Medial Arterial Calcification: An Overlooked Player in Peripheral Arterial Disease.
Peripheral arterial disease (PAD) is a global health issue that is becoming more prevalent in an aging world population. Diabetes mellitus and chronic kidney disease are also on the increase, and both are associated with accelerated vascular calcification and an unfavorable prognosis in PAD. These data challenge the traditional athero-centric view of PAD, instead pointing toward a disease process complicated by medial arterial calcification. Like atherosclerosis, aging is a potent risk factor for medial arterial calcification, and accelerated vascular aging may underpin the devastating manifestations of PAD, particularly in patients prone to calcification. Consequently, this review will attempt to dissect the relationship between medial arterial calcification and atherosclerosis in PAD and identify common as well as novel risk factors that may contribute to and accelerate progression of PAD. In this context, we focus on the complex interplay between oxidative stress, DNA damage, and vascular aging, as well as the unexplored role of neuropathy.
From the King's College London, British Heart Foundation Centre of Research Excellence, Cardiovascular Division, King's College London, London, UK.
Chin Yee
CY
Ho
From the King's College London, British Heart Foundation Centre of Research Excellence, Cardiovascular Division, King's College London, London, UK. cathy.shanahan@kcl.ac.uk.
Catherine M
CM
Shanahan
D000818:Animals; D001158:Arteries / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology; D016922:Cellular Senescence; D020219:Chondrogenesis; D004249:DNA Damage; D003929:Diabetic Neuropathies / Q000453:epidemiology / Q000473:pathology; D005786:Gene Expression Regulation; D006801:Humans; D050380:Monckeberg Medial Calcific Sclerosis / Q000453:epidemiology / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D034881:Nuclear Lamina / Q000378:metabolism / Q000473:pathology; D010012:Osteogenesis; D018384:Oxidative Stress; D058729:Peripheral Arterial Disease / Q000453:epidemiology / Q000235:genetics / Q000378:metabolism / Q000473:pathology*; D012307:Risk Factors; D015398:Signal Transduction
DNA damage; aging; calcification; neuropathy; nuclear lamina