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Clinical Trial
. 2017 Feb;44(2):249-258.
doi: 10.1007/s00259-016-3552-9. Epub 2016 Oct 29.

Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study

Björn A Blomberg  1   2 , Pim A de Jong  3 , Anders Thomassen  4 , Marnix G E Lam  3 , Werner Vach  5 , Michael H Olsen  6 , Willem P T M Mali  3 , Jagat Narula  7 , Abass Alavi  8 , Poul F Høilund-Carlsen  4   9
Affiliations
Clinical Trial

Thoracic aorta calcification but not inflammation is associated with increased cardiovascular disease risk: results of the CAMONA study

Björn A Blomberg et al. Eur J Nucl Med Mol Imaging. 2017 Feb.

Abstract

Purpose: Arterial inflammation and vascular calcification are regarded as early prognostic markers of cardiovascular disease (CVD). In this study we investigated the relationship between CVD risk and arterial inflammation (18F-FDG PET/CT imaging), vascular calcification metabolism (Na18F PET/CT imaging), and vascular calcium burden (CT imaging) of the thoracic aorta in a population at low CVD risk.

Methods: Study participants underwent blood pressure measurements, blood analyses, and 18F-FDG and Na18F PET/CT imaging. In addition, the 10-year risk for development of CVD, based on the Framingham risk score (FRS), was estimated. CVD risk was compared across quartiles of thoracic aorta 18F-FDG uptake, Na18F uptake, and calcium burden on CT.

Results: A total of 139 subjects (52 % men, mean age 49 years, age range 21 - 75 years, median FRS 6 %) were evaluated. CVD risk was, on average, 3.7 times higher among subjects with thoracic aorta Na18F uptake in the highest quartile compared with those in the lowest quartile of the distribution (15.5 % vs. 4.2 %; P < 0.001). CVD risk was on average, 3.7 times higher among subjects with a thoracic aorta calcium burden on CT in the highest quartile compared with those in the lowest two quartiles of the distribution (18.0 % vs. 4.9 %; P < 0.001). CVD risk was similar in subjects in all quartiles of thoracic aorta 18F-FDG uptake.

Conclusion: Our findings indicate that an unfavourable CVD risk profile is associated with marked increases in vascular calcification metabolism and vascular calcium burden of the thoracic aorta, but not with arterial inflammation.

Keywords: Arterial inflammation; Atherosclerosis; PET/CT; Vascular calcification; [18F]Fluorodeoxyglucose (18F-FDG); [18F]Sodium fluoride (Na18F).

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Conflict of interest statement

Compliance with ethical standards Funding This study was funded by the MD/PhD ‘Alexandre Suerman’ programme, University Medical Center Utrecht, Utrecht, The Netherlands, the Anna Marie and Christian Rasmussen’s Memorial Foundation, University of Southern Denmark, Odense, Denmark, and the Jørgen and Gisela Thrane’s Philanthropic Research Foundation, Broager, Denmark. Conflicts of interest None. Ethical approval All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the principles of the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent Informed consent was obtained from all individual participants included in the study.

Figures

Fig. 1
Fig. 1
Axial CT (a, c), 18F-FDG PET/CT (b), and Na18F PET/CT (d) images obtained at the same location in 69-year-old man with hypertension, a body mass index of 28 kg/m2, and a Framingham risk score of 26 %. 18F-FDG accumulation is seen in the descending thoracic aorta (b white arrowheads), but not at sites with structural calcium deposits (a, c black arrowheads). In the Na18F PET/CT image (d) active (white arrowhead) and indolent (black arrowhead) vascular calcifications are distinguished
Fig. 2
Fig. 2
a Thoracic aorta 18F-FDG activity (FDGMAX) versus thoracic aorta Na18F activity (NaFMAX). FDGMAX is not correlated with NaFMAX (Spearman’s ρ = 0.07, P = 0.427). b FDGMAX versus thoracic aorta CT calcium burden. FDGMAX is not correlated with thoracic aorta CT calcium burden (Spearman’s ρ = 0.04, P = 0.654). c NaFMAX versus thoracic aorta CT calcium burden. NaFMAX is positively correlated with thoracic aorta CT calcium burden (Spearman’s ρ = 0.42, P < 0.001). (FDGMAX and NaFMAX are the maximum activity concentrations of 18F-FDG and Na18F, respectively, adjusted for blood activity, injected dose and PET/CT technology)
Fig. 3
Fig. 3
The 10-year cardiovascular disease (CVD) risk estimated by the Framingham risk score in relation to quartiles of (a) thoracic aorta 18F-FDG activity (FDGMAX), (b) thoracic aorta Na18F activity (NaFMAX), and (c) thoracic aorta CT calcium burden. CVD risk is similar in all quartiles of thoracic aorta FDGMAX, but increases linearly with each increasing quartile of thoracic aorta NaFMAX (P < 0.001 for a linear trend) and with each increasing quartile of thoracic aorta CT calcium burden (P < 0.001 for a linear trend). s.e. standard error, μ mean
Fig. 4
Fig. 4
The 10-year cardiovascular disease (CVD) risk, estimated by the Framingham risk score, in (a) subjects with below or above average thoracic aorta 18F-FDG activity (FDGMAX) and Na18F activity (NaFMAX), (b) subjects with or without thoracic aorta CT calcium burden and below or above average FDGMAX, (c) subjects with or without thoracic aorta CT calcium burden and below or above average NaFMAX. NaFMAX and thoracic aorta CT calcium burden differentiated subjects at high and low CVD risk, whereas FDGMAX did not, μ mean
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