Inflammation, Calcification, and Risk Prediction in Patients with Stable Cardiovascular Disease: Beyond the Scope of Usual Care

Abstract

The number of patients with established cardiovascular disease (CVD) in a chronic phase is growing. Patients with stable CVD are at risk for recurrent cardiovascular events, and also at risk for cancer, due to shared risk factors, such as smoking and obesity. This thesis focuses on etiology and risk prediction of both recurrent cardiovascular events and cancer in patients with stable CVD, in three parts.

Inflammation is thought be one of the major shared pathways leading from common risk factors to development and progression of both CVD and cancer. In the first part of this thesis, it is shown that inflammation is a risk factor for recurrent cardiovascular events as well as cancer, markedly lung cancer, in patients with established CVD. The level of inflammation can be reduced by healthy lifestyle changes.

The second part focuses on cardiovascular calcification. Cardiovascular calcification is a multifaceted process and it is shown that the association of traditional atherosclerotic risk factors with calcification of coronary arteries, thoracic aorta, mitral annulus, and aortic valve varies. Preliminary results indicate that addition of coronary artery calcification to a risk model with traditional atherosclerotic risk factors, improves cardiovascular risk prediction in patients with stable CVD.

The third part of this thesis shows that recurrent major cardiovascular events and interventions, as well as cancer can be estimated with easily available predictors in patients with stable CVD. These estimations of a patient’s future risk, aid in emphasizing healthy lifestyle changes, and determining cardiovascular preventive treatment strategies.