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01.10.2018 | Original articles

Long-term vitamin-K antagonist use and coronary artery calcification

verfasst von: S. Ünlü, MD, MSc, A. Şahinarslan, MD, H. K. Kılıç, MD, G. Gökalp, MD, B. Sezenöz, MD, G. Erbaş, MD, R. M. Yalçın, MD, M. Araç, MD

Erschienen in: Herz | Ausgabe 6/2020

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Abstract

Background

The aim of this study was to investigate the impact of vitamin K antagonist (VKA) therapy on coronary artery calcification (CAC) by comparing long-term VKA users with metallic prosthetic valves (MPVs) and VKA-free patients undergoing coronary calcium scoring for cardiovascular (CV) risk stratification.

Methods

A total of 108 patients (43 VKA users with MPV and 65 gender-, age-, and risk-factor-matched VKA-free patients) were included in the study. CAC was determined via computed tomography (CT) and quantified on the basis of the Agatston score. The VKA group comprised patients who had an MPV for longer than 5 years, which entailed long-term VKA use.

Results

Long-term VKA users had more calcified coronary arteries compared with the control group (178.1 ± 278 vs. 61.1 ± 130.6, p = 0.01). There was no difference between groups in terms of traditional CV risk factors. The mean duration of VKA use was 15 ± 7 years for the patients with MPV. There was no correlation between the duration of VKA use and mean Agatston score (r = 0.2, p = 0.215).

Conclusion

With its unique selection of patient groups, our study extends the findings of previous research that long-term VKA use is related to CAC as detected via CT scanning. The longer and more potent VKA regimen required for MPV patients is the primary cause of CAC in this group.

Hohnloser SH (2016) Treatment safety of non-vitamin K oral anticoagulants in patients with atrial fibrillation. Herz 41(1):37–47CrossRef

Chatrou ML, Winckers K, Hackeng TM et al (2012) Vascular calcification: the price to pay for anticoagulation therapy with vitamin K‑antagonists. Blood Rev 26(4):155–166. https://doi.org/10.1016/j.blre.2012.03.002CrossRefPubMed

Luo G, Ducy P, McKee MD et al (1997) Spontaneous calcification of arteries and cartilage in mice lacking matrix GLA protein. Nature 386(6620):78–81. https://doi.org/10.1038/386078a0CrossRefPubMed

Weijs B, Blaauw Y, Rennenberg RJ et al (2011) Patients using vitamin K antagonists show increased levels of coronary calcification: an observational study in low-risk atrial fibrillation patients. Eur Heart J 32(20):2555–2562. https://doi.org/10.1093/eurheartj/ehr226CrossRefPubMed

Agatston AS, Janowitz WR, Hildner FJ et al (1990) Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 15(4):827–832CrossRef

Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, Kondos G, Kronmal RA (2009) Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 53(4):345–352. https://doi.org/10.1016/j.jacc.2008.07.072CrossRefPubMedPubMedCentral

Demer LL, Tintut Y (2008) Vascular calcification: pathobiology of a multifaceted disease. Circulation 117(22):2938–2948. https://doi.org/10.1161/CIRCULATIONAHA.107.743161CrossRefPubMedPubMedCentral

Kataoka Y, Wolski K, Uno K et al (2012) Spotty calcification as a marker of accelerated progression of coronary atherosclerosis: insights from serial intravascular ultrasound. J Am Coll Cardiol 59(18):1592–1597. https://doi.org/10.1016/j.jacc.2012.03.012CrossRefPubMed

Criqui MH, Denenberg JO, Ix JH et al (2014) Calcium density of coronary artery plaque and risk of incident cardiovascular events. JAMA 311(3):271–278. https://doi.org/10.1001/jama.2013.282535CrossRefPubMedPubMedCentral

10.

Criqui MH, Knox JB, Denenberg JO et al (2017) Coronary artery calcium volume and density: potential interactions and overall predictive value: the multi-ethnic study of atherosclerosis. JACC Cardiovasc Imaging 10(8):845–854. https://doi.org/10.1016/j.jcmg.2017.04.018CrossRefPubMed

11.

Rennenberg RJ, Kessels AG, Schurgers LJ et al (2009) Vascular calcifications as a marker of increased cardiovascular risk: a meta-analysis. Vasc Health Risk Manag 5(1):185–197CrossRef

12.

Poterucha TJ, Goldhaber SZ (2016) Warfarin and vascular calcification. Am J Med 129(6):635e1–635e4. https://doi.org/10.1016/j.amjmed.2015.11.032CrossRef

13.

Johnson RC, Leopold JA, Loscalzo J (2006) Vascular calcification: pathobiological mechanisms and clinical implications. Circ Res 99(10):1044–1059. https://doi.org/10.1161/01.RES.0000249379.55535.21CrossRef

14.

Herrmann SM, Whatling C, Brand E et al (2000) Polymorphisms of the human matrix gla protein (MGP) gene, vascular calcification, and myocardial infarction. Arterioscler Thromb Vasc Biol 20(11):2386–2393CrossRef

15.

Sheng K, Zhang P, Lin W et al (2017) Association of Matrix Gla protein gene (rs1800801, rs1800802, rs4236) polymorphism with vascular calcification and atherosclerotic disease: a meta-analysis. Sci Rep 7(1):8713. https://doi.org/10.1038/s41598-017-09328-5CrossRefPubMedPubMedCentral

16.

Khosroshahi HE, Sahin SC, Akyuz Y et al (2014) Long term follow-up of four patients with Keutel syndrome. Am J Med Genet A 164 A(11):2849–2856. https://doi.org/10.1002/ajmg.a.36699CrossRefPubMed

17.

Munroe PB, Olgunturk RO, Fryns JP et al (1999) Mutations in the gene encoding the human matrix Gla protein cause Keutel syndrome. Nat Genet 21(1):142–144. https://doi.org/10.1038/5102CrossRefPubMed

18.

Kruger T, Oelenberg S, Kaesler N et al (2013) Warfarin induces cardiovascular damage in mice. Arterioscler Thromb Vasc Biol 33(11):2618–2624. https://doi.org/10.1161/ATVBAHA.113.302244CrossRefPubMed

19.

Lerner RG, Aronow WS, Sekhri A et al (2009) Warfarin use and the risk of valvular calcification. J Thromb Haemost 7(12):2023–2027. https://doi.org/10.1111/j.1538-7836.2009.03630.xCrossRefPubMed

20.

Andrews J, Psaltis PJ, Bayturan O et al (2017) Warfarin use is associated with progressive coronary arterial calcification: insights from serial Intravascular ultrasound. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2017.04.010CrossRefPubMed

21.

Schurgers LJ, Joosen IA, Laufer EM et al (2012) Vitamin K‑antagonists accelerate atherosclerotic calcification and induce a vulnerable plaque phenotype. PLoS ONE 7(8):e43229. https://doi.org/10.1371/journal.pone.0043229CrossRefPubMedPubMedCentral

22.

Schurgers LJ, Spronk HM, Skepper JN et al (2007) Post-translational modifications regulate matrix Gla protein function: importance for inhibition of vascular smooth muscle cell calcification. J Thromb Haemost 5(12):2503–2511. https://doi.org/10.1111/j.1538-7836.2007.02758.xCrossRefPubMed

23.

Zühlke L, Engel ME, Karthikeyan G et al (2015) Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 36(18):1115–122aCrossRef

24.

Nishimura RA, Otto CM, Bonow RO et al (2017) 2017 AHA/ACC Focused Update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation 135(25):e1159–e1195. https://doi.org/10.1161/CIR.0000000000000503CrossRefPubMed

25.

Nicholls SJ, Tuzcu EM, Wolski K et al (2007) Coronary artery calcification and changes in atheroma burden in response to established medical therapies. J Am Coll Cardiol 49(2):263–270. https://doi.org/10.1016/j.jacc.2006.10.038CrossRefPubMed

26.

Loffredo L, Perri L, Violi F (2015) Myocardial infarction and atrial fibrillation: different impact of anti-IIa vs anti-Xa new oral anticoagulants: a meta-analysis of the interventional trials. Int J Cardiol 178:8–9. https://doi.org/10.1016/j.ijcard.2014.10.124CrossRefPubMed

27.

Villines TC, O’Malley PG, Feuerstein IM et al (2009) Does prolonged warfarin exposure potentiate coronary calcification in humans? Results of the warfarin and coronary calcification study. Calcif Tissue Int 85(6):494–500. https://doi.org/10.1007/s00223-009-9300-4CrossRefPubMed

Titel: Long-term vitamin-K antagonist use and coronary artery calcification
verfasst von: S. Ünlü, MD, MSc
A. Şahinarslan, MD
H. K. Kılıç, MD
G. Gökalp, MD
B. Sezenöz, MD
G. Erbaş, MD
R. M. Yalçın, MD
M. Araç, MD
Publikationsdatum: 01.10.2018
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 6/2020
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-018-4760-9

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