Coronary arterial calcification: A review of mechanisms, promoters and imaging

Coronary artery calcification (CAC) was once thought to be a passive, degenerative, and quiescent development of disease. However, it has now been shown to be an active process associated with atherosclerosis that is stimulated by inflammatory pathways. Calcification forms within the intimal and medial layers of the vessel wall by way of mechanisms similar to bone development. A variety of imaging modalities have been used to identify and characterize CAC, from early microcalcifications to well-developed fibroatheromas that have calcified. There are sex and race differences in prevalence and development of CAC, and medical therapies such as statin and warfarin use exhibit pro-calcific effects on the vessel wall. Effective medical treatment of CAC has yet to be established; therefore a greater understanding of the factors that induce calcification is needed to develop appropriate therapeutic strategies. (C) 2018 Elsevier Inc. All rights reserved.