Coronary artery calcification and its progression: what does it really mean? Renu Virmani, Baltimore, USA
Atherosclerosis: metabolism dysfunction drives inflammation in the vessels
Renu Virmani is President of CVPath Institute, Gaithersburg, and Clinical Professor, Department of Pathology at Georgetown University; University of Maryland-Baltimore; George Washington University, and Vanderbilt University, USA. MD. She is recognized as one of the leaders in the search for diagnostic and treatment therapies for vulnerable plaque. Dr. Virmani received her MD from Lady Hardinge Medical College, Delhi University, New Delhi, India. Currently, Dr. Virmani is a member of the American Heart Association, the US and Canadian Academy of Pathology, and is a Fellow of the American College of Cardiology.
Coronary artery calcification is a clinical marker of atherosclerosis, starting as microcalcifications and evolving to larger calcium fragments which eventually become sheet-like deposits. These changes occur concurrently with the progression of atherosclerotic plaque. Formerly considered a passive age-related process, coronary artery calcification is now recognized as an active process associated with atherosclerosis, and as a marker of the state of atherosclerotic plaque stability. Indeed, multiple cohort and population studies have shown that coronary artery calcium scoring is effective and reproducible in predicting the risk for cardiovascular disease, supporting a role in informing individualized risk management.
However, it has been suggested that the effect of calcification might be biphasic. Microcalcification, or spotty calcification, represents an active stage of vascular calcification correlated with inflammation. Plaque rupture has been shown to correlate positively with the number of spotty calcifications, and inversely with the number of large calcifications. Calcification of differential amounts, sizes, shapes, and positions may play differential roles in plaque homeostasis, which is further impacted by the environment surrounding the calcification. The interactive effects of these important factors influencing calcification and plaque is inadequately understood and merits further study.
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