Vascular calcification - a 21st century epidemic

Vascular wall calcification is an active process with complex regulation. It is contributed to by numerous mechanisms also involved in bone mineralization. Population ageing, metabolic syndrome, chronic kidney disease and diabetes mellitus are accompanied by an inc­ reased prevalence of extraosseous calcification, mainly in the aortic valve region and arterial walls. There are five basic clinical mani­ festations of vascular calcification: calcific aortic valve stenosis, medial calcific sclerosis, intimal calcification in atherosclerosis, vascu­ lar calcification in chronic kidney disease and calcific uremic arteriolopathy. These types of calcification have a significant clinical impact. More than 2% of persons over 65 years are diagnosed with aortic valve stenosis of degenerative etiology. The amount of cal­ cium deposited in the stenotic aortic valve is the best marker of the rate of aortic valve disease progression. Vascular wall calcification decreases vascular elasticity and contributes to atherosclerotic macroangiopathy. This results in decreased tissue perfusion. Medial cal­ cific sclerosis, a typical vascular condition observed in type 2 diabetes, leads to a 3-fold increase in the risk of leg amputation. In de­ veloped countries, the costs of management of the diabetic foot are currently equal to those associated with treatment of osteoporotic fractures.

Keywords: vascular calcification, atherosclerosis, calcification, osteoporosis