The Relationship Between Renin-Angiotensin System Inhibition and Coronary Artery Calcification Evaluated by Intravascular Ultrasound

Introduction: Coronary artery calcification is significantly associated with major adverse cardiac events in patients with coronary artery disease (CAD), and severely calcified lesions are significantly associated with poor outcomes after percutaneous coronary intervention (PCI). Hypothesis: The relationship between renin-angiotensin system inhibition and coronary artery calcification is unknown. Methods: Five hundred stable CAD patients undergoing PCI were divided into none/mild and moderate/severe calcification groups according to the grade of calcification in the target lesion evaluated by intravascular ultrasound (IVUS). Calcification with a calcium arch >180° and calcium length >5 mm in the target lesion was defined as moderate/severe calcification. We examined the association between patient’s characteristics and morphology in target lesions assessed by IVUS. Results: One hundred ninety of the 500 patients (38%) showed moderate/severe calcification of the culprit lesion. In the moderate/severe calcification group, the survival rate was significantly lower, and cumulative incidence of major cardiovascular and cerebrovascular events (MACCE) was higher than in the none/mild calcification group after PCI (p=0.015 and p=0.003, respectively). Age, body mass index, hypertension, use of angiotensin-converting enzyme inhibitor (ACEI), hemodialysis, high-sensitivity C-reactive protein levels, low-density lipoprotein cholesterol levels, serum albumin levels were associated with moderate/severe calcification lesion in univariate logistic analysis, but the use of angiotensin II receptor blocker was not. Multivariate logistic analysis identified age [odds ratio (OR); 1.05, 95% confidence interval (CI): 1.02-1.08, p<0.001], use of ACEI (OR; 0.46, 95% CI: 0.23-0.91, p=0.025), and hemodialysis (OR; 6.07, 95% CI: 2.39-15.42, p<0.001) as independent factors of moderate/severe calcification lesions. A comparison of P-value for interaction of use of ACEI and hemodialysis was p=0.51. Conclusions: Using of ACEI was negatively associated with moderate/severe calcification in target lesions assessed by IVUS. ACEI may have a potential for inhibitory effect on coronary artery calcification.