Korean Circ J.  2011 Feb;41(2):76-82. 10.4070/kcj.2011.41.2.76.

The Relationship Between Coronary Artery Calcification and Bone Mineral Density in Patients According to Their Metabolic Syndrome Status

• Lee HT
• Shin J
• Lim YH
• Kim BK
• Kim YT
• Lee JU
• Hong S
• Song SY
• Cho SH

• KMID: 2225139
• DOI: http://doi.org/10.4070/kcj.2011.41.2.76

Abstract

BACKGROUND AND OBJECTIVES
The extent of coronary artery calcification (CAC) is closely related to total atherosclerotic plaque burden. However, the pathogenesis of CAC is still unclear. Conditions such as diabetes mellitus, renal failure, smoking, and chronic inflammation have been suggested to link vascular calcification and bone loss. In the present study, we hypothesized that bone loss can contribute to the pathogenesis of CAC in patients with the chronic inflammatory condition that accompanies metabolic syndrome (MetS). The objective of this study was to investigate the relationship between CAC and bone mineral density (BMD) in patients with MetS and in patients without MetS, by using coronary multidetector-row computed tomography (MDCT).
SUBJECTS AND METHODS
Data from 395 consecutive patients was analyzed retrospectively. From the MDCT database, only those patients who underwent both coronary MDCT and dual-energy X-ray absorptiometry within an interval of one month, were selected. The presence of MetS was determined by the updated criteria as defined by the Third Adult Treatment Panel Report of the National Cholesterol Education Program.
RESULTS
In patients with MetS, a significant correlation was found between CAC and age {odds ratio (OR)=1.139, 95% confidence interval (CI) 1.080 to 1.201, p<0.001}, CAC and male sex (OR=3.762, 95% CI 1.339 to 10.569, p=0.012), and CAC and T-score of L-spine (OR=0.740, 95% CI 0.550 to 0.996, p=0.047) using a forward multiple logistic regression analysis model including clinical variables of gender, age, lipid profile, body mass index, diabetes mellitus, hypertension, smoking, and BMD. But in patients without MetS, BMD by itself was not found to contribute to CAC.
CONCLUSION
BMD was inversely correlated with CAC only in patients with MetS. This finding suggests that low BMD accompanied by MetS, may have significant clinical implications.

Keyword

Bone density; Metabolic syndrome X; Coronary artery disease

MeSH Terms

Absorptiometry, Photon
Adult
Aluminum Hydroxide
Body Mass Index
Bone Density
Carbonates
Cholesterol
Coronary Artery Disease
Coronary Vessels
Diabetes Mellitus
Humans
Hypertension
Inflammation
Logistic Models
Male
Metabolic Syndrome X
Multidetector Computed Tomography
Plaque, Atherosclerotic
Renal Insufficiency
Retrospective Studies
Smoke
Smoking
Vascular Calcification
Aluminum Hydroxide
Carbonates
Cholesterol
Smoke

Reference

1. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area: a histopathologic correlative study. Circulation. 1995. 92:2157–2162.

2. Mazzini MJ, Schulze PC. Proatherogenic pathways leading to vascular calcification. Eur J Radiol. 2006. 57:384–389.

3. Moe SM, Chen NX. Inflammation and vascular calcification. Blood Purif. 2005. 23:64–71.

4. Festa A, D'Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS). Circulation. 2000. 102:42–47.

5. Sakkinen PA, Wahl P, Cushman M, Lewis MR, Tracy RP. Clustering of procoagulation, inflammation, and fibrinolysis variables with metabolic factors in insulin resistance syndrome. Am J Epidemiol. 2000. 152:897–907.

6. Fernandez-Real JM, Ricart W. Insulin resistance and inflammation in an evolutionary perspective: the contribution of cytokine genotype/phenotype to thriftiness. Diabetologia. 1999. 42:1367–1374.

7. Farhat GN, Strotmeyer ES, Newman AB, et al. Volumetric and areal bone mineral density measures are associated with cardiovascular disease in older men and women: the health, aging, and body composition study. Calcif Tissue Int. 2006. 79:102–111.

8. Barengolts EI, Berman M, Kukreja SC, Kouznetsova T, Lin C, Chomka EV. Osteoporosis and coronary atherosclerosis in asymptomatic postmenopausal women. Calcif Tissue Int. 1998. 62:209–213.

9. Hofbauer LC, Brueck CC, Shanahan CM, Schoppet M, Dobnig H. Vascular calcification and osteoporosis: from clinical observation towards molecular understanding. Osteoporos Int. 2007. 18:251–259.

10. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Curr Opin Cardiol. 2006. 21:1–6.

11. Lee WY, Park JS, Noh SY, Rhee EJ, Kim SW, Zimmet PZ. Prevalence of the metabolic syndrome among 40,698 Korean metropolitan subjects. Diabetes Res Clin Pract. 2004. 65:143–149.

12. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol. 1990. 15:827–832.

13. Choi SH, An JH, Lim S, et al. Lower bone mineral density is associated with higher coronary calcification and coronary plaque burdens by multidetector row coronary computed tomography in pre- and postmenopausal women. Clin Endocrinol (Oxf). 2009. 71:644–651.

14. Sinnott B, Syed I, Sevrukov A, Barengolts E. Coronary calcification and osteoporosis in men and postmenopausal women are independent processes associated with aging. Calcif Tissue Int. 2006. 78:195–202.

15. Farhat G, Cauley J, Matthews K, et al. Volumetric BMD and vascular calcification in middle-aged women: the Study of Women's Health Across the Nation. J Bone Miner Res. 2006. 21:1839–1846.

16. Cha BS, Kim HJ. Metabolic syndrome and cardiovascular disease. Korean Circ J. 2003. 33:645–652.

17. Noh HJ, Kwon NH, Joo SB. Severity of coronary atherosclerosis: influence of metabolic syndrome risk factor clustering and hs-CRP. Korean Circ J. 2006. 36:802–808.

18. Kim D, Choi SY, Choi EK, et al. Distribution of coronary artery calcification in an asymptomatic Korean population: association with risk factors of cardiovascular disease and metabolic syndrome. Korean Circ J. 2008. 38:29–35.

19. Reilly MP, Wolfe ML, Rhodes T, Girman C, Mehta N, Rader DJ. Measures of insulin resistance add incremental value to the clinical diagnosis of metabolic syndrome in association with coronary atherosclerosis. Circulation. 2004. 110:803–809.

20. Wong ND, Sciammarella MG, Polk D, et al. The metabolic syndrome, diabetes, and subclinical atherosclerosis assessed by coronary calcium. J Am Coll Cardiol. 2003. 41:1547–1553.

21. Abedin M, Tintut Y, Demer LL. Vascular calcification: mechanisms and clinical ramifications. Arterioscler Thromb Vasc Biol. 2004. 24:1161–1170.

22. Christian RC, Harrington S, Edwards WD, Oberg AL, Fitzpatrick LA. Estrogen status correlates with the calcium content of coronary atherosclerotic plaques in women. J Clin Endocrinol Metab. 2002. 87:1062–1067.