Arterial Stiffness and Coronary Artery Calcification

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Coronary calcification is thought to represent primarily calcification of atheroma [2, 3]. Evidence of an association between arterial stiffness and coronary calcification has been mixed. Haydar et al. [20] have shown that among 55 men and women with ESRD, cfPWV was positively associated with coronary calcification after adjusting for age, sex, duration of dialysis, CRP, and diastolic BP.

In contrast, Megnien et al. [21] concluded that aortic stiffening (cfPWV) was not associated with coronary or extracoronary atherosclerosis among 190

asymptomatic high-risk men aged 29-62. However, the sample size (n = 190 men) was relatively small, and is a subset of 4,190 subjects who were selected for further evaluation from 16,000 screenees because they had at least one cardiovascular risk factor. Their tables show an increase in cfPWV (unadjusted) across coronary calcium categories (0, 1-9, 10-99) until the highest category (>100), in which it decreases precipitously. The same pattern was observed across increasing number of sites with any plaque. Since people with fatal or non-fatal CVD events were excluded from the study, it is possible that these results may also reflect a survivor bias, in which men who had both high arterial stiffness and high levels of calcified plaque were unrepresented in the study sample.

Finally, two larger studies (reported as abstracts) have reported strong associations between coronary calcification and cfPWV. First, in a study of 484 older adults (aged 70-96) from the Cardiovascular Health Study, the association between aortic stiffness (cfPWV) and both coronary and aortic calcification was evaluated. Among the older women (mean age 79 years), higher aortic stiffness was associated with higher quartiles of both coronary and aortic calcification after adjustment for age and mean arterial pressure [22], The absence of an association among these older men may also be due to a survival bias. Second, in a cross-sectional analysis of 477 overweight postmenopausal women (aged 52-62) with no history of coronary heart disease, the prevalence of any coronary calcium was higher among those with higher levels of arterial stiffness (cfPWV) [23]. A 1-SD increase in cfPWV was associated with a 38% increase in odds of coronary calcification. These associations remained significant after adjusting for age, systolic BP, heart rate, waist circumference, weight, fasting glucose and smoking status.

In summary, the few studies which have evaluated the relationship between arterial stiffness and coronary calcification have had mixed results, but the larger studies have shown a positive association between aortic stiffness (as indexed by cfPWV) and coronary calcification. Assuming that coronary calcification represents calcified plaque, an association between coronary calcification and arterial stiffness is supported by evidence that arterial stiffness (cf-PWV) is associated with other measures of atheroma such as intravascular ultrasound-detected coronary plaque volume [24]. In an interesting longitudinal study of304 elderly Japanese men and women, Sawabe et al. [25] found that repeat PWV measures correlated with the overall atherosclerotic burden at autopsy across eight sites of the large arteries. Several studies have also reported that arterial stiffness is associated with thicker carotid IMT, but because IMT may be a marker of both atherosclerosis and arterial remodeling, we have not discussed them here.

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