From the Guidelines
Calcification on the aorta is a condition that requires prompt evaluation and management by a cardiologist to prevent serious cardiovascular events. The management of aortic calcification typically focuses on addressing underlying risk factors rather than the calcification itself. According to the 2021 guidelines 1, lifestyle modifications are essential, including adopting a heart-healthy diet low in saturated fats and sodium, regular physical activity (aim for at least 150 minutes of moderate exercise weekly), smoking cessation, and maintaining healthy weight and blood pressure levels. Medications may be prescribed depending on the specific situation, such as statins (like atorvastatin 10-80mg daily or rosuvastatin 5-40mg daily) to lower cholesterol, antihypertensives to control blood pressure, and possibly low-dose aspirin (81mg daily) for cardiovascular protection. Regular monitoring with imaging studies and blood tests is important to track progression, as aortic calcification occurs as part of atherosclerosis, where inflammation and lipid deposits in artery walls gradually harden with calcium, reducing arterial elasticity and increasing the risk of serious cardiovascular events like aneurysms or heart attacks. The presence of aortic calcium predicts the presence of coronary heart disease, and the amount of calcification directly associates with the extent of atherosclerosis, as noted in the 2010 guidelines 1. Additionally, the 2010 guidelines 1 highlight that risk factors for the development of aortic atheroma include age, sex, heredity, hypertension, diabetes mellitus, hyperlipidemia, sedentary lifestyle, smoking, and endothelial dysfunction. It is crucial to prioritize the management of these risk factors to prevent the progression of aortic calcification and reduce the risk of associated cardiovascular events. In patients with severe atherosclerosis of the aorta, calcification may be severe and diffuse, causing an eggshell appearance seen on chest x-ray or CT, also termed “porcelain aorta,” which can increase the risk of stroke and distal embolism significantly, as noted in the 2010 guidelines 1. Therefore, a comprehensive management plan that includes lifestyle modifications, medications, and regular monitoring is essential to prevent the progression of aortic calcification and reduce the risk of associated cardiovascular events. The 2014 guidelines 1 also emphasize the importance of evaluating and managing valvular heart disease, which can be associated with aortic calcification, and highlight the need for individualized management plans based on the specific clinical factors and patient preferences. Overall, the management of aortic calcification requires a multifaceted approach that prioritizes the prevention of cardiovascular events and improves quality of life.
From the Research
Calcification on Aorta
- Calcification of the aorta is a condition where calcium deposits form on the aortic valve or wall, which can lead to atherosclerosis and increase the risk of cardiovascular events 2, 3, 4, 5, 6.
- Studies have shown that statins may slow the progression of aortic sclerosis and reduce mortality, but the evidence is conflicting 2, 4.
- Angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) may also be beneficial in reducing mortality and slowing the progression of aortic stenosis, but the evidence is limited 4.
- Calcium channel blockers (CCBs) may be associated with an increased risk of all-cause mortality in patients with moderate or severe aortic stenosis 5.
- Mid-life physical activity has been shown to be inversely associated with calcification of the descending aorta, but the relationship between physical activity and coronary artery calcification is complex and U-shaped 6.
Risk Factors
- Hyperlipidemia and serum cholesterol levels have been identified as risk factors for structural valve deterioration (SVD) and calcification of the aorta 2.
- Atherosclerotic risk factors, such as hypertension, diabetes, and peripheral arterial disease, are also associated with an increased risk of calcification and cardiovascular events 3, 4, 5.
- Age and gender are also important risk factors, with older adults and men being more likely to develop calcification and cardiovascular disease 3, 4, 5, 6.
Treatment and Prevention
- Statin therapy may be beneficial in reducing mortality and slowing the progression of aortic stenosis, but the evidence is conflicting 2, 4.
- ACE-Is and ARBs may also be beneficial in reducing mortality and slowing the progression of aortic stenosis, but the evidence is limited 4.
- Physical activity and lifestyle modifications, such as a healthy diet and regular exercise, may help reduce the risk of calcification and cardiovascular disease 6.
- Surgical strategies, such as anaortic or "no-touch" techniques, may be necessary in patients with severely atherosclerotic aortas to reduce the risk of perioperative stroke and cardiovascular events 3.