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 (CAC) scores (Agatston score) and compared 10-year atherosclerotic CV disease (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 centre, 1991-2022. Among all patients with an Agatston score in routine care, we defined a cohort with chondrocalcinosis detected before the CAC 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, s.d. 737.9) than in matched comparators (mean 297.1, s.d. 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.