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CAC level correlates with LV parameters in middle-aged patients
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Middle-aged patients with high measurements of coronary artery calcium had higher left ventricular volumes, higher LV mass and worse LV diastolic function than those with low measurements, according to a study published in Circulation: Cardiovascular Imaging.
Greater changes in CAC were independently related to higher LV mass in black patients, according to the study.
“We looked at early adulthood to middle age because this is a window in which we can see abnormalities that might not be causing symptoms but could later increase the risk of heart problems,” Henrique Turin Moreira, MD, PhD, attending physician at Hospital das Clínicas de Ribeirão Preto at the University of São Paulo, said in a press release. “Prevention and control of these abnormalities are key, so early identification of risks can be crucial.”
João A.C. Lima, MBA, MD, director of cardiovascular imaging and professor of medicine at Johns Hopkins University and a Cardiology Today Editorial Board Member, and colleagues analyzed data from 3,189 patients (mean age, 50 years; 57% women; 52% white) from the CARDIA study. These patients underwent both cardiac CT and echocardiography at 15-year follow-up, and 2,449 patients had their CAC score measured at 25-year follow-up.
High CAC scores were associated with higher LV end-diastolic volume (beta = 0.811; P = .007), higher LV mass (beta = 1.218; P = .007), higher left atrial volume index (beta = 0.214; P = .009), higher LV end-systolic volume (beta = 0.35; P = .048) and higher early filling to early diastolic mitral annular velocity ratio (beta = 0.059; P = .014) after traditional CV risk factors and demographics were added to the model.
Greater changes in CAC scores during follow-up were independently related to a higher LV mass index in black patients (beta = 4.789; P < .001). This was not seen in white patients (beta = 1.051; P = .283).
“Taken together, these findings suggest that strict cardiovascular risk factors control starting during young adulthood may result in better cardiovascular function at middle age, especially in black individuals,” Lima and colleagues wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.
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Matthew J. Budoff, MD
The primary findings of this study are that higher CAC scores were independently associated with indices of LV function, namely higher LV mass index, LV volumes, LV filling pressures and higher left atrial volume index. Specifically, higher CAC score remained independently related to higher LV mass index even after adjusting for baseline demographics, CV risk factors, 10-year change in risk factors and chronic risk exposure.
Simply put, since CAC predicts events including sudden death and HF, this gives us a mechanism or at least an association of increasing coronary calcium being associated with thickening and dilation of the heart.
It reiterates the importance of being aggressive in patients with high calcium scores, and if they are going higher (based on repeat values), then more aggressive management of risk factors such as hypertension and high cholesterol to try to stave off these negative factors. We need randomized trials in persons with CAC progression to see if different therapies such as ACE inhibitors could positively impact this process.
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