Iranian Heart Journal

Iranian Heart Journal

The Correlation of Renal Artery Calcification With Coronary Artery Calcification in Iraqi Patients

Document Type : Original Article

Authors
Abdulameer Jasim Jawad al-Gburi 1
Mustafa Subhi Hussein 2
1 Department of Medicine, College of Medicine, Mustansiriyah University, Baghdad, Iraq.
2 Baquba Teaching Hospital, Diyala, Iraq.
Abstract
Background: Coronary artery disease remains the most common cause of death. Because coronary artery calcium (CAC) scores may indicate an increased risk of developing symptomatic coronary artery disease, we sought to determine whether CAC scores correlate with renal artery calcification (RAC) identified on computed tomography (CT).
 
Methods: CT was employed to determine the presence and extent of RAC and CAC in 476 patients without clinical cardiovascular disease, utilizing an Agatston scoring system. Cardiovascular risk factors, including diabetes, hypertension, dyslipidemia, family history of ischemic heart disease, and smoking, were documented for all patients.
 
Results: RAC was present in 24% of patients, with a higher frequency in men than in women (66.7% vs 51.9%; P = 0.006). The RAC score was correlated with the CAC score (r = 0.67). In a multivariable model that included standard cardiovascular disease risk variables, the presence of RAC was associated with age, current smoking, and the CAC score (OR for CAC, 1.24; P < 0.001). Specifically, a CAC score greater than 100 Agatston units (AU) was observed in 73% (84/114) of patients with RAC and 3% (12/362) of patients without RAC. A RAC score of 4 AU had a sensitivity of 87% and a specificity of 99% for predicting a CAC score greater than 100 AU.
 
Conclusions: RAC was correlated with CAC independent of conventional risk factors. RAC scoring may be used to identify patients with a CAC score greater than 100 AU, for whom statin therapy may be beneficial. (Iranian Heart Journal 2026; 27(1): 17-25)
Keywords
atherosclerosis
calcium
renal arteries
coronary artery calcium score
Agatston score

1.         Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, et al. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023;147:e93-e621.

2.         Myerburg RJ. Scientific gaps in the prediction and prevention of sudden cardiac death. J Cardiovasc Electrophysiol 2002; 13:709–23.

3.         Goff DC, Lloyd-Jones DM, Bennett G, Coady S, D’Agostino RB, Gibbons R, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:S49-73.

4.         Khot UN, Khot MB, Bajzer CT, Sapp SK, Ohman EM, Brener SJ, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290:898–904.

5.         Greenland P, Smith SC, Grundy SM. Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests. Circulation 2001; 104:1863–7.

6.         al-Gburi AJ, al-Obaidi SR. Coronary Calcification in Iraqi Middle-Aged Women With Previous Preeclampsia: A Cohort Study. IHA 2022; 23:88–96.

7.         Lakoski SG, Greenland P, Wong ND, Schreiner PJ, Herrington DM, Kronmal RA, et al. Coronary artery calcium scores and risk for cardiovascular events in women classified as “low risk” based on Framingham risk score: the multi-ethnic study of atherosclerosis (MESA). Arch Intern Med 2007; 167:2437–42.

8.         Greenland P, Bonow RO, Brundage BH, Budoff MJ, Eisenberg MJ, Grundy SM, et al. ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain: a report of the American College of Cardiology Foundation Clinical Expert Consensus Task Force (ACCF/AHA Writing Committee to Update the 2000 Expert Consensus Document on Electron Beam Computed Tomography) developed in collaboration with the Society of Atherosclerosis Imaging and Prevention and the Society of Cardiovascular Computed Tomography. Journal of the American College of Cardiology 2007; 49:378–402.

9.         Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology 2019; 73:e285-e350.

10.      Khoury Z, Schwartz R, Gottlieb S, Chenzbraun A, Stern S, Keren A. Relation of coronary artery disease to atherosclerotic disease in the aorta, carotid, and femoral arteries evaluated by ultrasound. The American journal of cardiology 1997; 80:1429–33.

11.      Fazio S, Linton MF. The inflamed plaque: cytokine production and cellular cholesterol balance in the vessel wall. The American journal of cardiology 2001; 88:12E-15E.

12.      Libby P. Vascular biology of atherosclerosis: overview and state of the art. The American journal of cardiology 2003; 91:3A-6A.

13.      Boström K. Insights into the mechanism of vascular calcification. The American journal of cardiology 2001; 88:20E-22E.

14.      Dhore CR, Cleutjens JP, Lutgens E, Cleutjens KB, Geusens PP, Kitslaar PJ, et al. Differential expression of bone matrix regulatory proteins in human atherosclerotic plaques. Arterioscler Thromb Vasc Biol 2001; 21:1998–2003.

15.      Engelse MA, Neele JM, Bronckers AL, Pannekoek H, Vries CJ de. Vascular calcification: expression patterns of the osteoblast-specific gene core binding factor alpha-1 and the protective factor matrix gla protein in human atherogenesis. Cardiovasc Res 2001; 52:281–9.

16.      Allison MA, Criqui MH, Wright CM. Patterns and risk factors for systemic calcified atherosclerosis. Arterioscler Thromb Vasc Biol 2004; 24:331–6.

17.      Allison MA, Cheung P, Criqui MH, Langer RD, Wright CM. Mitral and aortic annular calcification are highly associated with systemic calcified atherosclerosis. Circulation 2006; 113:861–6.

18.      Allison MA, DiTomasso D, Criqui MH, Langer RD, Wright CM. Renal artery calcium: relationship to systemic calcified atherosclerosis. Vasc Med 2006; 11:232–8.

19.      Johnson LW, Lozner EC, Johnson S, Krone R, Pichard AD, Vetrovec GW, et al. Coronary arteriography 1984-1987: a report of the Registry of the Society for Cardiac Angiography and Interventions. I. Results and complications. Cathet Cardiovasc Diagn 1989; 17:5–10.

20.      Al-Gburi AJJ. Iatrogenic Aortic Dissection. Medical Journal of Babylon 2022; 19:129–32.

21.      Zhang Y, Kim B-K, Chang Y, Ryu S, Cho J, Lee W-Y, et al. Thyroid hormones and coronary artery calcification in euthyroid men and women. Arterioscler Thromb Vasc Biol 2014; 34:2128–34.

22.      Al-Gburi AJ, Al-Obaidi SR, Abdullah WH. Short-term outcomes among patients with subclinical hypothyroidism undergoing primary percutaneous coronary intervention. Ghana Med J 2023; 57:37–42.

23.      Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension 2018; 71:e13-e115.

24.      Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. Journal of the American College of Cardiology 1990; 15:827–32.

25.      Demer LL, Tintut Y. Mineral exploration: search for the mechanism of vascular calcification and beyond: the 2003 Jeffrey M. Hoeg Award lecture. Arterioscler Thromb Vasc Biol 2003; 23:1739–43.

26.      Stary HC. The development of calcium deposits in atherosclerotic lesions and their persistence after lipid regression. The American journal of cardiology 2001; 88:16E-19E.

27.      Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. Journal of the American College of Cardiology 1998; 31:126–33.

28.      Freedman BI, Hsu F-C, Langefeld CD, Bowden DW, Moossavi S, Dryman BN, et al. Renal artery calcified plaque associations with subclinical renal and cardiovascular disease. Kidney International 2004; 65:2262–7.

29.      Allison MA, Lillie EO, DiTomasso D, Wright CM, Criqui MH. Renal artery calcium is independently associated with hypertension. Journal of the American College of Cardiology 2007; 50:1578–83.

30.      Tolkin L, Bursztyn M, Ben-Dov IZ, Simanovsky N, Hiller N. Incidental renal artery calcifications: a study of 350 consecutive abdominal computed tomography scans. Nephrol Dial Transplant 2009; 24:2170–5.

31.      Chiu Y-W, Adler S, Budoff M, Takasu J, Ashai J, Mehrotra R. Prevalence and prognostic significance of renal artery calcification in patients with diabetes and proteinuria. Clinical Journal of the American Society of Nephrology: CJASN 2010; 5:2093–100.

32.      Rifkin DE, Ix JH, Wassel CL, Criqui MH, Allison MA. Renal artery calcification and mortality among clinically asymptomatic adults. Journal of the American College of Cardiology 2012; 60:1079–85.

33.      Roseman DA, Hwang S-J, Manders ES, O’Donnell CJ, Upadhyay A, Hoffmann U, et al. Renal artery calcium, cardiovascular risk factors, and indexes of renal function. The American journal of cardiology 2014; 113:156–61.

34.      Thomas IC, Ratigan AR, Rifkin DE, Ix JH, Criqui MH, Budoff MJ, et al. The association of renal artery calcification with hypertension in community-living individuals: the multiethnic study of atherosclerosis. Journal of the American Society of Hypertension: JASH 2016; 10:167–74.

35.      Vashishtha D, McClelland RL, Ix JH, Rifkin DE, Jenny N, Allison M. Relation Between Calcified Atherosclerosis in the Renal Arteries and Kidney Function (from the Multi-Ethnic Study of Atherosclerosis). The American journal of cardiology 2017; 120:1434–9.

36.      Ricalde A, Allison M, Rifkin D, Shaw R. Anthropometric measures of obesity and renal artery calcification: Results from the Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2018; 271:142–7.

37.      Mitrev LV, Germaine P, Crudeli C, Santisi A, Trivedi A, van Helmond N, et al. Is Calcium Score in the Abdominal Aorta or Renal Arteries Predictive of Acute Kidney Injury After Cardiopulmonary Bypass: An Exploratory Study. Cureus 2022; 14:e31466.

38.      Dinges C, Boxhammer E, Kremser I, Gansterer K, Steindl J, Schörghofer N, et al. Can Radiological Renal Artery Parameters Predict Acute Kidney Injury in Infective Endocarditis Surgery?-From Imaging to Outcomes. Diagnostics (Basel, Switzerland) 2024; 14.

39.      Winkler NE, Galantay J, Hebeisen M, Donati TG, Stehli J, Kasel AM, et al. Pre-interventional renal artery calcification and survival after transcatheter aortic valve implantation. The international journal of cardiovascular imaging 2025; 41:113–22.

40.      Siegel CL, Ellis JH, Korobkin M, Dunnick NR. CT-detected renal arterial calcification: correlation with renal artery stenosis on angiography. AJR Am J Roentgenol 1994; 163:867–72.

41.      Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008; 358:1336–45.

42.      Al Rifai M, Al-Mallah MH, Blaha MJ, Patel J, McEvoy JW, Nasir K, et al. Epidemiology and Prognostic Implications of Coronary Artery Calcium in Asymptomatic Individuals With Prediabetes: A Multicohort Study. Diabetes Care 2024; 47:698–706.

43.      Al-Gburi AJJ. Left ventricular diastolic reserve by exercise stress echocardiography in prediabetes. Tzu Chi Med J 2023; 35:188–92.

44.      Allison MA, Wright CM. Age and gender are the strongest clinical correlates of prevalent coronary calcification (R1). Int J Cardiol 2005; 98:325–30.

45.      Wong ND, Sciammarella M, Arad Y, Miranda-Peats R, Polk D, Hachamovich R, et al. Relation of thoracic aortic and aortic valve calcium to coronary artery calcium and risk assessment. The American journal of cardiology 2003; 92:951–5.

46.      Allison MA, Wright CM. A comparison of HDL and LDL cholesterol for prevalent coronary calcification. Int J Cardiol 2004; 95:55–60.

47.      Greco BA, Breyer JA. Atherosclerotic ischemic renal disease. Am J Kidney Dis 1997; 29:167–87.

48.      Wright JR, Shurrab AE, Cheung C, Waldek S, O’Donoghue DJ, Foley RN, et al. A prospective study of the determinants of renal functional outcome and mortality in atherosclerotic renovascular disease. Am J Kidney Dis 2002; 39:1153–61.

49.      Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG. Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney International 2000; 57:2072–9.

50.      Edmonds ME. Medial arterial calcification and diabetes mellitus. Z Kardiol 2000; 89 Suppl 2:101–4.

51.      Raggi P. Cardiovascular calcification in end stage renal disease. Contrib Nephrol 2005; 149:272–8.

Iranian Heart Journal
Volume 27, Issue 1
Winter 2026
Pages 17-25