Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Baltimore, Maryland.
Am J Cardiol. 2021 Oct 1;156:58-64. doi: 10.1016/j.amjcard.2021.06.035. Epub 2021 Jul 27.
The early stages of aortic valve calcification (AVC) and coronary artery calcification (CAC) include shared ASCVD risk factors, yet there is considerable heterogeneity between the burden of AVC, and CAC. We sought to identify the markers associated with limited CAC among persons with significant AVC. There were 325 participants from the Multi-Ethnic Study of Atherosclerosis without clinical ASCVD and with AVC ≥100 Agatston units (AU) at Visit 1. Multivariable-adjusted prevalence ratios for limited CAC (0 to 99 AU) were calculated using modified Poisson regression. Participants had a mean age of 72.1 years, median AVC score of 209, and 34% were women. A total of 133 (41%) participants had CAC <100, of whom 46/133 had CAC = 0. Younger age (PR = 1.40, 95% CI: 1.22 to 1.62, per 10-years), female gender (PR = 1.68, 95% CI: 1.28 to 2.20), and low 10-year ASCVD risk (PR = 2.30, 95% CI: 1.85 to 2.85) were most strongly associated with limited CAC. Neither a normal lipoprotein(a) nor normal measures of inflammation were significantly associated with limited CAC. Lower serum phosphate (PR = 1.15, 95% CI: 1.01 to 1.31; per 0.5 mg/dl lower) and calcium-phosphate product (PR = 1.16, 95% CI: 1.02 to 1.34; per SD lower) were associated with an approximately 15% higher prevalence of limited CAC. In conclusion, more than 40% of persons with significant AVC had CAC. Beyond traditional risk factors, lower serum phosphate, and lower calcium-phosphate product were associated with a higher prevalence of limited CAC.
主动脉瓣钙化 (AVC) 和冠状动脉钙化 (CAC) 的早期阶段包括共同的 ASCVD 危险因素，但 AVC 和 CAC 的负担之间存在相当大的异质性。我们试图确定与 AVC 严重程度患者中 CAC 有限相关的标志物。共有 325 名来自动脉粥样硬化多民族研究的参与者，他们在首次就诊时没有临床 ASCVD，且 AVC 大于等于 100 个 Agatston 单位 (AU)。使用修正泊松回归计算 CAC 有限 (0 至 99 AU) 的多变量调整患病率比。参与者的平均年龄为 72.1 岁，中位数 AVC 评分为 209，34%为女性。共有 133 名 (41%) 参与者的 CAC<100，其中 46/133 的 CAC=0。年龄较轻 (PR=1.40，95%CI：1.22 至 1.62，每增加 10 年)、女性 (PR=1.68，95%CI：1.28 至 2.20) 和低 10 年 ASCVD 风险 (PR=2.30，95%CI：1.85 至 2.85) 与 CAC 有限最密切相关。正常脂蛋白 (a) 或炎症的正常指标均与 CAC 有限无显著相关性。血清磷酸盐水平较低 (PR=1.15，95%CI：1.01 至 1.31；每降低 0.5mg/dl) 和钙磷乘积较低 (PR=1.16，95%CI：1.02 至 1.34；每降低一个标准差) 与 CAC 有限的患病率增加约 15%相关。总之，超过 40% 的 AVC 严重程度患者有 CAC。除了传统危险因素外，血清磷酸盐水平较低和钙磷乘积较低与 CAC 有限的患病率较高相关。
