What is the role of coronary artery calcification in the pathogenesis of atherosclerotic coronary artery disease (CAD)?

Updated: Jul 24, 2019
  • Author: J Bayne Selby, Jr, MD; Chief Editor: Eugene C Lin, MD  more...
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Coronary artery calcification is a recognized marker for atherosclerotic coronary artery disease (CAD) and can begin in patients as young as 10-20 years. The calcification itself is calcium phosphate (hydroxyapatite), which is similar to that in bone. [6]

In an early study of autopsy findings in 2,500 patients, calcium in the coronary arteries and the total plaque burden were shown to be correlated. Patients who died of coronary artery disease were found to have 2-5 times as much calcium as those who died of other causes.

The American College of Cardiology (ACC) and American Heart Association (AHA) Consensus Panel have noted that coronary calcium is part of the development of atherosclerosis and occurs exclusively in atherosclerotic arteries and is absent in the normal vessel wall.

Atherosclerotic risk factors have been evaluated in multiple longitudinal epidemiologic studies, such as the Framingham Heart Study. These studies have defined advancing age, male sex (or better stated, the absence of protective female hormones), hypertension, dyslipidemias, diabetes, cigarette smoking, and family history as predictors of subsequent cardiac events and angiographically demonstrated coronary artery disease.

Multiple angiographic and epidemiologic studies have shown that the mechanism of myocardial infarction and/or sudden cardiac death in asymptomatic patients is plaque rupture with superimposed thrombosis. In most cases, the plaque burden is not flow limiting; therefore, the patient does not have a positive stress-test result or even a significantly abnormal coronary angiogram.

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