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Presence of valvular calcification predicts the response to cinacalcet: data from the ADVANCE study.
J Heart Valve Dis. 2013 May; 22(3):391-9.JH

Abstract

BACKGROUND AND AIM OF THE STUDY

Cardiac valve calcification (CVC) and coronary artery calcification (CAC) appear to be linked pathogenetically, and both are associated with a poor prognosis among patients with chronic kidney disease on dialysis (CKD-5D). Little is known, however, about factors that affect the progression of CVC and CAC.

METHODS

A post-hoc analysis was performed of the ADVANCE study to assess whether patients with CVC are more prone to CAC progression, and whether CVC predicts the response to different treatments for secondary hyperparathyroidism.

RESULTS

Subjects were randomized to treatment with either cinacalcet and low doses of vitamin D analogs or larger, varying doses of vitamin D. Among 235 subjects, aortic valve or mitral valve calcification was detected in 108 (46%) and 118 (50%), respectively; 69 subjects (29%) had calcification of both valves. CVC was associated both with baseline CAC and CAC progression (p < 0.05). Subjects with aortic valve calcification who were treated with cinacalcet and low doses of vitamin D experienced less progression of CAC than subjects given larger, varying doses of vitamin D (adjusted OR: 0.26; 95% CI: 0.10, 0.64). This effect was greater in subjects with larger CAC burden at baseline.

CONCLUSION

The study findings suggest that CVC is a predictor of CAC progression and, potentially, of greater cardiovascular vulnerability. Treatment with cinacalcet combined with low doses of vitamin D slowed the progression of CAC compared to therapy using larger, varying doses of vitamin D.

Links

clinical trials

Authors+Show Affiliations

Bellasi A
Division of Nephrology, Sant' Anna Hospital, Como, Italy.
Reiner M
No affiliation info available
Pétavy F
No affiliation info available
Goodman W
No affiliation info available
Floege J
No affiliation info available
Raggi P
No affiliation info available

MeSH

AgedBone Density Conservation AgentsCalcinosisCinacalcetCoronary VesselsDose-Response Relationship, DrugDrug MonitoringFemaleHeart ValvesHumansHyperparathyroidism, SecondaryKidney Failure, ChronicLogistic ModelsMaleMiddle AgedNaphthalenesPrognosisReceptors, Calcium-SensingRenal DialysisTreatment OutcomeVitamin D

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24151766

Clinical Trial Links

ADVANCE: Study to Evaluate Cinacalcet Plus Low Dose Vitamin D on Vascular Calcification in Subjects With Chronic Kidney Disease Receiving Hemodialysis

Citation

Bellasi, Antonio, et al. "Presence of Valvular Calcification Predicts the Response to Cinacalcet: Data From the ADVANCE Study." The Journal of Heart Valve Disease, vol. 22, no. 3, 2013, pp. 391-9.
Bellasi A, Reiner M, Pétavy F, et al. Presence of valvular calcification predicts the response to cinacalcet: data from the ADVANCE study. J Heart Valve Dis. 2013;22(3):391-9.
Bellasi, A., Reiner, M., Pétavy, F., Goodman, W., Floege, J., & Raggi, P. (2013). Presence of valvular calcification predicts the response to cinacalcet: data from the ADVANCE study. The Journal of Heart Valve Disease, 22(3), 391-9.
Bellasi A, et al. Presence of Valvular Calcification Predicts the Response to Cinacalcet: Data From the ADVANCE Study. J Heart Valve Dis. 2013;22(3):391-9. PubMed PMID: 24151766.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presence of valvular calcification predicts the response to cinacalcet: data from the ADVANCE study. AU - Bellasi,Antonio, AU - Reiner,Maureen, AU - Pétavy,Frank, AU - Goodman,William, AU - Floege,Juergen, AU - Raggi,Paolo, PY - 2013/10/25/entrez PY - 2013/10/25/pubmed PY - 2013/12/18/medline SP - 391 EP - 9 JF - The Journal of heart valve disease JO - J Heart Valve Dis VL - 22 IS - 3 N2 - BACKGROUND AND AIM OF THE STUDY: Cardiac valve calcification (CVC) and coronary artery calcification (CAC) appear to be linked pathogenetically, and both are associated with a poor prognosis among patients with chronic kidney disease on dialysis (CKD-5D). Little is known, however, about factors that affect the progression of CVC and CAC. METHODS: A post-hoc analysis was performed of the ADVANCE study to assess whether patients with CVC are more prone to CAC progression, and whether CVC predicts the response to different treatments for secondary hyperparathyroidism. RESULTS: Subjects were randomized to treatment with either cinacalcet and low doses of vitamin D analogs or larger, varying doses of vitamin D. Among 235 subjects, aortic valve or mitral valve calcification was detected in 108 (46%) and 118 (50%), respectively; 69 subjects (29%) had calcification of both valves. CVC was associated both with baseline CAC and CAC progression (p < 0.05). Subjects with aortic valve calcification who were treated with cinacalcet and low doses of vitamin D experienced less progression of CAC than subjects given larger, varying doses of vitamin D (adjusted OR: 0.26; 95% CI: 0.10, 0.64). This effect was greater in subjects with larger CAC burden at baseline. CONCLUSION: The study findings suggest that CVC is a predictor of CAC progression and, potentially, of greater cardiovascular vulnerability. Treatment with cinacalcet combined with low doses of vitamin D slowed the progression of CAC compared to therapy using larger, varying doses of vitamin D. SN - 0966-8519 UR - https://www.unboundmedicine.com/medline/citation/24151766/Presence_of_valvular_calcification_predicts_the_response_to_cinacalcet:_data_from_the_ADVANCE_study_ L2 - https://ClinicalTrials.gov/search/term=24151766 [PUBMED-IDS] DB - PRIME DP - Unbound Medicine ER -