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Magni V, Capra D, Cozzi A, Monti CB, Mobini N, Colarieti A, Sardanelli F. Mammography biomarkers of cardiovascular and musculoskeletal health: A review. Maturitas 2023; 167:75-81. [PMID: 36308974 DOI: 10.1016/j.maturitas.2022.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 10/09/2022] [Accepted: 10/10/2022] [Indexed: 11/07/2022]
Abstract
Breast density (BD) and breast arterial calcifications (BAC) can expand the role of mammography. In premenopause, BD is related to body fat composition: breast adipose tissue and total volume are potential indicators of fat storage in visceral depots, associated with higher risk of cardiovascular disease (CVD). Women with fatty breast have an increased likelihood of hypercholesterolemia. Women without cardiometabolic diseases with higher BD have a lower risk of diabetes mellitus, hypertension, chest pain, and peripheral vascular disease, while those with lower BD are at increased risk of cardiometabolic diseases. BAC, the expression of Monckeberg sclerosis, are associated with CVD risk. Their prevalence, 13 % overall, rises after menopause and is reduced in women aged over 65 receiving hormonal replacement therapy. Due to their distinct pathogenesis, BAC are associated with hypertension but not with other cardiovascular risk factors. Women with BAC have an increased risk of acute myocardial infarction, ischemic stroke, and CVD death; furthermore, moderate to severe BAC load is associated with coronary artery disease. The clinical use of BAC assessment is limited by their time-consuming manual/visual quantification, an issue possibly solved by artificial intelligence-based approaches addressing BAC complex topology as well as their large spectrum of extent and x-ray attenuations. A link between BD, BAC, and osteoporosis has been reported, but data are still inconclusive. Systematic, standardised reporting of BD and BAC should be encouraged.
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Affiliation(s)
- Veronica Magni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Davide Capra
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Andrea Cozzi
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
| | - Caterina B Monti
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Nazanin Mobini
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy.
| | - Anna Colarieti
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy
| | - Francesco Sardanelli
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Mangiagalli 31, 20133 Milano, Italy; Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097 San Donato Milanese, Italy.
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2
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Nudy M, Asmaro R, Jiang X, Schnatz PF. The association between incidentally found breast arterial calcification on routine screening mammography and the development of coronary artery disease and stroke: results of a 10-year prospective study. Menopause 2022; 29:1375-1380. [PMID: 36449932 DOI: 10.1097/gme.0000000000002088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE The objective of this study is to assess whether the presence of breast arterial calcifications (BACs) found on routine mammography is prospectively associated with the development of cardiovascular disease (CVD) events after 10 years of follow-up. METHODS Women presenting for screening mammography were enrolled in this prospective cohort. Baseline data were collected including history of CVD and CVD risk factors. Mammograms were assessed for the presence or absence of BAC. Participants completed questionnaires 10 years after baseline that assessed the development of CVD (coronary artery disease [CAD] and stroke) and CVD risk factors. RESULTS Of the 1,995 participants who enrolled at baseline, complete 10-year follow-up data were available for 1,039; of those, 114 (11.0%) were BAC-positive and 925 (89.0%) were BAC-negative at baseline. After controlling for age, BAC-positive women were more likely to develop CAD (odds ratio, 3.14; 95% confidence interval, 1.86-5.27; P < 0.001) compared with BAC-negative women after 10 years of follow-up. After controlling for age, BAC-positive women were more likely to have had a stroke (odds ratio, 5.10; 95% CI, 1.82-14.30) compared with BAC-negative women after 10 years. CONCLUSIONS The presence of BAC on routine screening mammography was associated with a significantly increased risk of developing CAD and stroke after 10 years of follow-up. Additional large prospective, population-based studies are needed to confirm BAC as a predictor of future CVD events and its utility in stratifying a woman's risk of CVD.
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Affiliation(s)
- Matthew Nudy
- From the Division of Cardiology, Penn State College of Medicine, Heart and Vascular Institute, Hershey, PA
| | - Ragad Asmaro
- Department of ObGyn, Reading Hospital/Tower Health; Reading, PA
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3
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Osman M, Regner S, Osman K, Shahan C, Kheiri B, Kadiyala M, Sokos G, Sengupta PP, Shapiro MD, Michos ED, Bianco C. Association Between Breast Arterial Calcification on Mammography and Coronary Artery Disease: A Systematic Review and Meta-Analysis. J Womens Health (Larchmt) 2022; 31:1719-1726. [PMID: 33826862 PMCID: PMC9836700 DOI: 10.1089/jwh.2020.8733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: Breast arterial calcification (BAC), which may be detected during screening mammography, is hypothesized to be a noninvasive imaging marker that may enhance cardiovascular risk assessment. Materials and Methods: In this systematic review and meta-analysis, we sought to assess the association between BAC and coronary artery disease (CAD) by conducting a meta-analysis. We conducted a literature search of PubMed, Scopus, Cochrane library, ClinicalTrials.gov, and conference proceedings, from inception through December 24, 2019. The outcome of interest was the presence of CAD in patients with BAC. This was reported as crude and adjusted odds ratio (OR). Results: A total of 18 studies comprising 33,494 women (mean age of 60.8 ± 3.7 years, 25% with diabetes, 57% with hypertension, and 21% with history of tobacco smoking) were included in the current meta-analysis. The prevalence of BAC among study participants was 10%. There was a statistically significant association between BAC and CAD (unadjusted OR 2.14; 95% confidence interval [CI] 1.63-2.81, p < 0.001, I2 = 76.5%). Moreover, adjusted estimates were available from 10 studies and BAC was an independent predictor of CAD (OR 2.39; 95% CI 1.68-3.41, p < 0.001, I2 = 61.7%). In the meta-regression analysis, covariates included year of publication, age, hypertension, diabetes mellitus, and history of tobacco smoking. None of these study covariates explained the heterogeneity across studies. Conclusions: BAC detected as part of screening mammography is a promising noninvasive imaging marker that may enhance CAD risk prediction in women. The clinical value of BAC for cardiovascular risk stratification merits further evaluation in large prospective studies.
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Affiliation(s)
- Mohammed Osman
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Sean Regner
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Khansa Osman
- Department of Cardiology, Michigan Health Specialist, Michigan State University, Flint, Michigan, USA
| | - Cimmie Shahan
- Department of Cardiology, Division of Radiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Babikir Kheiri
- Department of Cardiology, Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Madhavi Kadiyala
- Department of Cardiology, Michigan Health Specialist, Michigan State University, Flint, Michigan, USA
| | - George Sokos
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Partho P. Sengupta
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
| | - Michael D. Shapiro
- Department of Cardiology, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Erin D. Michos
- Department of Cardiology, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Christopher Bianco
- Department of Cardiology, West Virginia University School of Medicine, Morgantown, West Virginia, USA
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4
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Bochkareva EV, Butina EK, Bayramkulova EK, Molchanova OV, Rozhkova NI, Gavrilova NE, Drapkina OM. Prevalence and Severity of Breast Arterial Calcification on Routine Mammography. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2022. [DOI: 10.20996/1819-6446-2022-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim. To determine the frequency of detection and severity of breast arterial calcification (BAC) among women undergoing mammography on the basis of medical institutions in Moscow.Material and methods. The analysis included 4274 digital mammograms of women aged 40-93 who underwent preventive or diagnostic mammography. Standard full-format digital mammograms were performed in craniocaudal and mediolateral oblique projections. In addition to the standard diagnosis of breast disease, all mammograms were evaluated for the presence of BAC. The severity of BAC was assessed on a 12-point scale: mild 3-4 points, moderate 5-6 points, severe 7-12 points.Results. The average frequency of BAC was 10.1%, in the middle age group 50-59 years – 6.0%. The incidence of BAC increased with age, from 0.4% to 0.6% in women <50 years of age to >50% in women ≥80 years of age. A statistically significant and pronounced correlation was found between the woman's age and the presence of BAC r Pearson =0.769 (p<0.001). There was also a less noticeable but statistically significant correlation between age and severity of BAC r Spearman =0.319 (p<0.001). Regression analysis made it possible to estimate the probability of CAD depending on age. In women <50 years of age, only mild to moderate calcification occurred, while those ≥65 years of age had a significant increase in the incidence of severe CAD.Conclusion. There was an expected increase with age in both prevalence and severity of BAC. Cases of severe BAC in women younger than 65 years of age and any BAC in women younger than 50 years of age are atypical and require clarification of their association with cardiovascular and other diseases.
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Affiliation(s)
- E. V. Bochkareva
- National Medical Research Center for Therapy and Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - O. V. Molchanova
- National Medical Research Center for Therapy and Preventive Medicine
| | - N. I. Rozhkova
- The National Center of Oncology of Reproductive Organs of “P.A. Herzen Moscow Oncology Research Institute” – Branch of the National Research Radiological Center
| | | | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
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Iribarren C, Chandra M, Lee C, Sanchez G, Sam DL, Azamian FF, Cho HM, Ding H, Wong ND, Molloi S. High-sensitivity troponin I is associated with cardiovascular outcomes but not with breast arterial calcification among postmenopausal women. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 15:200157. [PMID: 36573194 PMCID: PMC9789357 DOI: 10.1016/j.ijcrp.2022.200157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Background Prior studies support the utility of high sensitivity troponin I (hsTnI) for cardiovascular disease (CVD) risk stratification among asymptomatic populations; however, only two prior studies examined women separately. The association between hsTnI and breast arterial calcification is unknown. Methods Cohort study of 2896 women aged 60-79 years recruited after attending mammography screening between 10/2012 and 2/2015. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Pre-specified endpoints were incident coronary heart disease (CHD), ischemic stroke, heart failure and its subtypes and all CVD. Results After 7.4 (SD = 1.7) years of follow-up, 51 CHD, 30 ischemic stroke and 46 heart failure events were ascertained. At a limit of detection of 1.6 ng/L, 98.3 of the cohort had measurable hsTnI concentration. HsTnI in the 4-10 ng/L range were independently associated of CHD (adjusted hazard ratio[aHR] = 2.78; 95% CI, 1.48-5.22; p = 0.002) and all CVD (aHR = 2.06; 95% CI, 1.37-3.09; p = 0.0005) and hsTnI over 10 ng/L was independently associated with CHD (aHR = 4.75; 95% CI, 1.83-12.3; p = 0.001), ischemic stroke (aHR = 3.81; 95% CI, 1.22-11.9; p = 0.02), heart failure (aHR = 3.29; 95% CI, 1.33-8.13; p = 0.01) and all CVD (aHR = 4.78; 95% CI, 2.66-8.59; p < 0.0001). No significant association was found between hsTnI and BAC. Adding hsTnI to a model containing the Pooled Cohorts Equation resulted in significant and clinical important improved calibration, discrimination (Δ Cindex = 6.5; p = 0.02) and reclassification (bias-corrected clinical NRI = 0.18; 95% CI, -0.13-0.49 after adding hsTnI categories). Conclusions Our results support the consideration of hsTnI as a risk enhancing factor for CVD in asymptomatic women that could drive preventive or therapeutic decisions.
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Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA,Corresponding author. Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, 94612, USA.
| | - Malini Chandra
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Catherine Lee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Gabriela Sanchez
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Danny L. Sam
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Farima Faith Azamian
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Hyo-Min Cho
- Medical Measurement Team, Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Nathan D. Wong
- Division of Cardiology, Department of Medicine and Department of Epidemiology, University of California Irvine, Irvine, CA, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
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6
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Montgomery GH, Schnur JB, Erblich J, Narula J, Benck K, Margolies L. Breast Arterial Calcification Rates in a Diverse, Urban Group of Screening Mammography Patients. Ann Epidemiol 2022; 75:16-20. [PMID: 36031094 DOI: 10.1016/j.annepidem.2022.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Breast arterial calcifications (BAC), detected by digital mammography are a potential marker of coronary artery disease (CAD). Past BAC research has been limited by having primarily racially and ethnically homogeneous samples, samples at higher risk for CAD, and neglecting to explore the influence of women's health factors. The purpose of this study was to evaluate the prevalence of, and factors associated with, BAC in an ethnically and racially diverse group. METHODS We conducted a retrospective chart review on 17,237 screening mammography patients. Mammography results and patient responses to a demographic and medical history questionnaire were abstracted. Logistic regression was used. RESULTS BAC prevalence was 12.3%. Age was a significant risk factor, with the odds of BAC approximately doubling every decade. Age-adjusted analyses showed: 1) higher BAC prevalence among Hispanic, Black, and Ashkenazi women; 2) lower BAC prevalence among nulliparous and pre-menopausal women, those with dense breasts and breast implants, and those currently using HRT; and 3) no association between BAC prevalence and BMI or age at menarche. CONCLUSIONS BAC prevalence differs according to age, ethnicity, race, women's health, and breast-specific factors. Communication of BAC information in clinical settings could potentially prompt women to engage in preventive care.
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Affiliation(s)
- Guy H Montgomery
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Julie B Schnur
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joel Erblich
- Center for Behavioral Oncology, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Psychology, Hunter College, City University of New York, New York, New York, USA
| | - Jagat Narula
- Department of Medicine, Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kelley Benck
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laurie Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Iribarren C, Chandra M, Lee C, Sanchez G, Sam DL, Azamian FF, Cho HM, Ding H, Wong ND, Molloi S. Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women. Circ Cardiovasc Imaging 2022; 15:e013526. [PMID: 35290077 PMCID: PMC8931858 DOI: 10.1161/circimaging.121.013526] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 02/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Breast arterial calcification (BAC), a common incidental finding in mammography, has been shown to be associated with angiographic coronary artery disease and cardiovascular disease (CVD) outcomes. We aimed to (1) examine the association of BAC presence and quantity with hard atherosclerotic CVD (ASCVD) and global CVD; (2) ascertain model calibration, discrimination and reclassification of ASCVD risk; (3) assess the joint effect of BAC presence and 10-year pooled cohorts equations risk on ASCVD. METHODS A cohort study of 5059 women aged 60-79 years recruited after attending mammography screening between October 2012 and February 2015 was conducted in a large health plan in Northern California, United States. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Prespecified end points were incident hard ASCVD and a composite of global CVD. RESULTS Twenty-six percent of women had BAC >0 mg. After a mean (SD) follow-up of 6.5 (1.6) years, we ascertained 155 (3.0%) ASCVD events and 427 (8.4%) global CVD events. In Cox regression adjusted for traditional CVD risk factors, BAC presence was associated with a 1.51 (95% CI, 1.08-2.11; P=0.02) increased hazard of ASCVD and a 1.23 (95% CI, 1.002-1.52; P=0.04) increased hazard of global CVD. While there was no evidence of dose-response association with ASCVD, a threshold effect was found for global CVD at very high BAC burden (95th percentile when BAC present). BAC status provided additional risk stratification of the pooled cohorts equations risk. We noted improvements in model calibration and reclassification of ASCVD: the overall net reclassification improvement was 0.12 (95% CI, 0.03-0.14; P=0.01) and the bias-corrected clinical-net reclassification improvement was 0.11 (95% CI, 0.01-0.22; P=0.04) after adding BAC status. CONCLUSIONS Our results indicate that BAC has potential utility for primary CVD prevention and, therefore, support the notion that BAC ought to be considered a risk-enhancing factor for ASCVD among postmenopausal women.
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Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Malini Chandra
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Catherine Lee
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Gabriela Sanchez
- Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA, USA
| | - Danny L. Sam
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA, USA
| | - Farima Faith Azamian
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Hyo-Min Cho
- Medical Measurement Team, Korea Research Institute of Standards and Science, Daejeon, South Korea
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Nathan D. Wong
- Division of Cardiology, Department of Medicine and Department of Epidemiology, University of California Irvine, Irvine, CA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, CA, USA
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Van Berkel B, Van Ongeval C, Van Craenenbroeck AH, Pottel H, De Vusser K, Evenepoel P. Prevalence, progression and implications of breast artery calcification in patients with chronic kidney disease. Clin Kidney J 2022; 15:295-302. [PMID: 35145644 PMCID: PMC8825218 DOI: 10.1093/ckj/sfab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Indexed: 12/19/2022] Open
Abstract
Breast arterial calcification (BAC) is increasingly recognized as a specific marker of medial calcification. The present retrospective observational cohort study aimed to define the prevalence, progression rate, risk factors and clinical implications of BAC in chronic kidney disease (CKD) patients across stages of disease. The presence and extent of BAC were determined on mammograms in 310 females (58.7 ± 10.8 years, Caucasian) with CKD across various stages of disease [CKD G2-5D n = 132; transplant (Tx) recipients n = 178]. In a subset of 88 patients, repeat mammography was performed, allowing us to calculate the annualized BAC rate. Overall, BAC was observed in 34.7% of the patients. BAC prevalence (P = 0.02) and BAC score (P = 0.05) increased along the progression of CKD. In the overall cohort, patients with BAC were characterized by older age, more cardiovascular disease, more inflammation, higher pulse pressure and borderline higher prevalence of diabetes and were more often treated with a vitamin K antagonist (VKA). The BAC progression rate was significantly lower in Tx patients as compared with CKD G5D. Progressors were characterized by more inflammation, worse kidney function, higher BAC score and higher serum phosphate level (Tx only) at baseline and were more often treated with a VKA. Major adverse cardiovascular event-free survival was significantly worse in Tx patients with BAC. In conclusion, BAC is common among CKD patients, progresses at a slower pace in Tx patients as compared with CKD 5D and associates with dismal cardiovascular outcomes. BAC score, kidney function, serum phosphate at baseline and VKA usage seem to be important determinants of progression.
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Affiliation(s)
- Brecht Van Berkel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Chantal Van Ongeval
- Department of Imaging and Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Amaryllis H Van Craenenbroeck
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Hans Pottel
- Department of Public Health and Primary Care, KU Leuven Kulak, Kortrijk, Belgium
| | - Katrien De Vusser
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Pieter Evenepoel
- Department of Nephrology and Renal Transplantation, University Hospitals Leuven and Laboratory of Nephrology, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
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9
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Brown AL, Wahab RA, Zhang B, Smetherman DH, Mahoney MC. Reporting and Perceptions of Breast Arterial Calcification on Mammography: A Survey of ACR Radiologists. Acad Radiol 2022; 29 Suppl 1:S192-S198. [PMID: 33610451 DOI: 10.1016/j.acra.2021.01.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES The ACR Breast Commission conducted a member survey to evaluate current practices of reporting breast arterial calcification (BAC) on mammography and to determine perceptions about the value of BAC communication and follow-up recommendations among radiologists. MATERIALS AND METHODS In September 2020, an 18-item online survey was emailed to radiologist members of the American College of Radiology (ACR). Questions included radiologist demographics, current BAC reporting practices, follow-up recommendations, and perceptions about BAC. Five-point Likert scales were used and multivariate analysis was performed. RESULTS Of 598 completed survey responses, up to 87% (522/598) of ACR radiologist members include BAC in mammogram reports. However, only 41% (212/522) of respondents report BAC 'always' or 'most of the time'. Radiologist factors significantly associated with BAC reporting include years in practice and fellowship training with those in practice longer more likely to report BAC (OR 1.10, 95% CI, [1.01-1.20], p = 0.023) and those with fellowship training less likely to report BAC (OR 0.63, 95% CI, [0.42-0.94], p = 0.024). When BAC is reported, 69% (360/522) simply indicate the presence of BAC, 23% (121/522) provide a subjective grading of BAC burden, and 1% (6/522) calculate a BAC score. Among the radiologists reporting BAC, 58% (301/522) make no subsequent recommendations, while the remainder recommend primary care follow-up (39%; 204/522), cardiology evaluation (13%; 68/522), and/or coronary calcium scoring CT (11%; 59/522). Overall, there was agreement from 66% (392/598) of respondents that BAC is a cardiovascular risk factor. However, there was no consensus on whether patients and/or providers should be informed about BAC or whether reporting of BAC should become a standardized practice in breast imaging. Older and more experienced radiologists are more likely to agree that BAC is a cardiovascular risk factor (p = 0.022), providers should be informed about BAC (p = 0.002 and 0.006), BAC reporting should be a standardized practice (p = 0.004 and 0.001), and feel more comfortable informing patients about BAC (p = 0.001 and 0.003). CONCLUSION Radiologists' reporting practices and perceptions regarding BAC are not homogeneous. Although many radiologists report BAC to varying degrees, it is not routinely reported or recommended for follow-up in mammogram reports. Experienced radiologists are more likely to include and value BAC in their breast imaging practice.
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Affiliation(s)
- Ann L Brown
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (A.L.B., R.A.W., M.C.M.).
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (A.L.B., R.A.W., M.C.M.)
| | - Bin Zhang
- Department of Epidemiology, Cincinnati Children's Medical Center, Cincinnati, Ohio (B.Z.)
| | - Dana H Smetherman
- Department of Radiology, Ochsner Health, New Orleans, Louisiana (D.H.S.)
| | - Mary C Mahoney
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, Ohio (A.L.B., R.A.W., M.C.M.)
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Iribarren C, Chandra M, Molloi S, Sanchez G, Azamian-Bidgoli F, Cho HM, Ding H, Yaffe K. Breast Arterial Calcification Is Not Associated with Mild Cognitive Impairment or Incident All-Cause Dementia Among Postmenopausal Women: The MINERVA Study. J Womens Health (Larchmt) 2020; 30:848-856. [PMID: 33290145 DOI: 10.1089/jwh.2020.8372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Since vascular risk factors are implicated in cognitive decline, and breast arterial calcification (BAC) is related to vascular risk, we postulated that BAC may be associated with cognitive impairment and dementia. Methods: We used a multiethnic cohort of 3,913 asymptomatic women 60-79 years of age recruited after mammography screening at a large health plan in 2012-2015. A BAC mass score (mg) was derived from digital mammograms. Cognitive function was measured at baseline using the Montreal Cognitive Assessment (MoCA) and incident all-cause dementia (n = 49 events; median follow-up = 5.6 years) were ascertained with validated ICD-9 and ICD-10 codes. We used cross-sectional linear regression of MoCA scores on BAC, then multinomial logistic regression predicting mild cognitive impairment not progressing to dementia and incident all-cause dementia and, finally, Cox regression of incident all-cause dementia. Results: No association by linear regression was found between MoCA scores and BAC presence in unadjusted or adjusted analysis. Women with severe (upper tertile) BAC had a MoCA score lower by 0.58 points (standard error [SE] = 0.18) relative to women with no BAC. However, this difference disappeared after multivariate adjustment. No significant associations were found in multinomial logistic regression for either BAC presence or gradation in unadjusted or adjusted analysis. No significant associations were found between BAC presence with incident all-cause dementia (fully adjusted hazard ratio = 0.74; 95% confidence interval: 0.39-1.39). Likewise, no significant association with incident all-cause dementia was noted for BAC gradation. Conclusions: Our results do not support the hypothesis that BAC presence or gradation may contribute to cognitive impairment or development of all-cause dementia.
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Affiliation(s)
- Carlos Iribarren
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Malini Chandra
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California, USA
| | - Gabriela Sanchez
- Kaiser Permanente Division of Research, Oakland, California, USA
| | - Fatemeh Azamian-Bidgoli
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California, USA
| | - Hyo-Min Cho
- Safety Measurement Institute, Korea Research Institute of Standards and Science (KRISS), Daejeon, Republic of Korea
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California, USA
| | - Kristine Yaffe
- Departments of Psychiatry and Neurology and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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11
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Breast arterial calcifications as a biomarker of cardiovascular risk: radiologists' awareness, reporting, and action. A survey among the EUSOBI members. Eur Radiol 2020; 31:958-966. [PMID: 32851451 PMCID: PMC7813731 DOI: 10.1007/s00330-020-07136-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/31/2020] [Indexed: 11/20/2022]
Abstract
Objectives To investigate the knowledge of radiologists on breast arterial calcifications (BAC) and attitude about BAC reporting, communication to women, and subsequent action. Methods An online survey was offered to EUSOBI members, with 17 questions focused on demographics, level of experience, clinical setting, awareness of BAC association with cardiovascular risk, mammographic reporting, modality of BAC assessment, and action habits. Descriptive statistics were used. Results Among 1084 EUSOBI members, 378 (34.9%) responded to the survey, 361/378 (95.5%) radiologists, 263 females (69.6%), 112 males (29.6%), and 3 (0.8%) who did not specify their gender. Of 378 respondents, 305 (80.7%) declared to be aware of BAC meaning in terms of cardiovascular risk and 234 (61.9%) to routinely include BAC in mammogram reports, when detected. Excluding one inconsistent answer, simple annotation of BAC presence was declared by 151/233 (64.8%), distinction between low versus extensive BAC burden by 59/233 (25.3%), and usage of an ordinal scale by 22/233 (9.5%) and of a cardinal scale by 1/233 (0.4%). Among these 233 radiologists reporting BAC, 106 (45.5%) declared to orally inform the woman and, in case of severe BAC burden, 103 (44.2%) to investigate cardiovascular history, and 92 (39.5%) to refer the woman to a cardiologist. Conclusion Among EUSOBI respondents, over 80% declared to be aware of BAC cardiovascular meaning and over 60% to include BAC in the report. Qualitative BAC assessment predominates. About 40% of respondents who report on BAC, in the case of severe BAC burden, investigate cardiovascular history and/or refer the woman to a cardiologist. Key Points • Of 1084 EUSOBI members, 378 (35%) participated: 81% of respondents are aware of breast arterial calcification (BAC) cardiovascular meaning and 62% include BAC in the mammogram report. • Of those reporting BAC, description of presence was declared by 65%, low versus extensive burden distinction by 25%, usage of an ordinal scale by 10%, and of a cardinal scale by 0.4%; 46% inform the woman and, in case of severe BAC burden, 44% examine cardiovascular history, and 40% refer her to a cardiologist. • European breast radiologists may be ready for large-scale studies to ascertain the role of BAC assessment in the comprehensive framework of female cardiovascular disease prevention. Electronic supplementary material The online version of this article (10.1007/s00330-020-07136-6) contains supplementary material, which is available to authorized users.
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12
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Seifi B, Javadrashid R, Seifi F, Khamanian J, Zarrintan A, Mirza-Aghazadeh-Attari M. Breast artery calcification as a predictor of coronary artery calcification: a cross-sectional study. Pol J Radiol 2020; 85:e369-e374. [PMID: 32817770 PMCID: PMC7425222 DOI: 10.5114/pjr.2020.97932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/28/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Coronary artery disease is the main cause of burden of disease in the world. Coronary calcification is seen as an aetiopathological event in the pathogenesis of cardiovascular diseases. Studies have shown that breast artery calcification, which is routinely found in mammography of elderly women, could be predictive of coronary artery calcification. MATERIAL AND METHODS In this cross-sectional study, 60 women over 40 years of age were included. All of these patients had undergone mammography after having an indication to undergo a computed tomography-angiography. Breast arterial calcification and calcium scores were determined for each patient, and the paired-t test was used to analyse the data. RESULTS The mean age of patients was 49.52 ± 8.83 years. Of these 60 women, 50% were postmenopausal and 50% were not. In 37 (61.7%) cases, mild to severe coronary calcification was observed, and 50 (83.3%) had mild to severe breast arterial calcification. There was a significant correlation between coronary calcification and breast artery calcification (p = 0.001), and there was also a significant relationship between coronary calcification and postmenopausal calcification (p < 0.001). CONCLUSIONS Breast artery calcification can be a suitable predictor for coronary artery calcification and is a valid method for predicting cardiovascular disease probability in the future.
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Affiliation(s)
- Batool Seifi
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Javadrashid
- Department of Radiology, Medical Radiation Sciences Research Group, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Seifi
- Department of Radiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jhila Khamanian
- Department of community and preventive medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Armin Zarrintan
- Medical Radiation Sciences Research Group, Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Mirza-Aghazadeh-Attari
- Medical Radiation Sciences Research Group, Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
- Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
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13
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Iribarren C, Chandra M, Molloi S, Sam D, Sanchez G, Bidgoli FA, Cho HM, Ding H, Lo JC. No Association Between Bone Mineral Density and Breast Arterial Calcification Among Postmenopausal Women. J Endocr Soc 2020; 4:bvz026. [PMID: 32064410 PMCID: PMC7009123 DOI: 10.1210/jendso/bvz026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/26/2019] [Indexed: 11/19/2022] Open
Abstract
Context The association between bone mineral density (BMD) and breast arterial calcification (BAC) remains poorly understood and controversial. Objective The objective of this article is to examine the association between BMD and BAC in a large cohort of postmenopausal women undergoing routine mammography. Design A cross-sectional analysis of baseline data from a multiethnic cohort was performed. Setting The setting for this analysis is an integrated health care delivery system in Northern California in the United States. Patients A total of 1273 women age 60 to 79 years (mean age, 67 years) were recruited within 12 months of screening mammography. Main outcome measure A BAC score (mg) was obtained from digital mammograms using a novel densitometry method. BAC presence was defined as a BAC score greater than 0 mg, and severe BAC as a BAC score greater than 20 mg. Results Overall, 53% of women had osteopenia and 21% had osteoporosis. The prevalence of BAC greater than 0 mg was 29%, 30%, and 29% among women with normal BMD, osteopenia, and osteoporosis, respectively (P = 0.98). The prevalence of BAC greater than 20 mg was 5%, 3%, and 5% among women with normal BMD, osteopenia and osteoporosis, respectively (P = .65). The odds ratios (ORs) of BAC greater than 0 mg vs BAC = 0 mg after multivariable adjustment were 1.09 (95% CI, 0.81-1.48; P = .54) for osteopenia and 0.99 (95% CI, 0.69-1.48; P = .98) for osteoporosis. The adjusted ORs for BAC greater than 20 mg vs BAC 20 mg or less were 1.03 (95% CI, 0.52-2.01; P = .93) for osteopenia and 1.89 (95 CI, 0.81-4.47; P = .14) for osteoporosis. Conclusion Our findings do not support an association of either osteopenia or osteoporosis with BAC presence or severity among postmenopausal women.
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Affiliation(s)
| | - Malini Chandra
- Kaiser Permanente Division of Research, Oakland, California
| | - Sabee Molloi
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Danny Sam
- Kaiser Permanente Santa Clara Medical Center, Santa Clara, California
| | | | - Fatemeh Azamian Bidgoli
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Hyo-Min Cho
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Huanjun Ding
- Department of Radiological Sciences, University of California Irvine School of Medicine, Irvine, California
| | - Joan C Lo
- Kaiser Permanente Division of Research, Oakland, California.,Kaiser Permanente Oakland Medical Center, Oakland, California
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14
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Quispe R, Al-Rifai M, Di Carlo PA, Michos ED, Amin NP, Kianoush S, Handy CE, McEvoy JW, Blaha MJ, Nasir K, Blumenthal RS, Tota-Maharaj R, Lima JA, Comin-Colet J, Cainzos-Achirica M. Breast Arterial Calcium. JACC Cardiovasc Imaging 2019; 12:2538-2548. [DOI: 10.1016/j.jcmg.2018.07.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/28/2018] [Accepted: 07/05/2018] [Indexed: 12/22/2022]
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15
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Bochkareva EV, Kim IV, Butina EK, Stulin ID, Trukhanov SA, Rudenko BA, Boytsov SA, Drapkina OM. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 2. Association of Breast Arterial Calcification and Cardiovascular Diseases. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-3-424-430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Prospects for the use of mammographic detection of breast arterial calcification (BAC) to improve the stratification of cardiovascular risk in the female population are of increasing interest. The purpose of the 2 part of the review is the analysis of modern literature on the relationship of the BAC with the prevalence and mortality from cardiovascular diseases (CVD). The presence of BAC on mammograms is associated with a higher likelihood of myocardial infarction, death from coronary heart disease (CHD) and CVD, as well as a 3.5-fold increase in the risk of CHD and a 5-year coronary incident (p=0.003). Women with BAC have a higher likelihood of coronary artery disease detected during angiography than women without BAC (p<0.001). Severe BAC has a stronger association with CVD than mild calcification. The association of BAC with cerebrovascular diseases and a 1.4-fold increase in the risk of ischemic stroke (p=0.004), atheromatosis of the carotid arteries and an increase in the thickness of the intima-media complex is shown. BAC is associated with atherosclerotic lesions of peripheral arteries and a decrease in the ankle-brachial index <0.9 (p=0.048). In women with chronic kidney disease, the presence of BAC indicates a 4.5-fold increase in the risk of complications associated with impaired blood flow in peripheral arteries. It is shown that the addition of BAC to the generally accepted (standard) vascular risk assessment algorithms Framingham Risk Score and Pooled Cohort Equation significantly increases the accuracy of prediction of CHD (p=0.02 and p=0.010, respectively). The detection of BAC on mammographic screening is a new promising direction for cardiovascular prophylaxis in women and opens up new opportunities for identifying groups of people with subclinical forms of CVD and high cardiovascular risk.
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Affiliation(s)
| | - I. V. Kim
- National Medical Research Center for Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Preventive Medicine
| | - I. D. Stulin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - S. A. Trukhanov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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16
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Peña JM. Thinking Outside the Heart. JACC Cardiovasc Imaging 2019; 12:1212-1214. [DOI: 10.1016/j.jcmg.2018.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 08/13/2018] [Indexed: 11/25/2022]
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17
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Bochkareva EV, Kim IV, Butina EK, Stulin ID, Trukhanov SA, Rudenko BA, Boytsov SA, Drapkina OM. Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2019. [DOI: 10.20996/1819-6446-2019-15-2-244-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - I. V. Kim
- National Medical Research Center for Preventive Medicine
| | - E. K. Butina
- National Medical Research Center for Preventive Medicine
| | - I. D. Stulin
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - S. A. Trukhanov
- A.I. Yevdokimov Moscow State University of Medicine and Dentistry
| | - B. A. Rudenko
- National Medical Research Center for Preventive Medicine
| | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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Kidney function, proteinuria and breast arterial calcification in women without clinical cardiovascular disease: The MINERVA study. PLoS One 2019; 14:e0210973. [PMID: 30653590 PMCID: PMC6336275 DOI: 10.1371/journal.pone.0210973] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 01/04/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast arterial calcification (BAC) may be a predictor of cardiovascular events and is highly prevalent in persons with end-stage kidney disease. However, few studies to date have examined the association between mild-to-moderate kidney function and proteinuria with BAC. METHODS We prospectively enrolled women with no prior cardiovascular disease aged 60 to 79 years undergoing mammography screening at Kaiser Permanente Northern California between 10/24/2012 and 2/13/2015. Urine albumin-to-creatinine ratio (uACR), along with specific laboratory, demographic, and medical data, were measured at the baseline visit. Baseline estimated glomerular filtration rate (eGFR), medication history, and other comorbidities were identified from self-report and/or electronic medical records. BAC presence and gradation (mass) was measured by digital quantification of full-field mammograms. RESULTS Among 3,507 participants, 24.5% were aged ≥70 years, 63.5% were white, 7.5% had eGFR <60 ml/min/1.73m2, with 85.7% having uACR ≥30 mg/g and 3.3% having uACR ≥300 mg/g. The prevalence of any measured BAC (>0 mg) was 27.9%. Neither uACR ≥30 mg/g nor uACR ≥300 were significantly associated with BAC in crude or multivariable analyses. Reduced eGFR was associated with BAC in univariate analyses (odds ratio 1.53, 95% CI: 1.18-2.00), but the association was no longer significant after adjustment for potential confounders. Results were similar in various sensitivity analyses that used different BAC thresholds or analytic approaches. CONCLUSIONS Among women without cardiovascular disease undergoing mammography screening, reduced eGFR and albuminuria were not significantly associated with BAC.
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Suh JW, Yun BL. Breast Arterial Calcification: A Potential Surrogate Marker for Cardiovascular Disease. J Cardiovasc Imaging 2018; 26:125-134. [PMID: 30310879 PMCID: PMC6160812 DOI: 10.4250/jcvi.2018.26.e20] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/04/2018] [Indexed: 11/22/2022] Open
Abstract
Breast arterial calcifications (BAC), frequently observed on screening mammography, have been considered as an incidental finding without increased risk for breast cancer. They are medial calcifications and therefore, are indicative of arteriosclerosis. Previous studies indicated that the risk factors of BAC partly overlap with those of cardiovascular disease (CVD), and the presence of BAC is associated with prevalent and incident CVD. This suggests that medial arterial calcification might contribute to CVD through a pathway distinct from the intimal atherosclerotic process. A recent study showed that the presence and severity of BAC are associated with the presence of coronary artery calcification or plaques on coronary computed tomography angiography in asymptomatic women aged more than 40 years. In addition, BAC provided an independent and incremental predictive value over conventional risk factors. Given that population-based mammography screening is currently recommended in asymptomatic women, the evaluation of BAC may be helpful in identifying high-risk women without additional cost or radiation exposure.
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Affiliation(s)
- Jung-Won Suh
- Department of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seongnam, Korea
| | - Bo La Yun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Radiology, Seoul National University College of Medicine, Seongnam, Korea
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