Coronary Calcification and Male Gender Predict Significant Stenosis in Symptomatic Patients in Northern and Southern Europe and the USA: A Euro-CCAD Study
Keywords:Stenosis, coronary artery calcification, risk factors, geographical region
Background and Aims: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.
Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group, there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.Conclusion: In symptomatic patients, the CAC score and male gender were the two most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.
National Cholesterol Education Program Expert Panel on Detection E, Treatment of High Blood Cholesterol in A (2002) Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 106 (25):3143-3421
Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS (1995) Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation 92 (8):2157-2162
Nicoll R, Henein M (2010) Extensive coronary calcification: a clinically unrecognised condition. Current vascular pharmacology 8 (5):701-705
Grundy SM, Cleeman JI, Merz CN, Brewer HB, Jr., Clark LT, Hunninghake DB, Pasternak RC, Smith SC, Jr., Stone NJ, National Heart L, Blood I, American College of Cardiology F, American Heart A (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 110 (2):227-239. doi:10.1161/01.CIR.0000133317.49796.0E
Nicoll R, Zhao Y, Wiklund U, Diederichsen A, Mickley H, Ovrehus K, Zamorano J, Gueret P, Schmermund A, Maffei E, Cademartiri F, Budoff M, Henein M (2017) Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study. Journal of diabetes and its complications 31 (7):1096-1102. doi:10.1016/j.jdiacomp.2017.03.013
Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circulation 97 (18):1837-1847
Diamond GA (1983) A clinically relevant classification of chest discomfort. Journal of the American College of Cardiology 1 (2 Pt 1):574-575
Erbel R, Delaney JA, Lehmann N, McClelland RL, Mohlenkamp S, Kronmal RA, Schmermund A, Moebus S, Dragano N, Stang A, Jockel KH, Budoff MJ, Multi-Ethnic Study of A, Investigator Group of the Heinz Nixdorf Recall S (2008) Signs of subclinical coronary atherosclerosis in relation to risk factor distribution in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). European heart journal 29 (22):2782-2791. doi:10.1093/eurheartj/ehn439
Schmermund A, Lehmann N, Bielak LF, Yu P, Sheedy PF, 2nd, Cassidy-Bushrow AE, Turner ST, Moebus S, Mohlenkamp S, Stang A, Mann K, Jockel KH, Erbel R, Peyser PA (2007) Comparison of subclinical coronary atherosclerosis and risk factors in unselected populations in Germany and US-America. Atherosclerosis 195 (1):e207-216. doi:10.1016/j.atherosclerosis.2007.04.009
Santos RD, Nasir K, Rumberger JA, Budoff MJ, Braunstein JB, Meneghelo R, Barreiros M, Pereirinha A, Carvalho JA, Blumenthal RS, Raggi P (2006) Difference in atherosclerosis burden in different nations and continents assessed by coronary artery calcium. Atherosclerosis 187 (2):378-384. doi:10.1016/j.atherosclerosis.2005.09.017
Bauer M, Delaney JA, Mohlenkamp S, Jockel KH, Kronmal RA, Lehmann N, Mukamal KJ, Moebus S, Polak JF, Dragano N, Budoff MJ, Erbel R, McClelland RL, Multi-Ethnic Study of A, Investigator Group of the Heinz Nixdorf Recall S (2013) Comparison of factors associated with carotid intima-media thickness in the Multi-ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (HNR). Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography 26 (6):667-673. doi:10.1016/j.echo.2013.03.011
Baldassarre D, Nyyssonen K, Rauramaa R, de Faire U, Hamsten A, Smit AJ, Mannarino E, Humphries SE, Giral P, Grossi E, Veglia F, Paoletti R, Tremoli E, group Is (2010) Cross-sectional analysis of baseline data to identify the major determinants of carotid intima-media thickness in a European population: the IMPROVE study. European heart journal 31 (5):614-622. doi:10.1093/eurheartj/ehp496
Shewan LG, Coats AJS, Henein M. Requirements for ethical publishing in biomedical journals. International Cardiovascular Forum Journal 2015;2:2 DOI: 10.17987/icfj.v2i1.4
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