Author + information
- Received January 13, 2012
- Revision received February 16, 2012
- Accepted March 6, 2012
- Published online May 1, 2012.
- Yu Kataoka, MD,
- Kathy Wolski, MPH,
- Kiyoko Uno, MD, PhD,
- Rishi Puri, MBBS,
- E. Murat Tuzcu, MD,
- Steven E. Nissen, MD and
- Stephen J. Nicholls, MBBS, PhD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Stephen J. Nicholls, Department of Cardiovascular Medicine, Heart & Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195
Objectives The purpose of this study was to determine atheroma progression in patients with spotty calcification.
Background Although extensively calcified atherosclerotic lesions have been proposed to be clinically quiescent, the presence of spotty calcification within plaque has been reported to be associated with an increased incidence of ischemic cardiovascular events. The relationship between spotty calcification and disease progression has not been investigated.
Methods A total of 1,347 stable patients with angiographic coronary artery disease underwent serial evaluation of atheroma burden with intravascular ultrasound imaging. Patients with spotty calcification were identified based on the presence of lesions (1 to 4 mm in length) containing an arc of calcification of <90°. Clinical characteristics and disease progression were compared between patients with spotty calcification (n = 922) and those with no calcification (n = 425).
Results Patients with spotty calcification were older (age 56 years vs. 54 years; p = 0.001), more likely to be male (68% vs. 54%; p = 0.01), and have a history of diabetes mellitus (30% vs. 24%; p = 0.01) and myocardial infarction (28% vs. 20%; p = 0.004), and have lower on-treatment high-density lipoprotein cholesterol levels (48 ± 16 mg/dl vs. 51 ± 17 mg/dl; p = 0.001). Patients with spotty calcification demonstrated a greater percent atheroma volume (PAV) (36.0 ± 7.6% vs. 29.0 ± 8.5%; p < 0.001) and total atheroma volume (174.6 ± 71.9 mm3 vs. 133.9 ± 64.9 mm3; p < 0.001). On serial evaluation, spotty calcification was associated with greater progression of PAV (+0.43 ± 0.07% vs. +0.02 ± 0.11%; p = 0.002). Although intensive low-density lipoprotein cholesterol and blood pressure lowering therapy slowed disease progression, these efficacies were attenuated in patients with spotty calcification.
Conclusions The presence of spotty calcification is associated with more extensive and diffuse coronary atherosclerosis and accelerated disease progression despite use of medical therapies.
Dr. Nissen has received research support to perform clinical trials through the Cleveland Clinic Coordinating Center for Clinical Research from Pfizer, AstraZeneca, Novartis, Roche, Daiichi-Sankyo, Takeda, Sanofi-Aventis, Resverlogix, and Eli Lilly; and is a consultant/advisor for many pharmaceutical companies but requires them to donate all honoraria or consulting fees directly to charity so that he receives neither income nor a tax deduction. Dr. Nicholls has received speaking honoraria from AstraZeneca, Pfizer, Merck Schering-Plough, and Takeda; consulting fees from AstraZeneca, Pfizer, Merck Schering-Plough, Takeda, Roche, Omthera, CSL Behring, Boehringer Ingelheim, NovoNordisk, LipoScience, and Anthera; and research support from AstraZeneca, Novartis, Resverlogix, Eli Lilly, Roche, Anthera, and Lipid Sciences. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 13, 2012.
- Revision received February 16, 2012.
- Accepted March 6, 2012.
- American College of Cardiology Foundation