Clinical decision-making for vitamin K-1 and K-2 deficiency and coronary artery calcification with warfarin therapy: are diet, factor Xa inhibitors or both the answer?
Coronary artery calcification is a recognised risk factor for ischaemic heart disease and mortality. Evidence is now strong that Mönckeberg's arteriosclerosis, a form of vascular calcification, can be attributable to vitamin K deficiency, but that vitamin K-2, especially the MK-4 form from foods like cheese can be protective. Warfarin blocks the recycling of hepatic and peripheral vitamin K leading to secondary vitamin K deficiency with adverse effects on vasculature, bone, kidneys, brain and other tissues and systems (inflammatory, immune function and neoplasia at least). There is individual susceptibility to vitamin K deficiency and warfarin sensitivity, partly explicable in terms of genetic polymorphisms, epigenetics, diet and pharmacotherapy. The emergence of extensive coronary calcification in a man with atrial fibrillation treated for a decade with warfarin is described by way of illustration and to raise the present clinical management conundrums. Finally, a putative set of recommendations is provided.
Institute of Population Health Sciences, National Health Research Institutes, Miaoli County, Taiwan, Republic of China.
Mark L
ML
Wahlqvist
Kiyoshi
K
Tanaka
Bing-Hsiean
BH
Tzeng
D002114:Calcinosis / Q000209:etiology / Q000628:therapy*; D003324:Coronary Artery Disease / Q000209:etiology / Q000628:therapy*; D004032:Diet; D065427:Factor Xa Inhibitors; D006801:Humans; D008297:Male; D008875:Middle Aged; D050380:Monckeberg Medial Calcific Sclerosis / Q000209:etiology / Q000628:therapy; D010837:Vitamin K 1 / Q000008:administration & dosage; D024482:Vitamin K 2 / Q000008:administration & dosage; D014813:Vitamin K Deficiency / Q000139:chemically induced* / Q000150:complications / Q000178:diet therapy; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D065427:Factor Xa Inhibitors; D024482:Vitamin K 2; D014859:Warfarin; D010837:Vitamin K 1