(Circulation. 1995;92:2029-2032.)
© 1995 American Heart Association, Inc.
Articles |
A Skeleton in the Atherosclerosis Closet
From the University of California, Los Angeles.
Correspondence to Linda Demer, MD, PhD, University of California, Los Angeles, Department of Medicine, Division of Cardiology, Box 951679, Room 47-123, Center for the Health Sciences, Los Angeles, CA 90095-1679. E-mail ldemer.medicine.medsch.ucla.edu.
Key Words: atherosclerosis • calcium • cardiovascular diseases • osteopontin
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Introduction |
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Routine chest x-rays often reveal calcium mineral deposits of the aorta and cardiac valves, sometimes with a density comparable to that of bone. Since atherosclerosis in the early 1900s was long dismissed as a passive, degenerative, inevitable process of aging, interest in its mechanism has been limited. Calcification in the coronary arteries has been widely regarded as uncommon. Recently, two new imaging methods, ultrafast computed tomography (UFCT) and intravascular ultrasound (IVUS), have changed this impression by revealing mineral deposits in the vast majority of significant lesions and in 90% of patients with coronary artery disease.1 2
UFCT and IVUS studies showed the unexpected result that coronary calcification occurs in the absence of coronary narrowing. In the simplest terms, where there is coronary calcification, there is usually atherosclerosis, but not necessarily stenosis. Some take this to mean that calcification is not a useful marker because it does not diagnose coronary narrowing specifically. Another interpretation is that calcification is a useful marker of early coronary atherosclerosis, in that it occurs long before end-stage disease, during the stage of compensatory enlargement. If this is so—and it agrees with reports of calcification in very young patients with familial hypercholesterolemia3 —coronary calcification may turn out to be useful as a marker for early, not necessarily stenotic, atherosclerosis.
Contributing to the notion that calcification is uncommon is the
absence of calcified lesions among textbook examples of vascular
disease. One reason may be that early calcium deposits are washed out
by routine histological preparation.4 In
addition, selection bias
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