Skip to main content
SpringerLink
Log in

Epidemiology of Coronary Calcification

  • Chapter
Coronary Radiology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 156 Accesses

Abstract

The amount of coronary calcification, detected by electron beam tomography (EBT) depends on sex and age. Studies among self-referred, asymptomatic subjects have shown that men generally have higher calcium scores than women and that calcium scores increase with age (Callister and Raggi 2000; Goel et al. 1992; Janowitz et al. 1993; Wong et al. 1994; Hoff et al. 2001). Table 4.6.1 shows sex-and age-stratified calcium scores of the largest study, which comprises 35246 self-referred subjects. More than 50% of the men already had detectable coronary calcification at the age of 40. Median calcium scores increased from 0.5 in men below 40 years to 473 in men over 74 years. Calcium scores in women were comparable to calcium scores in men who were 15 years younger. Until the age of 54 the median calcium score in women was 0. Median calcium scores in women increased to 75 in women over 74 years. Although the amount of coronary calcification increases with age, age itself is not a risk factor for coronary calcification. Rather, age is a cumulative measure of exposure to cardiovascular risk factors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 74.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Achenbach S, Ropers D, Pohle K et al (2002) Influence of lipid-lowering on the progression of coronary artery calcification: a prospective evaluation. Circulation 106: 1077–1082

    Article  PubMed  CAS  Google Scholar 

  • Arad Y, Spadaro LA, Goodman K et al (2000) Prediction of coronary events with electron beam computed tomography. J Am Coll Cardiol 36: 1253–1260

    Article  PubMed  CAS  Google Scholar 

  • Arad Y, Newstein D, Cadet F et al (2001) Association of multiple risk factors and insulin resistance with increased prevalence of asymptomatic coronary artery disease by an electron-beam computed tomographic study. Arterioscler Thromb Vasc Biol 21: 2051–2058

    Article  PubMed  CAS  Google Scholar 

  • Bielak LF, Klee GG, Sheedy PF et al (2000) Association of fibrinogen with quantity of coronary artery calcification measured by electron beam computed tomography. Arterioscler Thromb Vasc Biol 20: 2167–2171

    Article  PubMed  CAS  Google Scholar 

  • Bielak LF, Sheedy PF, Peyser PA (2001) Coronary artery calcification measured at electron-beam ct: agreement in dual scan runs and change over time. Radiology 218: 224–229

    PubMed  CAS  Google Scholar 

  • Bild DE, Folsom AR, Lowe LP et al (2001) Prevalence and correlates of coronary calcification in black and white young adults: the coronary artery risk development in young adults (CARDIA) study. Arterioscler Thromb Vasc Biol 21: 852–857

    Google Scholar 

  • Bots ML, Breslau PJ, Briet E et al (1992) Cardiovascular determinants of carotid artery disease. The Rotterdam Elderly Study. Hypertension 19: 717–720

    Google Scholar 

  • Bots ML, Hoes AW, Koudstaal PJ et al (1997) Common carotid intima-media thickness and risk of stroke and myocardial infarction: The Rotterdam Study. Circulation 96: 1432–1437

    Google Scholar 

  • Budoff MJ, Lane KL, Bakhsheshi H et al (2000) Rates of progression of coronary calcium by electron beam tomography. Am J Cardiol 86: 8–11

    Article  PubMed  CAS  Google Scholar 

  • Callister TQ, Raggi P (2000) Concise review: electron-beam tomography for early detection of coronary heart disease. In: Braunwald E, Fauci AS, Isselbacher KJ et al. (eds) Harrison’s online (www.harrisonsonline.com). McGraw-Hill, New York

    Google Scholar 

  • Callister TQ, Raggi P, Cooil B et al (1998a) Effect of HMGCoA reductase inhibitors on coronary artery disease as assessed by electron-beam computed tomography. N Engl J Med 339: 1972–1978

    Article  PubMed  CAS  Google Scholar 

  • Callister TQ, Cooil B, Raya SP et al (1998b) Coronary artery disease: improved reproducibility of calcium scoring with an electron-beam CT volumetric method. Radiology 208: 807–814

    PubMed  CAS  Google Scholar 

  • Camargo CA Jr, Stampfer MJ, Glynn RJ et al (1997) Moderate alcohol consumption and risk for angina pectoris or myocardial infarction in US male physicians. Ann Intern Med 126: 372–375

    Article  PubMed  Google Scholar 

  • Colhoun HM, Rubens MB, Underwood SR et al (2000) The effect of type 1 diabetes mellitus on the gender difference in coronary artery calcification. J Am Coll Cardiol 36: 2160–2167

    Article  PubMed  CAS  Google Scholar 

  • Danesh J, Collins R, Appleby P et al (1998) Association of fibrinogen, c-reactive protein, albumin, or leukocyte count with coronary heart disease: Meta-analyses of prospective studies. JAMA 279: 1477–1482

    Google Scholar 

  • Davis PH, Dawson JD, Mahoney LT et al (1999) Increased carotid intimal-medial thickness and coronary calcification are related in young and middle-aged adults. The Muscatine Study. Circulation 100: 838–842

    Google Scholar 

  • Detrano RC, Wong ND, Doherty TM et al (1999) Coronary calcium does not accurately predict near-term future coronary events in high-risk adults. Circulation 99: 2633–2638

    Article  PubMed  CAS  Google Scholar 

  • Doherty TM, Tang W, Detrano RC (1999) Racial differences in the significance of coronary calcium in asymptomatic black and white subjects with coronary risk factors. J Am Coll Cardiol 34: 787–794

    Article  PubMed  CAS  Google Scholar 

  • Erren M, Reinecke H, Junker R et al (1999) Systemic inflammatory parameters in patients with atherosclerosis of the coronary and peripheral arteries. Arterioscler Thromb Vasc Biol 19: 2355–2363

    Article  PubMed  CAS  Google Scholar 

  • Folsom AR, Wu KK, Rosamond WD et al (1997) Prospective study of hemostatic factors and incidence of coronary heart disease: the atherosclerosis risk in communities ( ARIC) study. Circulation 96: 1102–1108

    Google Scholar 

  • Ford ES, Smith SJ, Stroup DF et al (2002) Homocyst(e)ine and cardiovascular disease: a systematic review of the evidence with special emphasis on case-control studies and nested case-control studies. Int J Epidemiol 31: 59–70

    Article  PubMed  Google Scholar 

  • Freedman DS, Newman WP 3rd, Tracy RE et al (1988) Black-white differences in aortic fatty streaks in adolescence and early adulthood: The Bogalusa Heart Study. Circulation 77: 856–864

    Google Scholar 

  • Goel M, Wong ND, Eisenberg H et al (1992) Risk factor correlates of coronary calcium as evaluated by ultrafast computed tomography. Am J Cardiol 70: 977–980

    Article  PubMed  CAS  Google Scholar 

  • Grover SA, Coupai L, Hu XP (1995) Identifying adults at increased risk of coronary disease. How well do the current cholesterol guidelines work? JAMA 274: 801–806

    Article  PubMed  CAS  Google Scholar 

  • Haverkate F, Thompson SG, Pyke SD et al (1997) Production of c-reactive protein and risk of coronary events in stable and unstable angina. European concerted action on thrombosis and disabilities angina pectoris study group. Lancet 349: 462–466

    Google Scholar 

  • Hennekens CH, Rosner B, Cole DS (1978) Daily alcohol consumption and fatal coronary heart disease. Am J Epidemiol 107: 196–200

    PubMed  CAS  Google Scholar 

  • Hoff JA, Chomka EV, Krainik AJ et al (2001) Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol 87: 1335–1339

    Article  PubMed  CAS  Google Scholar 

  • Hofmann MA, Lalla E, Lu Y et al (2001) Hyperhomocysteinemia enhances vascular inflammation and accelerates atherosclerosis in a murine model. J Clin Invest 107: 675–683

    Article  PubMed  CAS  Google Scholar 

  • Hubert HB, Feinleib M, McNamara PM et al (1983) Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the framingham heart study. Circulation 67: 968–977

    Article  PubMed  CAS  Google Scholar 

  • Hunt ME, O’Malley PG, Vernalis MN et al (2001) C-reactive protein is not associated with the presence or extent of calcified subclinical atherosclerosis. Am Heart J 141: 206–210

    Article  PubMed  CAS  Google Scholar 

  • Janowitz WR, Agatston AS, Viamonte M Jr (1991) Comparison of serial quantitative evaluation of calcified coronary artery plaque by ultrafast computed tomography in persons with and without obstructive coronary artery disease. Am J Cardiol 68: 1–6

    Article  PubMed  CAS  Google Scholar 

  • Janowitz WR,Agatston AS, Kaplan G et al (1993) Differences in prevalence and extent of coronary artery calcium detected by ultrafast computed tomography in asymptomatic men and women. Am J Cardiol 72: 247–254

    Article  Google Scholar 

  • Jousilahti P, Vartiainen E, Pekkanen J et al (1998) Serum cholesterol distribution and coronary heart disease risk: observations and predictions among middle-aged population in eastern finland. Circulation 97: 1087–1094

    Article  PubMed  CAS  Google Scholar 

  • Klatsky AL, Friedman GD, Siegelaub AB (1981) Alcohol and mortality. A ten-year kaiser-permanente experience. Ann Intern Med 95: 139–145

    Google Scholar 

  • Kornowski R (1999) Impact of smoking on coronary atherosclerosis and remodeling as determined by intravascular ultrasonic imaging. Am J Cardiol 83:443–445, A449

    Google Scholar 

  • Kuller LH, Tracy RP, Shaten J et al (1996) Relation of c-reactive protein and coronary heart disease in the mrfit nested case-control study. Multiple Risk Factor Intervention Trial. Am J Epidemiol 144: 537–547

    Google Scholar 

  • Kuller LH, Matthews KA, Sutton-Tyrrell K et al (1999) Coronary and aortic calcification among women 8 years after menopause and their premenopausal risk factors: the Healthy Women Study. Arterioscler Thromb Vasc Biol 19: 2189–2198

    Article  PubMed  CAS  Google Scholar 

  • Levenson J, Giral P, Megnien JL et al (1997) Fibrinogen and its relations to subclinical extracoronary and coronary atherosclerosis in hypercholesterolemic men. Arterioscler Thromb Vasc Biol 17: 45–50

    Article  PubMed  CAS  Google Scholar 

  • Liuzzo G, Biasucci LM, Gallimore JR et al (1994) The prognostic value of c-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med 331: 417–424

    Article  PubMed  CAS  Google Scholar 

  • Maher JE, Raz JA, Bielak LF et al (1996) Potential of quantity of coronary artery calcification to identify new risk factors for asymptomatic atherosclerosis. Am J Epidemiol 144: 943–953

    Article  PubMed  CAS  Google Scholar 

  • Maher JE, Bielak LF, Raz JA et al (1999) Progression of coronary artery calcification: A pilot study. Mayo Clin Proc 74: 347–355

    Google Scholar 

  • Mahoney LT, Burns TL, Stanford W et al (1996) Coronary risk factors measured in childhood and young adult life are associated with coronary artery calcification in young adults: the Muscatine Study. J Am Coll Cardiol 27: 277–284

    Article  PubMed  CAS  Google Scholar 

  • Maresca G, di Blasio A, Marchioli R et al (1999) Measuring plasma fibrinogen to predict stroke and myocardial infarction: an update. Arterioscler Thromb Vasc Biol 19: 1368–1377

    Article  PubMed  CAS  Google Scholar 

  • McGill HC Jr, Strong JP (1968) The geographic pathology of atherosclerosis. Ann NY Acad Sci 149: 923–927

    Article  PubMed  Google Scholar 

  • Meade TW, Mellows S, Brozovic M et al (1986) Haemostatic function and ischaemic heart disease: principal results of the northwick park heart study. Lancet 2: 533–537

    Article  PubMed  CAS  Google Scholar 

  • Megnien JL, Sene V, Jeannin S et al (1992) Coronary calcification and its relation to extracoronary atherosclerosis in asymptomatic hypercholesterolemic men. The PCV Metra Group. Circulation 85: 1799–1807

    Google Scholar 

  • Megnien JL, Simon A, Lemariey M et al (1996) Hypertension promotes coronary calcium deposit in asymptomatic men. Hypertension 27: 949–954

    Article  PubMed  CAS  Google Scholar 

  • Mielke CH, Shields JP, Broemeling LD (2001) Coronary artery calcium, coronary artery disease, and diabetes. Diabetes Res Clin Pract 53: 55–61

    Article  PubMed  CAS  Google Scholar 

  • Mintz GS, Pichard AD, Popma JJ et al (1997) Determinants and correlates of target lesion calcium in coronary artery disease: a clinical, angiographic and intravascular ultrasound study. J Am Coll Cardiol 29: 268–274

    Article  PubMed  CAS  Google Scholar 

  • Newman AB, Shemanski L, Manolio TA et al (1999) Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study. The cardiovascular health study group. Arterioscler Thromb Vasc Biol 19: 538–545

    Google Scholar 

  • Newman AB, Naydeck BL, Sutton-Tyrrell K et al (2001) Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation 104: 2679–2684

    Article  PubMed  CAS  Google Scholar 

  • Newman AB, Naydeck BL, Whittle J et al (2002) Racial differences in coronary artery calcification in older adults. Arterioscler Thromb Vasc Biol 22: 424–430

    Article  PubMed  CAS  Google Scholar 

  • Oei HH, Vliegenthart R, Hak AE et al (2002) The association between coronary calcification assessed by electron beam computed tomography and measures of extracoronary atherosclerosis: The Rotterdam Coronary Calcification Study. J Am Coll Cardiol 39: 1745–1751

    Google Scholar 

  • O’Leary DH, Polak JF, Kronmal RA et al (1992) Distribution and correlates of sonographically detected carotid artery disease in the cardiovascular health study. The chs collaborative research group. Stroke 23: 1752–1760

    Google Scholar 

  • O’Leary DH, Polak JF, Kronmal RA et al (1999) Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study collaborative research group. N Engl J Med 340: 14–22

    Google Scholar 

  • Park R, Detrano R, Xiang M et al (2002) Combined use of computed tomography coronary calcium scores and C-reactive protein levels in predicting cardiovascular events in non-diabetic individuals. Circulation 106: 2073–2077

    Article  PubMed  CAS  Google Scholar 

  • Pearson TA (2002) New tools for coronary risk assessment: what are their advantages and limitations? Circulation 105: 886–892

    Article  PubMed  Google Scholar 

  • Pohle K, Maffert R, Ropers D et al (2001) Progression of aortic valve calcification: association with coronary atherosclerosis and cardiovascular risk factors. Circulation 104: 1927–1932

    Article  PubMed  CAS  Google Scholar 

  • Raggi P, Callister TQ, Cooil B et al (2000) Identification of patients at increased risk of first unheralded acute myocardial infarction by electron-beam computed tomography. Circulation 101: 850–855

    Article  PubMed  CAS  Google Scholar 

  • Redberg RF, Rifai N, Gee L et al (2000) Lack of association of c-reactive protein and coronary calcium by electron beam computed tomography in postmenopausal women: implications for coronary artery disease screening. J Am Coll Cardiol 36: 39–43

    Article  PubMed  CAS  Google Scholar 

  • Ridker PM, Cushman M, Stampfer MJ et al (1997) Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 336: 973–979

    Article  PubMed  CAS  Google Scholar 

  • Ridker PM, Glynn RJ, Hennekens CH (1998a) C-reactive protein adds to the predictive value of total and HDL cholesterol in determining risk of first myocardial infarction. Circulation 97: 2007–2011

    Article  PubMed  CAS  Google Scholar 

  • Ridker PM, Buring JE, Shih J et al (1998b) Prospective study of c-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 98: 731–733

    Article  PubMed  CAS  Google Scholar 

  • Ridker PM, Cushman M, Stampfer MJ et al (1998c) Plasma concentration of c-reactive protein and risk of developing peripheral vascular disease. Circulation 97: 425–428

    Article  PubMed  CAS  Google Scholar 

  • Rumberger JA, Simons DB, Fitzpatrick LA et al (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92: 2157–2162

    Google Scholar 

  • Schnyder G, Roffi M, Pin R et al (2001) Decreased rate of coronary restenosis after lowering of plasma homocystein levels. N Engl J Med 345: 1593–1600

    Article  PubMed  CAS  Google Scholar 

  • Schurgin S, Rich S, Mazzone T (2001) Increased prevalence of significant coronary artery calcification in patients with diabetes. Diabetes Care 24: 335–338

    Article  PubMed  CAS  Google Scholar 

  • Shemesh J, Apter S, Stroh CI et al (2000) Tracking coronary calcification by using dual-section spiral ct: a 3-year follow-up. Radiology 217: 461–465

    PubMed  CAS  Google Scholar 

  • Shemesh J, Apter S, Stolero D et al (2001) Annual progression of coronary artery calcium by spiral computed tomography in hypertensive patients without myocardial ischemia but with prominent atherosclerotic risk factors, in patients with previous angina pectoris or healed acute myocardial infarction, and in patients with coronary events during follow-up. Am J Cardiol 87: 1395–1397

    Article  PubMed  CAS  Google Scholar 

  • Stokes J 3rd, Kannel WB, Wolf PA et al (1989) Blood pressure as a risk factor for cardiovascular disease. The Framingham Study - 30 years of follow-up. Hypertension 13: I13 - I18

    Article  PubMed  Google Scholar 

  • Strong JP, Richards ML (1976) Cigarette smoking and athero- sclerosis in autopsied men. Atherosclerosis 23: 451–476

    Article  PubMed  CAS  Google Scholar 

  • Strong JP, Malcom GT, McMahan CA et al (1999) Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the pathobiological determinants of atherosclerosis in youth study. JAMA 281: 727–735

    Article  PubMed  CAS  Google Scholar 

  • Suh I, Shaten BJ, Cutler JA et al (1992) Alcohol use and mortality from coronary heart disease: the role of high-density lipoprotein cholesterol. The Multiple Risk Factor Intervention Trial research group. Ann Intern Med 116: 881–887

    Google Scholar 

  • Superko HR, Hecht HS (2001) Metabolic disorders contribute to subclinical coronary atherosclerosis in patients with coronary calcification. Am J Cardiol 88: 260–264

    Article  PubMed  CAS  Google Scholar 

  • Taylor AJ, Feuerstein I, Wong H et al (2001) Do conventional risk factors predict subclinical coronary artery disease? Results from the prospective army coronary calcium project. Am Heart J 141: 463–468

    Article  PubMed  CAS  Google Scholar 

  • Thompson SG, Kienast J, Pyke SD et al (1995) Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European concerted action on thrombosis and disabilities angina pectoris study group. N Engl J Med 332: 635–641

    Google Scholar 

  • Tuzcu EM, Berkalp B, de Franco AC et al (1996) The dilemma of diagnosing coronary calcification: angiography versus intravascular ultrasound. J Am Coll Cardiol 27: 832–838

    Article  PubMed  CAS  Google Scholar 

  • Vliegenthart R, Hollander M, Breteler MM et al (2002) Stroke is associated with coronary calcification as detected by electron-beam ct: the Rotterdam Coronary Calcification Study. Stroke 33: 462–465

    Article  PubMed  Google Scholar 

  • Wexler L, Brundage B, Crouse J et al (1996) Coronary artery calcification: Pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing group. Circulation 94: 1175–1192

    Google Scholar 

  • Witteman JCM, Kok FJ, van Saase JL et al (1986) Aortic calcification as a predictor of cardiovascular mortality. Lancet 2: 1120–1122

    Article  PubMed  CAS  Google Scholar 

  • Wong ND, Kouwabunpat D, Vo AN et al (1994) Coronary calcium and atherosclerosis by ultrafast computed tomography in asymptomatic men and women: relation to age and risk factors. Am Heart J 127: 422–430

    Article  PubMed  CAS  Google Scholar 

  • Wong ND, Hsu JC, Detrano RC et al (2000) Coronary artery calcium evaluation by electron beam computed tomography and its relation to new cardiovascular events. Am J Cardiol 86: 495–498

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization (1999) International Society of Hypertension guidelines for the management of hypertension. Guidelines subcommittee. J Hypertens 17: 151–183

    Google Scholar 

  • Yang T, Doherty TM, Wong ND et al (1999) Alcohol consumption, coronary calcium, and coronary heart disease events. Am J Cardiol 84: 802–806

    Article  PubMed  CAS  Google Scholar 

  • Yoon HC, Emerick AM, Hill JA et al (2002) Calcium begets calcium: progression of coronary artery calcification in asymptomatic subjects. Radiology 224: 236–241

    Article  PubMed  Google Scholar 

  • Zhou J, Moller J, Danielsen CC et al (2001) Dietary supplementation with methionine and homocysteine promotes early atherosclerosis but not plaque rupture in apoE-deficient mice. Arterioscler Thromb Vasc Biol 21: 1470–1476

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University Hospital Groningen, P.O. Box 30 001, 9700 RB, Groningen, Netherlands

    Rozemarijn Vliegenthart MSc,PhD

  2. Department of Epidemiology and Biostatistics, Erasmus MC, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands

    Hok-Hay S. Oei MD

Authors
  1. Rozemarijn Vliegenthart MSc,PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hok-Hay S. Oei MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Radiology, University Hospital of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands

    Matthijs Oudkerk MD, PhD (Professor) (Professor)

Rights and permissions

Reprints and permissions

Copyright information

© 2004 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Vliegenthart, R., Oei, HH.S. (2004). Epidemiology of Coronary Calcification. In: Oudkerk, M. (eds) Coronary Radiology. Medical Radiology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-06419-1_14

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-06419-1_14

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-06421-4

  • Online ISBN: 978-3-662-06419-1

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation