Calcium Begets Calcium: Progression of Coronary Artery Calcification in Asymptomatic Subjects

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Abstract
To test the hypothesis that the rate of coronary artery calcium progression is sex specific, namely, that it is greater in men than in women, and that it is age related, particularly in women. This was a retrospective study of the progression of coronary artery calcium in 217 consecutive asymptomatic subjects who underwent at least two electron-beam computed tomographic studies of the heart. Calcium in the distribution of the epicardial arteries was quantified by using both the conventional coronary artery calcium score (CCS) and the calcium volume score (CVS). Linear regression models were used to judge the joint influence of various risk factors, including sex and age, on rates of coronary artery calcium progression. This study included 103 women and 114 men. The mean interval between the subjects' first and last studies was 25 months +/- 11 (SD). Regression analyses clearly demonstrated that the amount of coronary artery calcium present at the initial study was the most important determinant of calcium progression. This was true when coronary artery calcium was quantified by using the conventional CCS (P <.001) or CVS (P <.001). Neither sex nor age was a significant predictor of coronary artery calcium progression. Among traditional risk factors, only hypertension (P =.02) and diabetes (P =.01) were significant independent factors for calcium progression. In asymptomatic subjects, the initial CCS and CVS were the most important factors that affected rate of coronary artery calcium progression. Neither age nor sex was as important as these factors in determination of coronary artery calcium progression.