Korean Circ J.  2008 Jan;38(1):29-35. 10.4070/kcj.2008.38.1.29.

Distribution of Coronary Artery Calcification in an Asymptomatic Korean Population: Association with Risk Factors of Cardiovascular Disease and Metabolic Syndrome

• Kim D
• Choi SY
• Choi EK
• Suh JW
• Lee W
• Kim YS
• Yoon DH
• Chung JW
• Oh BH

• KMID: 2225871
• DOI: http://doi.org/10.4070/kcj.2008.38.1.29

Abstract

BACKGROUND AND OBJECTIVES
Coronary artery calcification (CAC) has been used as surrogate marker for coronary atherosclerosis. We developed a set of age-and gender-stratified CAC distribution and risk factors for CAC in a population of asymptomatic Korean subjects.
SUBJECTS AND METHODS
Between 2003 and 2007, 3,961 asymptomatic subjects without a history of ischemic heart disease (male 64%, mean age 56+/-10 years) were screened for CAC by the use of multi-detector computed tomography.
RESULTS
The total CAC score was assigned to a percentile according to age and gender. The prevalence of CAC and mean CAC score increased with age [p<0.001 by analysis of variance (ANOVA)]. The prevalence of CAC (mean CAC score) was 36.2% (60.5+/-236.1) in males, and 17.0% (15.1+/-84.0) in females. The age-and sex-adjusted odds ratio for the presence of CAC for subjects with diabetes was 1.542 [95% confidence interval (CI) 1.252-1.899], for subjects with hypertension was 1.673 (95% CI 1.430-1.956), for subjects with metabolic syndrome was 1.727 (95% CI 1.461-2.042), and for subjects with abdominal obesity (abdominal obesity defined as a waist circumference > or =90 cm in males; > or =80 cm in females) was 1.445 (95% CI 1.222-1.709).
CONCLUSION
This study reports the distribution of CAC score by age and gender. It will serve as a reference standard for the clinical interpretation of CAC results in the asymptomatic Korean population.

Keyword

Coronary arteries; Pathologic calcification; Risk factors; Metabolic syndrome X

MeSH Terms

Biomarkers
Calcinosis
Cardiovascular Diseases
Coronary Artery Disease
Coronary Vessels
Female
Humans
Hypertension
Male
Metabolic Syndrome X
Myocardial Ischemia
Obesity
Obesity, Abdominal
Odds Ratio
Prevalence
Risk Factors
Waist Circumference

Reference

1. Mautner SL, Mautner GC, Froehlich J, et al. Coronary artery disease: prediction with in vitro electron beam CT. Radiology. 1994. 192:625–630.

2. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation. 1995. 92:2157–2162.

3. Sangiorgi G, Rumberger JA, Severson A, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998. 31:126–133.

4. Choe KO, Kim MJ, Choi BW, et al. Distribution of coronary calcium score in healthy middle-aged Korean. J Korean Radiol Soc. 1999. 41:885–891.

5. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001. 87:1335–1339.

6. Shisen J, Leung DY, Juergens CP. Gender and age differences in the prevalence of coronary artery calcification in 953 Chinese subjects. Heart Lung Circ. 2005. 14:69–73.

7. Cohn JS, McNamara JR, Schaefer EJ. Lipoprotein cholesterol concentrations in the plasma of human subjects as measured in the fed and fasted states. Clin Chem. 1988. 34:2456–2459.

8. National Cholesterol Education Program (NCEP). Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002. 106:3143–3421.

9. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Executive summary. Cardiol Rev. 2005. 13:322–327.

10. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990. 15:827–832.

11. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998. 97:1837–1847.

12. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004. 110:227–239.

13. Detrano R, Hsiai T, Wang S, et al. Prognostic value of coronary calcification and angiographic stenoses in patients undergoing coronary angiography. J Am Coll Cardiol. 1996. 27:285–290.

14. Fitzpatrick LA, Severson A, Edwards WD, Ingram RT. Diffuse calcification in human coronary arteries: association of osteopontin with atherosclerosis. J Clin Invest. 1994. 94:1597–1604.

15. Raggi P, James G. Coronary calcium screening and coronary risk stratification. Curr Atheroscler Rep. 2004. 6:107–111.

16. Choi YS, Youn HJ, Jung SE, et al. The association between coronary artery calcification on MDCT and angiographic coronary artery stenosis. Korean Circ J. 2007. 37:167–172.

17. Schmermund A, Baumgart D, Erbel R. Coronary calcification by electron beam tomography: comparison with coronary risk factors and angiography. J Cardiovasc Risk. 2000. 7:99–106.

18. Kim KS. Imaging markers of subclinical atherosclerosis. Korean Circ J. 2007. 37:1–8.

19. Budoff MJ, Achenbach S, Blumenthal RS, et al. Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology. Circulation. 2006. 114:1761–1791.

20. Greenland P, Bonow RO, Brundage BH, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography). Circulation. 2007. 115:402–426.

21. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004. 291:210–215.

22. Budoff MJ, Nasir K, Mao S, et al. Ethnic differences of the presence and severity of coronary atherosclerosis. Atherosclerosis. 2006. 187:343–350.

23. Kronmal RA, McClelland RL, Detrano R, et al. Risk factors for the progression of coronary artery calcification in asymptomatic subjects: results from the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2007. 115:2722–2730.

24. Wong ND. Metabolic syndrome: cardiovascular risk assessment and management. Am J Cardiovasc Drugs. 2007. 7:259–272.

25. Wong ND, Sciammarella MG, Polk D, et al. The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol. 2003. 41:1547–1553.

26. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation. 2004. 110:1251–1257.

27. Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, cardiovascular disease, and all causes in United States adults. Circulation. 2004. 110:1245–1250.

28. Cha BS, Kim HJ. Metabolic syndrome and cardiovascular disease. Korean Circ J. 2003. 33:645–652.

29. Kip KE, Marroquin OC, Kelley DE, et al. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women. Circulation. 2004. 109:706–713.

30. Lim S, Park KS, Lee HK, Cho SI. Changes in the characteristics of metabolic syndrome in Korea over the period 1998-2001 as determined by Korean National Health and Nutrition Examination Surveys. Diabetes Care. 2005. 28:1810–1812.