Warfarin Use Is Associated With Progressive Coronary Arterial Calcification: Insights From Serial Intravascular Ultrasound

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dc.contributor.authorAndrews J.
dc.contributor.authorPsaltis P.J.
dc.contributor.authorBayturan O.
dc.contributor.authorShao M.
dc.contributor.authorStegman B.
dc.contributor.authorElshazly M.
dc.contributor.authorKapadia S.R.
dc.contributor.authorTuzcu E.M.
dc.contributor.authorNissen S.E.
dc.contributor.authorNicholls S.J.
dc.contributor.authorPuri R.
dc.date.accessioned2024-07-22T08:09:37Z
dc.date.available2024-07-22T08:09:37Z
dc.date.issued2018
dc.description.abstractObjectives: This study compared serial changes in coronary percent atheroma volume (PAV) and calcium index (CaI) in patients with coronary artery disease who were treated with and without warfarin. Background: Warfarin blocks the synthesis and activity of matrix Gla protein, a vitamin K–dependent inhibitor of arterial calcification. The longitudinal impact of warfarin on serial coronary artery calcification in vivo in humans is unknown. Methods: In a post hoc patient-level analysis of 8 prospective randomized trials using serial coronary intravascular ultrasound examinations, this study compared changes in PAV and CaI in matched arterial segments in patients with coronary artery disease who were treated with (n = 171) and without (n = 4,129) warfarin during an 18- to 24-month period. Results: Patients (mean age 57.9 ± 9.2 years; male 73%; prior and concomitant 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statin) use, 73% and 97%, respectively) demonstrated overall increases in PAV of 0.41 ± 0.07% (p = 0.001 compared with baseline) and in CaI (median) of 0.04 (interquartile range [IQR]: 0.00 to 0.11; p < 0.001 compared with baseline). Following propensity-weighted adjustment for clinical trial and a range of clinical, ultrasonic, and laboratory parameters, there was no significant difference in the annualized change in PAV in the presence and absence of warfarin treatment (0.33 ± 0.05% vs. 0.25 ± 0.05%; p = 0.17). A significantly greater annualized increase in CaI was observed in warfarin-treated compared with non–warfarin-treated patients (median 0.03; IQR: 0.0 to 0.08 vs. median 0.02; IQR: 0.0 to 0.06; p < 0.001). In a sensitivity analysis evaluating a 1:1 matched cohort (n = 164 per group), significantly greater annualized changes in CaI were also observed in warfarin-treated compared with non–warfarin-treated patients. In a multivariate model, warfarin was independently associated with an increasing CaI (odds ratio: 1.16; 95% confidence interval: 1.05 to 1.28; p = 0.003). Conclusions: Warfarin therapy is associated with progressive coronary atheroma calcification independent of changes in atheroma volume. The impact of these changes on plaque stability and cardiovascular outcomes requires further investigation. © 2018 American College of Cardiology Foundation
dc.identifier.DOI-ID10.1016/j.jcmg.2017.04.010
dc.identifier.issn1936878X
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/14879
dc.language.isoEnglish
dc.publisherElsevier Inc.
dc.subjectAged
dc.subjectAnticoagulants
dc.subjectCoronary Artery Disease
dc.subjectCoronary Vessels
dc.subjectDisease Progression
dc.subjectDrug Administration Schedule
dc.subjectFemale
dc.subjectHumans
dc.subjectMale
dc.subjectMiddle Aged
dc.subjectPredictive Value of Tests
dc.subjectPrognosis
dc.subjectRandomized Controlled Trials as Topic
dc.subjectRisk Factors
dc.subjectTime Factors
dc.subjectUltrasonography, Interventional
dc.subjectVascular Calcification
dc.subjectWarfarin
dc.subjectacetylsalicylic acid
dc.subjectC reactive protein
dc.subjectcreatinine
dc.subjecthigh density lipoprotein cholesterol
dc.subjecthydroxymethylglutaryl coenzyme A reductase inhibitor
dc.subjectosteocalcin
dc.subjectpioglitazone
dc.subjectrosuvastatin
dc.subjectwarfarin
dc.subjectanticoagulant agent
dc.subjectwarfarin
dc.subjectadult
dc.subjectArticle
dc.subjectcalcium index
dc.subjectcardiovascular parameters
dc.subjectcardiovascular risk
dc.subjectcohort analysis
dc.subjectcomparative study
dc.subjectcontrolled study
dc.subjectcoronary artery calcification
dc.subjectcoronary percent atheroma volume
dc.subjectcreatinine blood level
dc.subjectdisease association
dc.subjectdisease exacerbation
dc.subjectfemale
dc.subjecthuman
dc.subjectintravascular ultrasound
dc.subjectlaboratory test
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectmiddle aged
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectsensitivity analysis
dc.subjectaged
dc.subjectblood vessel calcification
dc.subjectcoronary artery disease
dc.subjectcoronary blood vessel
dc.subjectdiagnostic imaging
dc.subjectdrug administration
dc.subjectdrug effect
dc.subjectinterventional ultrasonography
dc.subjectpathology
dc.subjectpredictive value
dc.subjectprognosis
dc.subjectrandomized controlled trial (topic)
dc.subjectrisk factor
dc.subjecttime factor
dc.titleWarfarin Use Is Associated With Progressive Coronary Arterial Calcification: Insights From Serial Intravascular Ultrasound
dc.typeArticle

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