Arteriosclerosis, Thrombosis, and Vascular Biology. 1996;16:978-983
© 1996 American Heart Association, Inc.
Articles |
Medial Artery Calcification
A Neglected Harbinger of Cardiovascular Complications in Non–Insulin-Dependent Diabetes Mellitus
the Departments of Medicine (S.L., L.N., M.L.) and Radiology (M.S.), Kuopio University Hospital, Kuopio; the Department of Medicine (T.R.), Turku University Hospital, Turku; and the Research and Development Centre (T.R.), Social Insurance Institution, Turku, Finland.
Correspondence to Markku Laakso, MD, Professor, Department of Medicine, University of Kuopio, SF-70210 Kuopio, Finland. E-mail Markku.Laakso@uku.fi.
Abstract
Medial artery calcification (MAC) is a nonobstructive condition leading to reduced arterial compliance that is commonly considered as a nonsignificant finding. The aim of our study was to investigate the predictive value of MAC in relation to 7-year cardiovascular mortality, coronary heart disease (CHD) events, stroke, and lower extremity amputation in 1059 patients (581 men and 478 women) with non–insulin-dependent diabetes mellitus (NIDDM). At baseline radiologically detectable MAC in femoral arteries was found in 439 patients (41.5%) and intimal-type calcification in 310 diabetic patients (29.3%). The mean fasting plasma glucose at baseline was somewhat higher in women and the duration of diabetes somewhat longer in patients with MAC than in those without, but otherwise the presence of MAC was unrelated to conventional cardiovascular risk factors. During the follow-up 305 diabetic patients died: 208 from cardiovascular disease, 158 from CHD, and 34 from stroke. Furthermore, 58 NIDDM patients underwent their first lower extremity amputation. MAC was a strong independent predictor of total (risk factor–adjusted odds ratio and 95% confidence interval: 1.6; 1.2, 2.2), cardiovascular (1.6; 1.1, 2.2), and CHD (1.5; 1.0, 2.2) mortality, and it was also a significant predictor of future CHD events (fatal or nonfatal myocardial infarction), stroke, and amputation. This relationship was observed regardless of glycemic control and known duration of NIDDM. MAC is a strong marker of future cardiovascular events in NIDDM unrelated to cardiovascular risk factors, supporting the hypothesis that reduced arterial elasticity could lead to clinical manifestations of diabetic macroangiopathy.
Key Words: medial artery calcification • non–insulin-dependent diabetes • mortality • cardiovascular disease
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C. M. Shanahan, N. R. B. Cary, J. R. Salisbury, D. Proudfoot, P. L. Weissberg, and M. E. Edmonds Medial Localization of Mineralization-Regulating Proteins in Association With Monckeberg’s Sclerosis : Evidence for Smooth Muscle Cell-Mediated Vascular Calcification Circulation, November 23, 1999; 100(21): 2168 - 2176. [Abstract] [Full Text] [PDF]
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S. D. Kanters, J.-D. Banga, R. P Stolk, and A. Algra Incidence and determinants of mortality and cardiovascular events in diabetes mellitus: a meta-analysis Vascular Medicine, May 1, 1999; 4(2): 67 - 75. [Abstract] [PDF]
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C. M. Giachelli Ectopic Calcification : Gathering Hard Facts about Soft Tissue Mineralization Am. J. Pathol., March 1, 1999; 154(3): 671 - 675. [Full Text] [PDF]
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D. A. Towler, M. Bidder, T. Latifi, T. Coleman, and C. F. Semenkovich Diet-induced Diabetes Activates an Osteogenic Gene Regulatory Program in the Aortas of Low Density Lipoprotein Receptor-deficient Mice J. Biol. Chem., November 13, 1998; 273(46): 30427 - 30434. [Abstract] [Full Text] [PDF]
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