Meer R, Oughzou I, Hoek A G, Dal Canto E, Blom M T, Doesburg T, de Jong P A, Elders P J M, Beulens J W J
Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands.
Department of Epidemiology & Data Science, Amsterdam UMC, Amsterdam, the Netherlands.
J Cardiovasc Comput Tomogr. 2025 Jul-Aug;19(4):444-452. doi: 10.1016/j.jcct.2025.04.005. Epub 2025 Apr 29.
Animal studies suggest that medial arterial calcification (MAC) increases arterial stiffness, which in turn could lead to cardiovascular disease (CVD), but human studies are lacking. We evaluated the associations of peripheral arterial calcification pattern and quantity with arterial stiffness in individuals with type 2 diabetes mellitus (T2DM).
Cross-sectional data was used of 774 individuals (64 % men, 67 [63-71] years) with T2DM who underwent carotid-femoral pulse wave velocity measurements (cfPWV) and CT-scans of the lower-extremities. Femoral and crural dominant arterial calcification patterns (MAC, intimal (IAC), absent/indistinguishable) were determined via a histologically-validated scoring algorithm. Calcification Agatston scores were categorized into zero (reference category) and tertiles>0. Multivariable-adjusted linear regression was used.
MAC and IAC were dominant in 38% and 24% of femoral arteries versus 29% and 15% of crural arteries, respectively. Femoral and crural MAC were associated with higher cfPWV (0.64 m/s [0.26-1.03]; 0.76 [0.37-1.14], respectively). Crural but not femoral IAC was associated with higher cfPWV (0.58 [0.10-1.06]; 0.25 [-0.20-0.69], respectively). Adjusted for calcification quantity, only crural MAC remained significantly associated with higher cfPWV. cfPWV was higher in individuals with MAC versus IAC, but not statistically significant (femoral p = 0.066; crural p = 0.490). Femoral and crural calcification scores in the highest tertile were associated with higher cfPWV (0.86 [0.34-1.39]; 0.78 [0.29-1.27], respectively).
Crural MAC was independently associated with increased arterial stiffness. Arterial stiffness was higher in MAC versus IAC. Crural and femoral arterial calcification quantity were associated with increased arterial stiffness. Peripheral arterial calcification, specifically MAC, may lead to CVD via increased arterial stiffness in T2DM.
动物研究表明，中膜动脉钙化（MAC）会增加动脉僵硬度，进而可能导致心血管疾病（CVD），但缺乏人体研究。我们评估了2型糖尿病（T2DM）患者外周动脉钙化模式和数量与动脉僵硬度之间的关联。
使用774例T2DM患者（64%为男性，年龄67[63 - 71]岁）的横断面数据，这些患者接受了颈股脉搏波速度测量（cfPWV）以及下肢CT扫描。通过组织学验证的评分算法确定股动脉和小腿动脉的主要钙化模式（MAC、内膜钙化（IAC）、无/难以区分）。钙化阿加斯顿评分分为零（参考类别）和>0的三分位数。采用多变量调整线性回归分析。
股动脉中MAC和IAC分别占主导的比例为38%和24%，而小腿动脉中分别为29%和15%。股动脉和小腿动脉的MAC均与较高的cfPWV相关（分别为0.64m/s[0.26 - 1.03]；0.76[0.37 - 1.14]）。小腿动脉而非股动脉的IAC与较高的cfPWV相关（分别为0.58[0.10 - 1.06]；0.25[-0.20 - 0.69]）。在调整钙化数量后，只有小腿动脉的MAC仍与较高的cfPWV显著相关。MAC患者的cfPWV高于IAC患者，但无统计学意义（股动脉p = 0.066；小腿动脉p = 0.490）。最高三分位数的股动脉和小腿动脉钙化评分与较高的cfPWV相关（分别为0.86[0.34 - 1.39]；0.78[0.29 - 1.27]）。
小腿动脉MAC与动脉僵硬度增加独立相关。MAC患者的动脉僵硬度高于IAC患者。小腿动脉和股动脉钙化数量与动脉僵硬度增加相关。外周动脉钙化，特别是MAC，可能通过增加T2DM患者的动脉僵硬度导致CVD。
