Patients using vitamin K antagonists show increased levels of coronary calcification: an observational study in low-risk atrial fibrillation patients

• Published in: European heart journal Vol. 32; no. 20; pp. 2555 - 2562
• Main Authors: Weijs, Bob, Blaauw, Yuri, Rennenberg, Roger J.M.W., Schurgers, Leon J., Timmermans, Carl C.M.M., Pison, Laurent, Nieuwlaat, Robby, Hofstra, Leonard, Kroon, Abraham A., Wildberger, Joachim, Crijns, Harry J.G.M.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-10-2011
• Subjects: Aged; Atrial Fibrillation - complications; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Cardiac dysrhythmias; Cardiology. Vascular system; Coronary Artery Disease - chemically induced; Coronary Artery Disease - diagnostic imaging; Coronary heart disease; Cross-Sectional Studies; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Multidetector Computed Tomography; Pharmacology. Drug treatments; Prospective Studies; Risk Factors; Stroke - etiology; Stroke - prevention & control; Vascular Calcification - chemically induced; Vascular Calcification - diagnostic imaging; Vitamin K - antagonists & inhibitors; Calcium; Anticoagulants; Atrial fibrillation; Human; Arrhythmia; Coronary artery; Cardiovascular disease; Patient; Risk; Anticoagulant; Coronary heart disease; Excitability disorder; Low; Risk factor; Calcification; Level; Antagonist; Circulatory system; Cardiology; Vitamin K
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehr226

Aims
Vitamin K antagonists (VKA) are currently the most frequently used drug to prevent ischaemic stroke in atrial fibrillation (AF) patients. However, VKA use has been associated with increased vascular calcification. The aim of this study was to investigate the contribution of VKA use to coronary artery calcification in low-risk AF patients.
Methods and results
A prospective coronary calcium scan was performed in 157 AF patients without significant cardiovascular disease (108 males; mean age 57 ± 9 years). A total of 71 (45%) patients were chronic VKA users. The duration of VKA treatment varied between 6 and 143 months (mean 46 months). No significant differences in clinical characteristics were found between patients on VKA treatment and non-anticoagulated patients. However, median coronary artery calcium scores differed significantly between patients without and patients with VKA treatment [0, inter-quartile range (IQR) 0-40, vs. 29, IQR 0-184; P = 0.001]. Mean coronary calcium scores increased with the duration of VKA use (no VKA: 53 ± 115, 6-60 months on VKA: 90 ± 167, and >60 months on VKA: 236 ± 278; P < 0.001). Multivariable logistic regression analysis revealed that age and VKA treatment were significantly related to increased coronary calcium score.
Conclusion
Patients using VKA show increased levels of coronary calcification. Age and VKA treatment were independently related to increased coronary calcium score.