Aortic stiffness and vitamin D are independent markers of aortic calcification in patients with peripheral arterial disease and in healthy subjects.

Eur J Vasc Endovasc Surg. 2011 Nov;42(5):689-95.

Zagura M, Serg M, Kampus P, Zilmer M, Eha J, Unt E, Lieberg J, Cockcroft JR, Kals J.

Department of Biochemistry, Centre of Excellence for Translational Medicine, University of Tartu, Tartu, Estonia; Endothelial Centre, University of Tartu, Tartu, Estonia. Maksim.Zagura@kliinikum.ee

Abstract

OBJECTIVE: Arterial stiffness is a significant determinant of cardiovascular risk and is related to vascular calcification. Vitamin D may regulate arterial calcification and has been associated with cardiovascular survival benefits. However, data about the relationship between arterial stiffness, aortic calcification and vitamin D levels in patients with peripheral arterial disease (PAD) and in healthy subjects are limited. We examined the potential association between aortic calcification, arterial stiffness and vitamin D levels in patients with symptomatic PAD and in healthy individuals.

METHODS: We studied 78 men with PAD (aged 63 ± 7 years) and 74 healthy men (aged 61 ± 10 years). Aortic pulse wave velocity (aPWV) was determined by applanation tonometry using the Sphygmocor device. Aortic calcification score (ACS) was quantified by computed tomography. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured using a radioimmune assay.

RESULTS: ACS (4.9(2.3-8.9) vs. 0.2(0.03-1.6) (cm³); p < 0.01), aPWV (9.8 ± 2.4 vs. 8.2 ± 1.6 (m s⁻¹; p < 0.01) and 25(OH)D (15.1 ± 5.4 vs. 19.0 ± 5.9 (ng ml⁻¹); p < 0.01) were different in the patients compared with the controls. In multivariate analysis, ACS was independently determined by 25(OH)D, aPWV, calcium and age in patients with PAD (R² = 0.49; p < 0.001) and by 25(OH)D, aPWV, cholesterol/high-density lipoprotein (HDL) and age in the control group (R² = 0.55; p < 0.001). Increased aPWV and lower levels of 25(OH)D were associated with decreased ankle-brachial pressure index (p = 0.03).

CONCLUSION: These results indicate that calcification of the aorta is independently associated with aortic stiffness and serum 25(OH)D level in patients with PAD and in healthy subjects. Aortic stiffness and abnormal vitamin D level may contribute to vascular calcification and are related to higher severity grade of atherosclerotic disease.

Copyright © 2011 European Society for Vascular Surgery.

PMID: 21871824

 

Supplement:

EJVES (Figure 1)

Figure 1. A cross-section of the abdomen illustrating calcification within the aortic wall.

EJVES (Figure 2)

Figure 2. Correlation between aPWV and log-ACS for the patients (r = 0.28, p = 0.03) and for the control subjects (r = 0.57, p < 0.001). Filled dots represent patients; empty dots represent controls. Continuous line represents regression line through the patient data; interrupted line represents regression line through the control data.

EJVES (Figure 3)

Figure 3. Correlation between 25(OH)D and log-ACS for the patients (r = 0.33, p = 0.01) and for the control subjects (r = -0.47, p < 0.001). Filled dots represent patients; empty dots represent controls. Continuous line represents regression line through the patient data; interrupted line represents regression line through the control data.

EJVES (Figure 4)

Figure 4. Relationship between ABPI and the tertiles of aPWV and 25(OH)D in PAD patients. ABPI, ankle–brachial pressure index; aPWV, aortic pulse wave velocity; 25(OH)D, 25-hydroxyvitamin D; MAP, mean arterial pressure.

EJVES (Figure 5)

Figure 5. A sagittal section of thorax illustrates diffuse calcification of the ascending and descending aorta.

EJVES (Figure 6)

Figure 6. 3D reconstruction demonstrating extensive calcification of the abdominal aorta.

 

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