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September 27, 2000

Origins and Consequences of Vascular Calcification

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(12):1515-1516. doi:10.1001/jama.284.12.1512

To the Editor: Dr Iribarren and colleagues1 provide evidence for an association between aortic arch calcification on chest radiography and coronary heart disease. However, the calcification seen on chest radiographs is a composite of both intimal and medial calcification. These are 2 pathophysiologically separate processes.2 Intimal calcification occurs within the perimeter of the internal elastic lamina as part of the atherosclerotic plaque and is often seen as discrete, punctate lesions on radiographs. It is associated with inflammatory cells, lipid, and vascular smooth muscle cells. In contrast, medial calcification occurs as an independent process in the context of aging, diabetes, end-stage renal disease, neuropathy, and a number of rare genetic syndromes. It is found in association with elastin and vascular smooth muscle cells and is often seen as linear deposits along the elastic lamellae that, when severe, resemble railroad tracks. It would be interesting to know if Iribarren et al found a difference in risk factor association between the 2 different types of calcification. One might predict that the intimal, punctate pattern of calcification would be more highly correlated with coronary heart disease because it is part of the atherosclerotic plaque.

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