<p>BACKGROUND: Arterial calcification, the hallmark of arteriosclerosis, has a widespread distribution in the human body with only moderate correlation among sites. Hitherto, a single measure capturing the systemic burden of arterial calcification was lacking. In this paper, we propose the C-factor as an overall measure of calcification burden. METHODS: To quantify calcification in the coronary arteries, aortic arch, extra- and intracranial carotid arteries, and vertebrobasilar arteries, 2384 Rotterdam Study participants underwent cardiac and extra-cardiac non-enhanced CT. We performed principal component analyses on the calcification volumes of all twenty-six possible combinations of these vessel beds. Each analysis' first principal component represents the C-factor. Subsequently, we determined the correlation between the C-factor derived from all vessel beds and the other C-factors with intraclass correlation coefficient (ICC) analyses. Finally, we examined the association of the C-factor and calcification in the separate vessel beds with cardiovascular, non-cardiovascular, and overall mortality using Cox-regression analyses. RESULTS: The ICCs ranged from 0.80 to 0.99. Larger calcification volumes and a higher C-factor were all individually associated with higher risk of cardiovascular, non-cardiovascular, and overall mortality. When included simultaneously in a model, the C-factor was still associated with all three mortality types (adjusted hazard ratio per standard deviation increase (HR) &gt; 1.52), whereas associations of the separate vessel beds with mortality attenuated substantially (HR &lt; 1.26). CONCLUSIONS: The C-factor summarizes the systemic component of arterial calcification on an individual level and appears robust among different combinations of vessel beds. Importantly, when mutually adjusted, the C-factor retains its strength of association with mortality while the site-specific associations attenuate.</p>

doi.org/10.1186/s12872-021-02126-y, hdl.handle.net/1765/136250
BMC Cardiovascular Disorders
Erasmus MC: University Medical Center Rotterdam

L.M. (Lieke) Kuiper, M.K. (Kamran) Ikram, M. (Maryam) Kavousi, M.W. (Meike) Vernooij, M.A. (Arfan) Ikram, & D. (Daniel) Bos. (2021). C-factor. BMC Cardiovascular Disorders, 21(1). doi:10.1186/s12872-021-02126-y