CT-Detected Growth of Coronary Artery Calcification in Asymptomatic Middle-Aged Subjects and Association With 15 Biomarkers

• Published in: JACC. Cardiovascular imaging Vol. 10; no. 8; pp. 858 - 866
• Main Authors: Diederichsen, Søren Zöga, Grønhøj, Mette Hjortdal, Mickley, Hans, Gerke, Oke, Steffensen, Flemming Hald, Lambrechtsen, Jess, Rønnow Sand, Niels Peter, Rasmussen, Lars Melholt, Olsen, Michael Hecht, Diederichsen, Axel
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Asymptomatic Diseases; biomarkers; Biomarkers - blood; Bone Remodeling; Chi-Square Distribution; Computed Tomography Angiography; Coronary Angiography - methods; coronary artery calcification; Coronary Artery Disease - blood; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Denmark - epidemiology; Disease Progression; Female; Humans; imaging; Incidence; Inflammation Mediators - blood; Kidney - metabolism; Kidney - physiopathology; Linear Models; Lipids - blood; Logistic Models; Male; Middle Aged; Multivariate Analysis; Myocardium - metabolism; Myocardium - pathology; Necrosis; Odds Ratio; Phosphates - blood; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Factors; Time Factors; Vascular Calcification - blood; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; X-ray computed tomography; CRP; CPP; cTnI; CAC; PTH; biomarkers; OPG; coronary artery calcification; imaging; CT; HDL; CV; X-ray computed tomography; LDL; suPAR; CHD
• ISSN: 1936-878X; 1876-7591; 1876-7591
• DOI: 10.1016/j.jcmg.2017.05.010

This study sought to determine the incidence and progression of coronary artery calcification (CAC) in asymptomatic middle-aged subjects and to evaluate the value of a broad panel of biomarkers in the prediction of CAC growth. CAC continues to be a major risk factor, but the value of biochemical markers in predicting CAC incidence and progression remains unresolved. At baseline, 1,227 men and women underwent traditional risk assessment and a computed tomography (CT) scan to determine the CAC score. Biomarkers of calcium-phosphate metabolism (calcium, phosphate, vitamin D3, parathyroid hormone, osteoprotegerin), lipid metabolism (triglyceride, high- and low-density lipoprotein, total cholesterol), inflammation (C-reactive protein, soluble urokinase-type plasminogen activator receptor), kidney function (creatinine, cystatin C, urate), and myocardial necrosis (cardiac troponin I) were analyzed. A second CT scan was scheduled after 5 years. General linear models were performed to examine the association between biomarkers and ΔCAC score, and additionally, sensitivity analyses were performed in terms of binary and ordinal logistic regressions. A total of 1,006 participants underwent a CT scan after 5 years. Among the 562 participants with a baseline CAC score of 0, 189 (34%) had incident CAC, whereas 214 (48%) of the 444 participants with baseline CAC score >0 had significant progression (>15% annual increase in CAC score). In the multivariate models (n = 1,006), age, sex, hypertension, diabetes, dyslipidemia, and smoking were associated with ΔCAC, whereas the strongest predictor was baseline CAC score. Low-density lipoprotein and total cholesterol levels were independently associated with CAC incidence (n = 562; incidence rate ratio [IRR]: 1.47; 95% confidence interval [CI]: 1.05 to 2.05; and IRR: 1.34; 95% CI: 1.01 to 1.77, respectively), whereas phosphate level was associated with CAC progression (n = 444; IRR: 3.60; 95% CI: 1.42 to 9.11). In this prospective study, a large part of participants had incident CAC or progression of prevalent CAC at 5 years of follow-up. Low-density lipoprotein and total cholesterol were associated with CAC incidence and phosphate with CAC progression, whereas 12 other biomarkers had little value. [Display omitted]