Coronary calcification and risk of cardiovascular disease : an epidemiologic study

Already in the eighteenth century, calcification of the coronary artery wall was recognized as being part of the atherosclerotic process.1 However, only after the recent development of electron-beam tomography (EBT), an ultrafast CT technique, it became possible to accurately quantify the amount of coronary calcification noninvasively. Quantitative measures of coronary calcification, detected by EBT, have been found to be closely related to the amount of atherosclerotic plaque in histopathologic investigations.2,3 Furthermore, the calcium score derived from EBT is strongly associated with the extent of angiographically detected coronary artery disease.4,5 Therefore, quantification of coronary calcification using EBT has been proposed as a promising method for noninvasive detection of asymptomatic subjects at high risk of developing coronary heart disease. Studies showing that coronary calcification increases the risk of coronary events have been performed in selected, high-risk populations with small numbers of events.6-10 There are currently no population-based data on the predictive value of coronary calcification. The focus of this thesis is to investigate whether coronary calcification predicts cardiovascular disease in the general population. For this purpose, an epidemiologic study was carried out in the population-based Rotterdam Coronary Calcification Study. The Rotterdam Coronary Calcification Study consists of participants from the Rotterdam Study who underwent EBT scanning of the heart. On the scans, the amount of coronary calcification was computed. Scandata were available for 2013 older adults. In chapter 2, the current knowledge on the pathogenesis, detection and epidemiology of coronary calcification is reviewed. Chapter 3 contains studies on the validation of the scanning and scoring technique. In chapter 4, associations between cardiovascular risk factors and coronary calcification and peripheral atherosclerosis are described. Chapter 5 focuses on the association between coronary calcification and cardiovascular disease. In chapter 6, the main results of the studies described in this thesis are placed in perspective and methodological issues discussed. In addition, this chapter comments on the relevance of the findings and provides suggestions for future research on the topic.

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