The Addition of Vascular Calcification Scores to Traditional Risk Factors Improves Cardiovascular Risk Assessment in Patients with Chronic Kidney Disease

Abstract

BackgroundAlthough a variety of non-invasive methods for measuring cardiovascular (CV) risk (such as carotid intima media thickness, pulse wave velocity (PWV), coronary artery and aortic calcification scores (measured either by CT scan or X-ray) and the ankle brachial index (ABI)) have been evaluated separately in chronic kidney disease (CKD) cohorts, few studies have evaluated these methods simultaneously. Here, we looked at whether the addition of non-invasive methods to traditional risk factors (TRFs) improves prediction of the CV risk in patients at different CKD stages.MethodsWe performed a prospective, observational study of the relationship between the outputs of non-invasive measurement methods on one hand and mortality and CV outcomes in 143 patients at different CKD stages on the other. During the follow-up period, 44 patients died and 30 CV events were recorded. We used Cox models to calculate the relative risk for outcomes. To assess the putative clinical value of each method, we also determined the categorical net reclassification improvement (NRI) and the integrated discrimination improvement.ResultsVascular calcification, PWV and ABI predicted all-cause mortality and CV events in univariate analyses. However, after adjustment for TRFs, only aortic and coronary artery calcification scores were found to be significant, independent variables. Moreover, the addition of coronary artery calcification scores to TRFs improved the specificity of prediction by 20%.ConclusionThe addition of vascular calcification scores (especially the coronary artery calcification score) to TRFs appears to improve CV risk assessment in a CKD population.

Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients

“…Data are expressed as medians (interquartile ranges) or number (percentages) or as mean ± SD risk factors, our data showed that high CAC scores remained strongly associated with CIN. Moreover, recent studies reported that the addition of vascular calcification scores to traditional cardiovascular risk factors increased the predictive abilities for all-cause and cardiovascular outcomes in CKD populations [21,22]. In the present study, we demonstrated that clear relationships with the finding that the model with both CAC scores and MRS could more accurately predict CIN incidence with an increased C-index.…”

Epidemiology and Mechanisms of Uremia-Related Cardiovascular Disease

“…200,201 Data from a post hoc analysis of 8 studies evaluating individuals in the general population receiving high-intensity statin therapy have recently suggested that statins may actually increase vascular calcification and in so doing may stabilize otherwise unstable plaques. 202 Statins have not been conclusively shown to reduce CVD events in patients with ESRD; however, medial rather than intimal calcification predominates in patients with kidney disease.…”

Higher coronary artery calcification score is associated with adverse prognosis in patients with stable angina pectoris

“…High serum phosphorus levels can promote the transformation of vascular smooth muscle cells into osteoblasts to increase bone calcium mobilization. Consequently, intercellular and intracellular calcium concentrations are increased, resulting in calcium phosphorus deposition in the atherosclerotic plaque and arterial muscle layer, which promotes CAC (15). Moreover, coronary angiography results from 32 patients showed that the rate of multi-vessel disease directly correlated with the CAC score, whereas single-vessel disease did not correlate with the CAC score.…”