Extent of arterial calcification by conventional vitamin K antagonist treatment

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  • Selma Hasific, Syddansk Universitet
  • ,
  • Kristian Altern Øvrehus, Syddansk Universitet
  • ,
  • Oke Gerke, Department of Nuclear Medicine, Odense University Hospital
  • ,
  • Jesper Hallas, Syddansk Universitet
  • ,
  • Martin Busk, Department of Cardiology, Lillebaelt Hospital, Beriderbakken 4, Vejle, Denmark.
  • ,
  • Jess Lambrechtsen, Syddansk Universitet
  • ,
  • Grazina Urbonaviciene
  • Niels Peter Rønnow Sand, Syddansk Universitet
  • ,
  • Jens Steen Nielsen, Steno Diabetes Centre Odense, Odense Patient Data Explorative Network
  • ,
  • Louise Diederichsen, Department of Rheumatology, Odense University Hospital, Odense, Denmark.
  • ,
  • Kenneth Bruun Pedersen, Syddansk Universitet
  • ,
  • Rasmus Carter-Storch, Syddansk Universitet
  • ,
  • Nivethitha Ilangkovan, Afdeling for Intern Medicin, Kolding Sygehus
  • ,
  • Hans Mickley, Syddansk Universitet
  • ,
  • Lars Melholt Rasmussen, Syddansk Universitet
  • ,
  • Jes Sandal Lindholt
  • Axel Diederichsen, Syddansk Universitet

BACKGROUND AND AIMS: Vitamin K antagonists (VKA) remain the most frequently prescribed oral anticoagulants worldwide despite the introduction of non-vitamin K antagonist oral anticoagulants (NOAC). VKA interfere with the regeneration of Vitamin K1 and K2, essential to the activation of coagulation factors and activation of matrix-Gla protein, a strong inhibitor of arterial calcifications. This study aimed to clarify whether VKA treatment was associated with the extent of coronary artery calcification (CAC) in a population with no prior cardiovascular disease (CVD).

METHODS: We collected data on cardiovascular risk factors and CAC scores from cardiac CT scans performed as part of clinical examinations (n = 9,672) or research studies (n = 14,166) in the period 2007-2017. Data on use of anticoagulation were obtained from the Danish National Health Service Prescription Database. The association between duration of anticoagulation and categorized CAC score (0, 1-99, 100-399, ≥400) was investigated by ordered logistic regression adjusting for covariates.

RESULTS: The final study population consisted of 17,254 participants with no prior CVD, of whom 1,748 and 1,144 had been treated with VKA or NOAC, respectively. A longer duration of VKA treatment was associated with higher CAC categories. For each year of VKA treatment, the odds of being in a higher CAC category increased (odds ratio (OR) = 1.032, 95%CI 1.009-1.057). In contrast, NOAC treatment duration was not associated with CAC category (OR = 1.002, 95%CI 0.935-1.074). There was no significant interaction between VKA treatment duration and age on CAC category.

CONCLUSIONS: Adjusted for cardiovascular risk factors, VKA treatment-contrary to NOAC-was associated to higher CAC category.

TidsskriftPLOS ONE
StatusUdgivet - okt. 2020

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