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Vascular calcifications as a marker of increased cardiovascular risk: A meta-analysis

Authors R J M W Rennenberg, A G H Kessels, L J Schurgers, J M A van Engelshoven, P W de Leeuw, A A Kroon

Published 22 January 2009 Volume 2009:5 Pages 185—197


Review by Single-blind

Peer reviewer comments 2

R J M W Rennenberg1, A G H Kessels2, L J Schurgers3, J M A van Engelshoven4, P W de Leeuw1, A A Kroon1

1Department of Internal Medicine; 2Department of Clinical Epidemiology and Medical Technology Assessment; 3Department of Biochemistry (VitaK); 4Department of Radiology, University Hospital Maastricht and Cardiovascular Research Institute Maastricht (CARIM), The Netherlands

Background: Several imaging techniques may reveal calcification of the arterial wall or cardiac valves. Many studies indicate that the risk for cardiovascular disease is increased when calcification is present. Recent meta-analyses on coronary calcification and cardiovascular risk may be confounded by indication. Therefore, this meta-analysis was performed with extensive subgroup analysis to assess the overall cardiovascular risk of finding calcification in any arterial wall or cardiac valve when using different imaging techniques.

Methods and results: A meta-analysis of prospective studies reporting calcifications and cardiovascular end-points was performed. Thirty articles were selected. The overall odds ratios (95% confidence interval [CI]) for calcifications versus no calcifications in 218,080 subjects after a mean follow-up of 10.1 years amounted to 4.62 (CI 2.24 to 9.53) for all cause mortality, 3.94 (CI 2.39 to 6.50) for cardiovascular mortality, 3.74 (CI 2.56 to 5.45) for coronary events, 2.21 (CI 1.81 to 2.69) for stroke, and 3.41 (CI 2.71 to 4.30) for any cardiovascular event. Heterogeneity was largely explained by length of follow up and sort of imaging technique. Subgroup analysis of patients with end stage renal disease revealed a much higher odds ratio for any event of 6.22 (CI 2.73 to 14.14).

Conclusion: The presence of calcification in any arterial wall is associated with a 3–4-fold higher risk for mortality and cardiovascular events. Interpretation of the pooled estimates has to be done with caution because of heterogeneity across studies.

Keywords: calcification, cardiovascular risk, meta-analysis, imaging

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