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Basic Pathology of Arterial and Valvular Calcification in Humans

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Cardiovascular Calcification and Bone Mineralization

Part of the book series: Contemporary Cardiology ((CONCARD))

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Abstract

In this chapter we will characterize arterial wall calcification into three main types: (1) inflammatory/atherosclerotic (mostly intimal), (2) metabolic (mostly medial), and (3) genetic (mostly medial). Several overlapping mechanisms trigger all three types of calcification. The extent of coronary artery calcification as determined by computed tomography (CT) is being used to predict future cardiovascular events; nevertheless the contribution of coronary calcium in plaque instability is unclear. In pathologic studies, small microcalcification or spotty calcification identified by clinical CT is associated with rupture-prone unstable plaque, whereas advanced or sheet-like calcification is associated with stable plaque. Carotid artery has distinct geometry at bifurcation region that contributes to unique blood flow patterns, which lead to acceleration of atherosclerosis development. In contrast to the coronary vasculature, Mönckeberg’s medial calcification, generally observed in the peripheral arteries, leads to arterial stiffness and is accelerated in the presence of type 2 diabetes and end-stage renal disease. Both medium- to small-sized muscular arteries, including arterioles, could calcify without athrosclerotic process.

Valvular calcification including degenerative aortic valve and mitral annular calcification is frequently observed in the elderly population, especially in the developed countries. Clinical and pathologic studies suggest that atherosclerotic risk factors are also linked to valvular calcification as there are similarities between atherosclerotic and valvular calcification. Both congenital and acquired valvular diseases are associated with early progression of valvular calcification (e.g., bicuspid/unicuspid aortic valve, mitral valve prolapse, rheumatic heart disease), leading to poor clinical outcomes.

A deeper understanding of vascular and valvular calcification will allow for better risk stratification of patients and eventually to improvement of patient outcomes with the development of new therapies. In this chapter, we focus on the pathologic description of calcification involving human coronary and peripheral artery disease as well as aortic and mitral valvular calcification.

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Authors and Affiliations

  1. CVPath Institute, Inc., Gaithersburg, MD, USA

    Atsushi Sakamoto, Yu Sato, Aloke V. Finn & Renu Virmani

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  1. Atsushi Sakamoto
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  2. Yu Sato
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  4. Renu Virmani
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Correspondence to Renu Virmani .

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  1. Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Elena Aikawa

  2. Department of Biomedical Engineering, Florida International University, Miami, FL, USA

    Joshua D. Hutcheson

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Sakamoto, A., Sato, Y., Finn, A.V., Virmani, R. (2020). Basic Pathology of Arterial and Valvular Calcification in Humans. In: Aikawa, E., Hutcheson, J. (eds) Cardiovascular Calcification and Bone Mineralization. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-030-46725-8_2

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  • DOI: https://doi.org/10.1007/978-3-030-46725-8_2

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-46724-1

  • Online ISBN: 978-3-030-46725-8

  • eBook Packages: MedicineMedicine (R0)

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