From the Guidelines
Yes, calcium absorption into coronary arteries can lead to cardiovascular events, as evidenced by the most recent study in 2021 1.
Calcium Absorption and Cardiovascular Events
Calcium deposits in arterial walls form calcified plaques that narrow blood vessels and reduce their flexibility, increasing the risk of heart attacks, strokes, and other cardiovascular complications. This process, known as coronary artery calcification, is a marker of atherosclerosis and indicates advanced vascular disease.
Key Findings
- The calcium hardens the arteries (arteriosclerosis) and contributes to plaque instability, which can trigger plaque rupture and subsequent blood clot formation that blocks blood flow to the heart muscle.
- Coronary calcium scoring using CT scans can assess this calcification and help predict cardiovascular risk, as supported by the 2019 ACC/AHA guideline 1.
- Lifestyle modifications including regular exercise, heart-healthy diet, smoking cessation, and management of conditions like diabetes and hypertension can help slow the progression of arterial calcification.
Clinical Implications
- Coronary artery calcium measurement can be a useful tool in refining risk assessment for preventive interventions, such as statin therapy, in individuals with intermediate predicted risk 1.
- The absence of coronary artery calcium can identify individuals at lower risk of ASCVD events and death over a >10-year period, and may reclassify a patient downward into a lower risk group in which preventive interventions could be postponed 1.
- Recent studies suggest that prolonged statin therapy may have procalcific effects on coronary atheromas and can increase CAC, highlighting the need for careful consideration of treatment strategies 1.
From the FDA Drug Label
Although the reduction of fatal and non-fatal strokes did not reach a pre-defined significance level (p=0.01), a favorable trend was observed with a 26% relative risk reduction (incidences of 1.7% for atorvastatin calcium and 2.3% for placebo). The primary endpoint was the occurrence of any of the major cardiovascular events: myocardial infarction, acute CHD death, unstable angina, coronary revascularization, or stroke. Atorvastatin calcium significantly reduced the rate of major cardiovascular events (primary endpoint events) (83 events in the atorvastatin calcium group vs. 127 events in the placebo group) with a relative risk reduction of 37%, HR 0. 63,95% CI (0.48,0.83) (p=0.001) Atorvastatin calcium significantly reduced the risk of stroke by 48% (21 events in the atorvastatin calcium group vs. 39 events in the placebo group), HR 0.52,95% CI (0.31,0.89) (p=0. 016) and reduced the risk of MI by 42% (38 events in the atorvastatin calcium group vs. 64 events in the placebo group), HR 0.58,95.1% CI (0.39,0.86) (p=0.007).
The calcium that is absorbed into coronary arteries can lead to cardiovascular events such as:
- Myocardial infarction
- Stroke
- Unstable angina
- Coronary revascularization However, the use of atorvastatin calcium can reduce the risk of these events by 37% 2.
From the Research
Calcium Absorption and Cardiovascular Events
- The relationship between calcium absorption into coronary arteries and cardiovascular events is complex and has been studied in various research papers 3, 4, 5, 6, 7.
- Coronary artery calcification (CAC) is a measure of atherosclerosis that predicts the risk of ischemic heart disease independent of other risk factors 5.
- Studies have shown that the presence and extent of CAC are associated with increased risk for cardiovascular events 6.
Effect of Calcium Intake on Coronary Artery Calcification
- Research suggests that high calcium intake may not increase coronary artery calcification 5.
- A study found that the mean age-adjusted coronary artery-calcification Agatston score decreased with increasing total calcium intake, although the trend was not significant after adjustment for age and other factors 5.
- Another study found that high total calcium intake was associated with a decreased risk of incident atherosclerosis over long-term follow-up, particularly if achieved without supplement use 7.
Impact of Statin Therapy on Coronary Artery Calcification
- Long-term use of statins is associated with increased likelihood of severe CAC in patients with significant smoking history 3.
- The annual rate of CAC with combination therapy with a PCSK9 inhibitor and a statin is lower than that with statin monotherapy 4.
- Statin duration of zero served as the referent control, and the relationship between statin duration and CACS remained significant after multivariate adjustment 3.
Distribution of Coronary Artery Calcification and Cardiovascular Events
- The distribution of CAC and coronary dominance as detected by cardiac computed tomography were incremental to traditional Agatston score in predicting incident major coronary heart disease (CHD) 6.
- The number of coronary arteries with CAC and the presence of CAC in the proximal dominant coronary artery were associated with major CHD events after multivariable adjustment for Framingham risk score and categories of AS 6.