of the Surgeon General (2010) How tobacco smoke causes disease: the biology and behavioral basis for smoking-attributable disease : a report of the Surgeon General. U.S. Dept. of Health and Human Services, Public Health Service For sale by the Supt. of Docs., U.S. G.P.O., Rockville, MD Washington, DC

Titel: Predictive value of coronary calcifications for future cardiac events in asymptomatic patients: underestimation of risk in asymptomatic smokers
verfasst von: Gregor S. Zimmermann
Tobias Rüther
Franz v. Ziegler
Martin Greif
Christoph Becker
Alexander Becker
Publikationsdatum: 06.03.2019
Verlag: Springer Netherlands
Erschienen in: The International Journal of Cardiovascular Imaging / Ausgabe 7/2019
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI: https://doi.org/10.1007/s10554-019-01571-3

Neu im Fachgebiet Kardiologie

19.04.2024 | Vorhofflimmern | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Predictive value of coronary calcifications for future cardiac events in asymptomatic patients: underestimation of risk in asymptomatic smokers

Abstract

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie

Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 7/2019

Association between age and progression of carotid artery atherosclerosis: a serial high resolution magnetic resonance imaging study

Left atrial volume index and left ventricular global longitudinal strain predict new-onset atrial fibrillation in patients with transient ischemic attack

Brief review: Pulmonary artery aneurysms and pseudoaneurysms

Cardiovascular imaging 2018 in the International Journal of Cardiovascular Imaging

Editor’s note February 2019

Predictive value of exercise stress echocardiography in asymptomatic patients with severe aortic regurgitation and preserved left ventricular systolic function without LV dilatation

Neu im Fachgebiet Kardiologie

Parodontalbehandlung verbessert Prognose bei Katheterablation

Antihypertensiva schützen auch alte Menschen noch vor Demenz

Sind Betablocker auch für ältere herzschwache Personen nützlich?

Stillende Frauen haben geringeres kardiovaskuläres Risiko

Update Kardiologie