Coronary artery calcium and atherosclerotic cardiovascular disease risk scores in patients with calcium pyrophosphate deposition disease

Objective: Calcium pyrophosphate deposition (CPPD) disease is associated with an increased risk for cardiovascular (CV) events. We examined the atherosclerotic burden by coronary artery calcium scores (Agatston score) and compared 10-year atherosclerotic CV (ASCVD) risk scores in patients with vs without chondrocalcinosis, a radiographic marker of CPPD.

Methods: We performed a cross-sectional analysis at an academic medical center, 1991-2022. Among all patients with an Agatston score in routine care, we defined a cohort with chondrocalcinosis detected before the coronary artery calcium scan. Comparators without chondrocalcinosis were matched 2:1 on age and sex-the primary analysis excluded statin users. We compared Agatston scores between the chondrocalcinosis cohort and comparators. We also tested for differences between cohorts in 10-year ASCVD risk score frequencies (low, borderline/intermediate, or high).

Results: 756 patients with chondrocalcinosis were matched to 1554 comparators (mean age 68 years, 53% female). CV risk factor burden was high in both cohorts, and statin use was infrequent. The unadjusted Agatston score was non-significantly higher in the chondrocalcinosis cohort (mean 359.1, SD 737.9) than in matched comparators (mean 297.1, SD 644.9) (p= 0.08). High 10-year ASCVD risk scores were significantly more common in the chondrocalcinosis cohort than comparators (p< 0.01).

Conclusion: Coronary atherosclerosis burden by CAC was not significantly different between patients with chondrocalcinosis and matched comparators, though 10-year ASCVD risk scores were higher in the chondrocalcinosis cohort, suggesting that factors beyond coronary artery calcification contribute to the increased CV event rate in patients with CPPD disease.