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The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

  • Lee, Hyung-Tak (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Shin, Jin-Ho (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Lim, Young-Hyo (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Kim, Bae-Keun (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Kim, Young-Taek (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Lee, Jae-Ung (Division of Cardiology, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Hong, Sang-Mo (Division of Endocrinology and Metabolism, Departments of Internal Medicine, Hanyang University College of Medicine) ;
  • Song, Soon-Young (Department of Radiology, Hanyang University College of Medicine) ;
  • Cho, Sam-Hyun (Department of Obsterics and Gynecology, Hanyang University College of Medicine)
  • 발행 : 2011.02.28

초록

Background and Objectives: The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT). Subjects and Methods: Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program. Results: In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC. Conclusion: BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

키워드

참고문헌

  1. 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;92:2157-62. https://doi.org/10.1161/01.CIR.92.8.2157
  2. Mazzini MJ, Schulze PC. Proatherogenic pathways leading to vascular calcification. Eur J Radiol 2006;57:384-9. https://doi.org/10.1016/j.ejrad.2005.12.025
  3. Moe SM, Chen NX. Inflammation and vascular calcification. Blood Purif 2005;23:64-71. https://doi.org/10.1159/000082013
  4. Festa A, D'Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation 2000;102:42-7. https://doi.org/10.1161/01.CIR.102.1.42
  5. Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP. Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. Am J Epidemiol 2000; 152:897-907. https://doi.org/10.1093/aje/152.10.897
  6. Fernandez-Real JM, Ricart W. Insulin resistance and inflammation in an evolutionary perspective: the contribution of cytokine genotype/phenotype to thriftiness. Diabetologia 1999;42:1367-74. https://doi.org/10.1007/s001250051451
  7. Farhat GN, Strotmeyer ES, Newman AB, et al. Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int 2006;79:102-11. https://doi.org/10.1007/s00223-006-0052-0
  8. Barengolts EI, Berman M, Kukreja SC, Kouznetsova T, Lin C, Chomka EV. Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int 1998;62:209-13. https://doi.org/10.1007/s002239900419
  9. Hofbauer LC, Brueck CC, Shanahan CM, Schoppet M, Dobnig H. Vascular calcification and osteoporosis: from clinical observation towards molecular understanding. Osteoporos Int 2007;18:251-9. https://doi.org/10.1007/s00198-006-0282-z
  10. 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. Curr Opin Cardiol 2006;21:1-6. https://doi.org/10.1097/01.hco.0000200416.65370.a0
  11. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ. Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract 2004;65:143-9. https://doi.org/10.1016/j.diabres.2003.12.007
  12. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, De-trano R. Quantification of coronary artery calcium using ultrafast com-puted tomography. J Am Coll Cardiol 1990;15:827-32. https://doi.org/10.1016/0735-1097(90)90282-T
  13. Choi SH, An JH, Lim S, et al. Lower bone mineral density is associated with higher coronary calcification and coronary plaque burdens by multidetector row coronary computed tomography in pre- and postmenopausal women. Clin Endocrinol (Oxf) 2009;71:644-51. https://doi.org/10.1111/j.1365-2265.2009.03535.x
  14. Sinnott B, Syed I, Sevrukov A, Barengolts E. Coronary calcification and osteoporosis in men and postmenopausal women are independent processes associated with aging. Calcif Tissue Int 2006;78:195-202. https://doi.org/10.1007/s00223-005-0244-z
  15. Farhat G, Cauley J, Matthews K, et al. Volumetric BMD and vascular calcification in middle-aged women: the Study of Women's Health Ac-ross the Nation. J Bone Miner Res 2006;21:1839-46. https://doi.org/10.1359/jbmr.060903
  16. Cha B, Kim H. Metabolic syndrome and cardiovascular disease. Korean Circ J 2003;33:645-52.
  17. Noh HJ, Kwon NH, Joo SB. Severity of coronary atherosclerosis: influence of metabolic syndrome risk factor clustering and hs-CRP. Korean Circ J 2006;36:802-8.
  18. Kim D, Choi SY, Choi EK, et al. Distribution of coronary artery calci-fication in an asymptomatic Korean population: association with risk factors of cardiovascular disease and metabolic syndrome. Korean Circ J 2008;38:29-35. https://doi.org/10.4070/kcj.2008.38.1.29
  19. Reilly MP, Wolfe ML, Rhodes T, Girman C, Mehta N, Rader DJ. Meas-ures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis. Circulation 2004;110:803-9. https://doi.org/10.1161/01.CIR.0000138740.84883.9C
  20. Wong ND, Sciammarella MG, Polk D, et al. The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol 2003;41:1547-53. https://doi.org/10.1016/S0735-1097(03)00193-1
  21. Abedin M, Tintut Y, Demer LL. Vascular calcification: mechanisms and clinical ramifications. Arterioscler Thromb Vasc Biol 2004;24: 1161-70. https://doi.org/10.1161/01.ATV.0000133194.94939.42
  22. Christian RC, Harrington S, Edwards WD, Oberg AL, Fitzpatrick LA. Estrogen status correlates with the calcium content of coronary atherosclerotic plaques in women. J Clin Endocrinol Metab 2002;87: 1062-7. https://doi.org/10.1210/jc.87.3.1062

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