As we age, calcium build-up in our coronary arteries becomes increasingly common. Studies suggest that by the age of 70, 90% of men and 67% of women have experienced some degree of coronary artery calcification. This hardening of the arteries can lead to a range of cardiovascular problems, and is more likely to occur in men than women. People with metabolic syndrome, dyslipidemia, smoking, high blood pressure, chronic kidney disease, and a high baseline level of C-reactive protein are also at greater risk.
Coronary artery calcification is divided into two main subtypes: intimate and medial. Intimate calcification is associated with atherosclerotic plaque, which is present in 50% of people aged 20-29 and increases to 80% in those aged 30-39.In those aged 60-69 with symptomatic coronary artery disease, calcification is present in 50%, and stenosis (narrowing) in 60%. Double-helix computed tomography scanners are more sensitive than single-helix scanners in detecting coronary calcification due to their higher resolution and thinner cutting ability. However, traditional sectioning methodology can omit a significant amount of mineralization.
Bone morphogenetic protein 2a, a powerful osteoblastic differentiation factor, has been identified in calcified human atherosclerotic plaque. Calcification is most commonly found in advanced lesions, but can also occur in small amounts in earlier lesions that appear in the second and third decades of life. Fluoroscopy can detect moderate to large calcifications but its ability to identify small calcium deposits is low. It appears that the vessel becomes less vulnerable to rupture only when extensive calcification occurs, while the initial or intermediate stages of calcification may actually increase the vulnerability of the plaque.
A coronary artery calcification assessment can be performed regardless of the patient's ability to exercise with maximum workload and regardless of the presence of electrocardiographic abnormalities at rest. A larger multicenter study involving 431 patients with symptoms of coronary artery disease (CAD) found that the amount of calcification detected in the EBCT tests correlated with the percentage of blockage determined histomorphometrically.