Coronary Artery Calcification: Current Concepts and Clinical Implications

Abstract

Coronary artery calcification (CAC) accompanies the development of advanced atherosclerosis. Its role in atherosclerosis holds great interest because the presence and burden of coronary calcification provide direct evidence of the presence and extent of coronary artery disease; furthermore, CAC predicts future events independently of concomitant conventional cardiovascular risk factors and to a greater extent than any other noninvasive biomarker of this disease. Nevertheless, the relationship between CAC and the susceptibility of a plaque to provoke a thrombotic event remains incompletely understood. This review summarizes the current understanding and literature on CAC. It outlines the pathophysiology of CAC and reviews laboratory, histopathological, and genetic studies, as well as imaging findings, to characterize different types of calcification and to elucidate their implications. Some patterns of calcification such as microcalcification portend increased risk of rupture and cardiovascular events and may improve prognosis assessment noninvasively. However, contemporary computed tomography cannot assess early microcalcification. Limited spatial resolution and blooming artifacts may hinder estimation of degree of coronary artery stenosis. Technical advances such as photon counting detectors and combination with nuclear approaches (eg, NaF imaging) promise to improve the performance of cardiac computed tomography. These innovations may speed achieving the ultimate goal of providing noninvasively specific and clinically actionable information.

The role of uromodulin in cardiovascular disease: a review

“…Atherosclerosis forms the pathogenetic basis of CHD, characterized by endothelial injury, inflammation, and endothelial cell apoptosis ( 104 ). Coronary artery calcification (CAC) typically accompanies advanced atherosclerosis development and serves as a predictor of future cardiovascular events ( 105 ). Uromodulin has been shown to be an inhibitor of calcification in blood and urine, reducing the risk of calcification ( 25 , 106 ).…”

Osteopontin/SPP1: a potential mediator between immune cells and vascular calcification

“…Vascular diseases, particularly cardiovascular and brain diseases, are the leading causes of human disease mortality. Vascular calcification (VC) is considered a common pathological process in various vascular diseases, such as diabetes ( 1 ), atherosclerosis ( 2 , 3 ), vascular injury ( 4 , 5 ), chronic kidney disease (CKD) ( 6 ), liver fibrosis ( 7 ), and aging ( 8 ), and is closely associated with chronic calcium-phosphate deposition in blood vessels ( 9 , 10 ). Intimal calcification and medial calcification are two types of VC; the former is closely related to the infiltration of inflammatory cells, vascular inflammation, lipid deposits, hyperlipidemia, and hypertension, and the latter is associated with aging, diabetes, CKD, and arterial stiffness ( 11 , 12 ).…”

Exploring the mediating role of calcium homeostasis in the association between diabetes mellitus, glycemic traits, and vascular and valvular calcifications: a comprehensive Mendelian randomization analysis

“…Although epidemiological studies have revealed potential associations between these calcifications and metabolic disorders such as DM and altered glycemic traits, the underlying mechanisms driving this association remain complex, multifaceted, and inadequately understood [ 9 , 10 ]. Additionally, retrospective and prospective analyses have revealed that obesity, smoking, and hypertension are also associated with an increased risk of vascular and valvular calcifications [ 5 , 9 ].…”