Coronary artery wall calcification

Many diseases may occur in the elderly because their bodies are already in a stage of degeneration, and it is common for them to develop diseases. The arteries are the part most prone to disease. There are many diseases related to the arteries, one of which is called coronary artery wall calcification. So what is the cause of coronary artery calcification in the elderly?

Risk factors for coronary artery calcification (i.e., accumulation of calcified plaques seen on computerized tomography) include established risk factors for heart disease, such as male sex, older age, glucose intolerance, tobacco use, dyslipidemia (disorders of lipoprotein metabolism, including hypercholesterolemia), hypertension, obesity, and increased inflammatory markers. Recent data suggest that sleep quantity and quality are associated with several of these risk factors.

Clinical Research

Clinical studies have shown that the progression of coronary atherosclerosis is a strong independent predictor of future coronary heart disease events. Margolis et al. studied 800 patients with angina pectoris and found that the 5-year survival rate of patients with calcification and symptoms shown on traditional X-ray examinations was 58%, while the 5-year survival rate of those without calcification was 87%. Therefore, the prognostic significance of coronary artery calcification appears to be independent of age, sex, and angiographic lesions. In addition, coronary artery calcification was also independent of exercise testing and left ventricular ejection fraction. The study by Detrano et al. also indicated that coronary artery calcification shown on conventional X-ray examinations can help identify asymptomatic high-risk patients with increased risk of cardiac events during a 1-year period. Naito et al. followed up 241 elderly patients for 4 years and found that 4.9% of the 82 patients with coronary artery calcification developed myocardial infarction, while none of the 159 patients without coronary artery calcification developed myocardial infarction. However, there was no significant difference in the overall mortality rate between the two groups.

Research Viewpoint

Some review articles point out that calcium deposition in atherosclerosis is clearly associated with disease severity and poor prognosis, and therefore coronary artery calcification is considered an "unfavorable" phenomenon. Some clinical and biomechanical studies have shown that calcium deposition tends to reduce the vulnerability of plaque rupture, so coronary artery calcification seems to be a "good" sign. An objective evaluation should consider that coronary artery calcification has two effects at the same time. Calcium deposition indicates the presence of atherosclerotic lesions. Generally speaking, the more severe the calcium deposition, the more extensive the atherosclerotic lesions. A group of atherosclerotic lesions, especially unstable lesions, predispose to coronary heart disease events. However, unstable lesions may be acalcified, whereas stable lesions are more likely to be calcified.

Coronary artery calcification is considered "bad" because the number of calcified plaques approximately reflects the sum of the atherosclerotic areas in the coronary artery branches. However, the factors that determine coronary artery prognosis are not only the amount of atherosclerosis, but also the possibility of each plaque being prone to rupture. In a sense, calcification may represent a protective effect.