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Cardiac Valvular Calcification as a Marker of Atherosclerosis and Arterial Calcification in End-stage Renal Disease
Angela Yee-Moon Wang, MD, MRCP;
Stella Sin-Yee Ho, PhD;
Mei Wang, MD, PhD;
Eric Kin-Hung Liu, PhD;
Simon Ho, MD, MRCP, FRCR;
Philip Kam-Tao Li, MD, FRCP;
Siu-Fai Lui, MD, FRCP;
John E. Sanderson, MD, FRCP
Arch Intern Med. 2005;165:327-332.
Background Patients with end-stage renal disease (ESRD) are at increased risk for tissue calcifications as a result of deranged mineral metabolism. We tested the hypothesis that valvular calcification is a marker of atherosclerosis in patients with ESRD.
Methods Echocardiography was performed in 92 patients undergoing peritoneal dialysis with no background atherosclerotic vascular complications to detect valvular calcification. We used B-mode ultrasonography to determine carotid artery intima-media thickness and the presence of plaque and calcification.
Results Compared with patients without valvular calcification (n = 66), those with valvular calcification (n = 26) had higher C-reactive protein levels (P = .01) and greater mean ± SE carotid intima-media thickness (1.12 ± 0.06 vs 0.88 ± 0.04 mm; P = .003). Carotid artery calcification was present unilaterally and bilaterally in 4 patients (15%) and 17 patients (65%) with valvular calcification vs 11 (17%) and 14 (21%) without, respectively (P<.001). Carotid artery plaque was present unilaterally and bilaterally in 11 patients (12%) and 16 patients (65%) with valvular calcification vs 3 (17%) and 17 (24%) without, respectively (P = .001). Using multiple logistic regression analysis, every 1-mm increase in carotid intima-media thickness was independently associated with a 6.51-fold (95% confidence interval, 1.58-26.73; P = .009) increased risk of valvular calcification, and calcification and plaque in the carotid arteries were associated with a 7.18-fold (95% confidence interval, 2.39-21.51; P<.001) and a 5.00-fold (95% confidence interval, 1.77-14.13; P = .002) increased risk of valvular calcification, respectively.
Conclusion The associations among valvular calcification, inflammation, carotid atherosclerosis, and arterial calcification suggest that valvular calcification is a marker of atherosclerosis and arterial calcification in patients with ESRD.
Author Affiliations: Departments of Medicine and Therapeutics (Drs A. Y.-M. Wang, M. Wang, Li, S.-F. Lui, and Sanderson) and Diagnostic and Interventional Radiology (Drs S. S.-Y. Ho, E. K.-H. Liu, and S. Ho), Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong.
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