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Luu J, Dayan N. The Duality of Screening Mammography: Advancing Women's Cardiovascular Health. Can J Cardiol 2023; 39:1951-1953. [PMID: 37748642 DOI: 10.1016/j.cjca.2023.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Affiliation(s)
- Judy Luu
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
| | - Natalie Dayan
- Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
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2
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Canan A, Ghandour AAH, Saboo SS, Rajiah PS. Opportunistic screening at chest computed tomography: literature review of cardiovascular significance of incidental findings. Cardiovasc Diagn Ther 2023; 13:743-761. [PMID: 37675086 PMCID: PMC10478026 DOI: 10.21037/cdt-23-79] [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: 02/27/2023] [Accepted: 07/14/2023] [Indexed: 09/08/2023]
Abstract
Background and Objective Several incidental cardiovascular findings are present in a routine chest computed tomography (CT) scan, many of which do not make it to the final radiology report. However, these findings have important clinical implications, particularly providing prognosis and risk-stratification for future cardiovascular events. The purpose of this article is to review the literature on these incidental cardiovascular findings in a routine chest CT and inform the radiologist on their clinical relevance. Methods A time unlimited review of PubMed and Web of Science was performed by using relevant keywords. Articles in English that involved adults were included. Key Content and Findings Coronary artery calcification (CAC) is the most common incidental cardiac finding detected in a routine chest CT and is a significant predictor of cardiovascular events. Noncoronary vascular calcifications in chest CT include aortic valve, mitral annulus, and thoracic aortic calcifications (TAC). Among these, aortic valve calcification (AVC) has the strongest association with coronary artery disease and cardiovascular events. Additional cardiac findings such as myocardial scar and left ventricular size and noncardiac findings such as thoracic fat, bone density, hepatic steatosis, and breast artery calcifications can also help in risk stratification and patient management. Conclusions The radiologist interpreting a routine chest CT should be cognizant of the incidental cardiovascular findings, which helps in the diagnosis and risk-stratification of cardiovascular disease. This will guide appropriate referral and management.
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Affiliation(s)
- Arzu Canan
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
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3
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Ibrahim M, Suleiman ME, Gandomkar Z, Tavakoli Taba A, Arnott C, Jorm L, Barraclough JY, Barbieri S, Brennan PC. Associations of Breast Arterial Calcifications with Cardiovascular Disease. J Womens Health (Larchmt) 2023; 32:529-545. [PMID: 36930147 DOI: 10.1089/jwh.2022.0394] [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: 03/18/2023] Open
Abstract
Cardiovascular diseases (CVD), including coronary artery disease (CAD), continue to be the leading cause of global mortality among women. While traditional CVD/CAD prevention tools play a significant role in reducing morbidity and mortality among both men and women, current tools for preventing CVD/CAD rely on traditional risk factor-based algorithms that often underestimate CVD/CAD risk in women compared with men. In recent years, some studies have suggested that breast arterial calcifications (BAC), which are benign calcifications seen in mammograms, may be linked to CVD/CAD. Considering that millions of women older than 40 years undergo annual screening mammography for breast cancer as a regular activity, innovative risk prediction factors for CVD/CAD involving mammographic data could offer a gender-specific and convenient solution. Such factors that may be independent of, or complementary to, current risk models without extra cost or radiation exposure are worthy of detailed investigation. This review aims to discuss relevant studies examining the association between BAC and CVD/CAD and highlights some of the issues related to previous studies' design such as sample size, population types, method of assessing BAC and CVD/CAD, definition of cardiovascular events, and other confounding factors. The work may also offer insights for future CVD risk prediction research directions using routine mammograms and radiomic features other than BAC such as breast density and macrocalcifications.
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Affiliation(s)
- Mu'ath Ibrahim
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Mo'ayyad E Suleiman
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ziba Gandomkar
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Amir Tavakoli Taba
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Clare Arnott
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Louisa Jorm
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Jennifer Y Barraclough
- Cardiovascular Program, The George Institute for Global Health, Newtown, Australia
- Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Sebastiano Barbieri
- Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia
| | - Patrick C Brennan
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Sydney, Australia
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4
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Relationship between breast arterial calcification and coronary artery disease by invasive coronary angiography in postmenopausal women. Eur J Radiol 2022; 157:110606. [DOI: 10.1016/j.ejrad.2022.110606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 10/01/2022] [Accepted: 11/08/2022] [Indexed: 11/15/2022]
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5
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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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6
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Okşul M, Şener YZ, Sarıkaya Y, Sarıkaya S, Yıldırım A, Canpolat U, Akpınar MG, Hazırolan T, Özer N, Tokgözoğlu SL. Breast artery calcification as an opportunistic predictor of cardiovascular disease. Ir J Med Sci 2022; 192:625-631. [PMID: 35971037 DOI: 10.1007/s11845-022-03127-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/05/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Atherosclerotic cardiovascular disease is still the leading cause of mortality for women. Breast cancer screening with mammography is recommended in all women aged over 40 years. AIMS Whether breast artery calcification (BAC) is associated with cardiovascular disease is not clear. We aimed to evaluate the association between BAC and the presence of coronary atherosclerosis determined by CT. METHODS All patients who underwent both mammography and coronary CT angiography between January 2010 and December 2016 were screened, and patients with a duration of less than 12 months between CT and mammography were included. RESULTS A total of 320 women were included and BAC was detected in 47 (14.6%) patients. BAC was correlated with age and CT coronary calcium score. Both the frequency of critical coronary artery stenosis (34% vs 10.6%; p = 0.001) and CT coronary calcium score (5.5 vs 0; p = 0.001) was significantly higher in patients with BAC. The absence of BAC was a strong predictor of the absence of significant coronary artery disease (p = 0.001). BAC was independently associated with all-cause mortality after excluding patients with breast cancer (HR: 5.32; p = 0.013). CONCLUSION Breast artery calcification is associated with coronary calcium score and significant coronary stenosis. A high BAC score is related to increased mortality.
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Affiliation(s)
- Metin Okşul
- Cardiology Department, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Yusuf Ziya Şener
- Cardiology Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
| | - Yasin Sarıkaya
- Radiology Department, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Sevtap Sarıkaya
- Radiology Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Arzu Yıldırım
- Cardiology Department, Medipol University Hospital, Istanbul, Turkey
| | - Uğur Canpolat
- Cardiology Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Tuncay Hazırolan
- Radiology Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Necla Özer
- Cardiology Department, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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7
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Kadıoğlu A, Bahadır S. Breast arterial calcifications as an indicator of atherosclerotic cardiovascular disease: comparative analysis of coronary computed tomography scoring systems and carotid intima-media thickness. Quant Imaging Med Surg 2022; 12:457-469. [PMID: 34993093 DOI: 10.21037/qims-21-98] [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: 01/26/2021] [Accepted: 05/27/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Breast arterial calcification (BAC) is easily detected and commonly observed on screening mammography. That is more frequent among people with diabetes, and these people are at risk of coronary artery disease. The incidence of BAC increases with advancing age. We aimed to determine whether BAC detected by mammography is associated with the development of coronary atherosclerosis in asymptomatic women. It can help reduce morbidity and mortality secondary to atherosclerotic cardiovascular disease. METHODS We included one hundred and eighty women over the age of 40 who underwent mammography screening in this multi-modality study. Mammography evaluated the presence of calcifications, the number of involved arteries, and the distribution. We questioned the patients about cardiovascular risk factors such as hypertension and diabetes. The coronary artery disease severity was assessed according to both Agatston and calcium scores on coronary computed tomography (CT). Besides, the relationship between these scores and correlation with carotid artery intima-media thickness was investigated. We stated mean and standard deviation (SD) for continuous variables and reported frequency distributions and percentages. SPSS software version 25.0 was used to perform the analysis. RESULTS Overall, 302 of 3,600 cases were positive for BAC. However, 120 of them could be included in the study by the eligibility criteria of our research. In univariate analysis, age, hyperlipidemia, DM, HT, and smoking history were risk factors that significantly affected BAC development. The impact of age and diabetes were maintained in the logistic regression analysis (P<0.005), while the significant effect of the other variables was vanished (P>0.02). Furthermore, moderate and high BAC scores were correlated with higher coronary atherosclerosis scores. CONCLUSIONS BAC may predict an additional risk factor for coronary artery disease, particularly in patients having higher scores. That may be an accurate indicator for subsequent development of coronary arterial calcifications so that it may be possible to reduce morbidity and mortality associated with coronary atherosclerosis.
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Affiliation(s)
- Aykut Kadıoğlu
- Radiology Department, Başkent University Alanya Medical Research and Training Hospital, Antalya, Turkey
| | - Suzan Bahadır
- Radiology Department, Başkent University Alanya Medical Research and Training Hospital, Antalya, Turkey
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8
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Biomarkers in metabolic syndrome. Adv Clin Chem 2022; 111:101-156. [DOI: 10.1016/bs.acc.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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9
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Zaki-Metias KM, MacLean JJ, Mergo PA, Ogunde B, Al-Hameed M, Trivax CZ. Breast Arterial Calcifications: Reporting Preferences and Impact on Screening for Coronary Artery Disease. JOURNAL OF BREAST IMAGING 2021; 3:687-693. [PMID: 38424930 DOI: 10.1093/jbi/wbab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Breast arterial calcifications (BAC) have been shown to correlate with measures of coronary artery disease risk stratification, although reporting of BAC is optional by BI-RADS guidelines. The purpose of this study is to determine referring provider preferences in BAC reporting on mammography reports and if such reporting has any impact on patient management. METHODS This study was approved by the local institutional review board. A voluntary eight-question survey regarding the preferences and outcomes of BAC reporting on mammography was distributed to 1085 primary care physicians, obstetrics and gynecologists, medical oncologists, and breast and general surgeons in our health system via a secure online platform. Data analysis including Pearson chi-square was performed with a P-value of <0.05 for significance. RESULTS A response rate of 19.1% (207/1085) was attained, with 21/207 (10.1%) of respondents indicating they do not routinely order mammograms excluded from further analysis. A total of 62.4% (116/186) of ordering physicians indicated a preference for reporting of BAC in both the body and impression of the radiology report, with 82.3% (153/186) of respondents placing importance on the quantity of atherosclerotic calcifications. Most participants (148/186, 79.6%) reported that the presence of BAC would prompt further investigation for coronary artery disease and associated risk factors. CONCLUSION The majority of responding physicians indicated a preference for detailed reporting of BAC and that such reporting would impact patient care. Understanding referring provider preferences regarding ancillary findings of BAC will allow for improved communication and value in mammography.
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Affiliation(s)
| | - Jeffrey J MacLean
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Paul A Mergo
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Barakat Ogunde
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Mohammed Al-Hameed
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
| | - Cory Z Trivax
- St. Joseph Mercy Oakland Hospital, Department of Radiology, Pontiac, MI, USA
- Huron Valley Radiology, Ypsilanti, MI, USA
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10
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Grassmann F, Yang H, Eriksson M, Azam S, Hall P, Czene K. Mammographic features are associated with cardiometabolic disease risk and mortality. Eur Heart J 2021; 42:3361-3370. [PMID: 34338750 PMCID: PMC8423470 DOI: 10.1093/eurheartj/ehab502] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/01/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023] Open
Abstract
Aims In recent years, microcalcifications identified in routine mammograms were found to be associated with cardiometabolic disease in women. Here, we aimed to systematically evaluate the association of microcalcifications and other mammographic features with cardiometabolic disease risk and mortality in a large screening cohort and to understand a potential genetic contribution. Methods and results This study included 57 867 women from a prospective mammographic screening cohort in Sweden (KARMA) and 49 583 sisters. Cardiometabolic disease diagnoses and mortality and medication were extracted by linkage to Swedish population registries with virtually no missing data. In the cardiometabolic phenome-wide association study, we found that a higher number of microcalcifications were associated with increased risk for multiple cardiometabolic diseases, particularly in women with pre-existing cardiometabolic diseases. In contrast, dense breasts were associated with a lower incidence of cardiometabolic diseases. Importantly, we observed similar associations in sisters of KARMA women, indicating a potential genetic overlap between mammographic features and cardiometabolic traits. Finally, we observed that the presence of microcalcifications was associated with increased cardiometabolic mortality in women with pre-existing cardiometabolic diseases (hazard ratio and 95% confidence interval: 1.79 [1.24–2.58], P = 0.002) while we did not find such effects in women without cardiometabolic diseases. Conclusions We found that mammographic features are associated with cardiometabolic risk and mortality. Our results strengthen the notion that a combination of mammographic features and other breast cancer risk factors could be a novel and affordable tool to assess cardiometabolic health in women attending mammographic screening.
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Affiliation(s)
- Felix Grassmann
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden.,Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Haomin Yang
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden.,Department of Epidemiology and Health Statistics, The School of Public Health, Fujian Medical University, Xuefu North Road 1, University Town, Fuzhou 350122, China
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden
| | - Shadi Azam
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12A, Stockholm 171 65, Sweden
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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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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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13
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McLenachan S, Camilleri F, Smith M, Newby DE, Williams MC. Breast arterial calcification on mammography and risk of coronary artery disease: a SCOT-HEART sub-study. Clin Radiol 2019; 74:421-428. [PMID: 30803814 PMCID: PMC6512949 DOI: 10.1016/j.crad.2019.01.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 01/22/2019] [Indexed: 01/28/2023]
Abstract
AIM To assess the prevalence of breast arterial calcification (BAC) in patients who also underwent routine surveillance mammography, and to determine the association with cardiovascular risk factors, coronary artery calcification, and coronary artery disease on coronary computed tomography angiography (CCTA). MATERIALS AND METHODS Four hundred and five female participants were identified who had undergone CCTA and subsequent mammography in the SCOT-HEART randomised controlled trial of CCTA in patients with suspected stable angina. Mammograms were assessed visually for the presence and severity of BAC. RESULTS BAC was identified in 93 (23%) patients. Patients with BAC were slightly older (63±7 versus 59±8 years, p<0.001), with a higher cardiovascular risk score (19±11 versus 16±10, p=0.022) and were more likely to be non-smokers (73% versus 49%, p<0.001). In patients with BAC, coronary artery calcification was present in 58 patients (62%; relative risk [RR] 1.26, 95% confidence intervals [CI]: 1.04, 1.53; p=0.02), non-obstructive coronary artery disease in 58 (62%; RR 1.27, 95% CI: 1.04 to 1.54, p=0.02), and obstructive coronary artery disease in 19 (20%; RR 1.62, 95% CI: 0.98, 2.66; p=0.058). Patients without BAC were very unlikely to have severe coronary artery calcification (negative predictive value 95%) but the diagnostic accuracy of BAC to identify coronary artery disease was poor (AUC 0.547). CONCLUSION Although BAC is associated with the presence and severity of coronary artery calcification, the diagnostic accuracy to identify patients with coronary artery disease or obstructive coronary artery disease is poor. Breast arterial calcification occurs in a fifth of patients referred for CCTA who tend to be older non-smokers. It is associated with higher coronary artery calcium but this is predominantly dependent on age and cardiovascular risks. Absence of breast arterial calcification excludes severe coronary artery calcification, negative predictive value of 95%.
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Affiliation(s)
- S McLenachan
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - F Camilleri
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - M Smith
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - D E Newby
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK
| | - M C Williams
- University of Edinburgh/British Heart Foundation Centre for Cardiovascular Science, Edinburgh, UK; Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK.
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Abstract
Cardiovascular disease continues to be the leading cause of death among women in the United States. One of the barriers to improving cardiovascular disease outcomes in women is the lack of reliable, effective screening modalities. Breast arterial calcification has emerged as a potential risk stratification tool. Localized deposition in the media of the artery, known as Mönckeberg medial calcific sclerosis, is notably different from the intimal atherosclerotic process commonly associated with coronary artery disease. Nonetheless, studies favor a correlation between breast arterial calcification and cardiovascular risk factors or coronary artery disease, defined as coronary artery calcification on computed tomography scan or both nonobstructive and obstructive lesions on angiography. Since a majority of women over the age of 40 undergo yearly breast cancer screening with mammography, measurement of breast arterial calcification may offer a personalized, noninvasive approach to risk-stratify women for cardiovascular disease at no additional cost or radiation. Mammography has the potential to alter the course of the leading cause of death in women, heart disease, through the evaluation of breast arterial calcification and identification of opportunities for prevention. Current evidence supports the universal reporting of breast arterial calcifications and personalized patient-provider discussions to more aggressively treat cardiac risk factors through targeted medical therapies or healthy lifestyle changes.
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Affiliation(s)
- Quan M Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego
| | - Lori B Daniels
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego
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16
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Ružičić D, Dobrić M, Vuković M, Hrnčić D, Đorđević S, Ružičić M, Aleksandrić S, Đorđević-Dikić A, Beleslin B. The correlation of SYNTAX score by coronary angiography with breast arterial calcification by digital mammography. Clin Radiol 2017; 73:454-459. [PMID: 29292048 DOI: 10.1016/j.crad.2017.12.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/21/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023]
Abstract
AIM To evaluate the hypothesis that breast arterial calcification (BAC) may predict coronary artery disease (CAD) severity. MATERIALS AND METHODS The study comprised 102 women >45 years (mean age 62±8 years) referred for digital mammography after coronary angiography. BAC was assessed using the Likert scale and CAD severity was assessed using the SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery trial) score. RESULTS In comparison to the low SYNTAX score group (≤22) patients with a intermediate-to-high SYNTAX score (>22) were older (p=0.001), they more often had hypercholesterolaemia (p<0.001), diabetes (p=0.021), and a history of smoking (p=0.048). They also had a statistically higher level of fasting blood glucose (p<0.001), glycated haemoglobin (HbA1C; p<0.001), triglycerides (p=0.002), fibrinogen (p=0.001), whereas high-density lipoprotein (HDLc) was lower than in the group with a SYNTAX score ≤22 (p=0.005). BAC was significantly higher in patients with a SYNTAX score >22 (p<0.001). At multivariate analysis, BAC (odds ratio [OR] 34.24, 95% confidence interval [CI]: 8.05-145.7, p<0.001), hypercholesterolaemia (OR 22.65, 95% CI: 4.18-122.81, p<0.001) and fibrinogen (OR 2.55, 95% CI: 1.28-5.07, p=0.008) were independent predictive factors for patients with intermediate-to-high SYNTAX score. CONCLUSIONS In women >45 years, there was a significant correlation between the severity of CAD as evaluated by the SYNTAX score and BAC as evaluated by the Likert scale. BAC, hypercholesterolaemia, and fibrinogen may be used as an additional diagnostic tool to predict the presence and severity of CAD.
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Affiliation(s)
- D Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia.
| | - M Dobrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - M Vuković
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - D Hrnčić
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, Street Višegradska 26, 11000, Belgrade, Serbia
| | - S Đorđević
- General Hospital Valjevo, Department of Radiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - M Ružičić
- General Hospital Valjevo, Department of Cardiology and Invasive Cardiology, Street Sinđelićeva 62, 14000 Valjevo, Serbia
| | - S Aleksandrić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - A Đorđević-Dikić
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
| | - B Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Street Pasterova 2, 11000 Belgrade, Serbia
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17
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Fathala A, Salem S, Alanazi F, Abunayyan D, Eldali AM, Alsugair A. Breast Arterial Calcifications on Mammography Do Not Predict Myocardial Ischemia on Myocardial Perfusion Single-Photon Emission Computed Tomography. Cardiol Res 2017; 8:220-227. [PMID: 29118884 PMCID: PMC5667709 DOI: 10.14740/cr604w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/27/2017] [Indexed: 01/25/2023] Open
Abstract
Background The aim of this study was to determine if breast arterial calcification (BAC) on mammography predicts myocardial ischemia (MI) on stress myocardial perfusion single-photon emission computed tomography (MPS). BAC is a type of medial artery calcification that can be seen incidentally on mammography, but the relationship between coronary artery calcification and MI on MPS is yet unknown. Methods A total of 435 consecutive women underwent mammography and stress MPS within 1 year of each other. BAC was quantitatively evaluated (0 - 13). Patients with known coronary artery diseases (CADs) such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), MI, positive coronary angiogram or positive MPS were excluded from the study. Risk factors for CAD were obtained from a chart review. Results The mean age was 58 ± 8 years. BAC was found in 258 (59%) of the study population. BAC-positive patients were significantly older than BAC-negative patients (P < 0.0001), there were strong associations between BAC and hypertension (P = 0.0309), chronic kidney disease (CKD) (P = 0.0001), and diabetes (P = 0.0309), but there were significant associations between BACV and hyperlipidemia, family history of CAD, and smoking (P = 0.6856, P = 0.9642, and P = 0.087, respectively). The mean score of BAC was 5 ± 5 in patients with normal MPS and was 6 ± 6 in patients with abnormal MPS. There were no associations between total BAC and MPS results (P = 0.2095), and between BAC categories and MPS result (P = 0.3069). Conclusions Based on our study, the presence and severity of BAC on screening or diagnostic mammography do not predict MI on stress MPS, and further cardiac workup based on the presence of BAC is not warranted. BAC is very common in mammography up to 59% and associated with age, diabetes, CKD, and hypertension. In contrast, the prevalence of MI is only 13% in women with BAC and associated with age, diabetes, CKD, hyperlipidemia, and impaired left ventricular function.
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Affiliation(s)
- Ahmed Fathala
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
| | - Salma Salem
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
| | - Fahad Alanazi
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
| | - Deema Abunayyan
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
| | - Abdelmoneim M Eldali
- Research Centre, Department of Biostatistics, Epidemiology and Scientific Computing, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
| | - Abdulaziz Alsugair
- Department of Radiology, Nuclear Medicine and Cardiovascular Imaging, King Faisal Specialist Hospital & Research Center, PO Box 3354, Riyadh, Saudi Arabia
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18
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Ryan AJ, Choi AD, Choi BG, Lewis JF. Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women. Clin Cardiol 2017; 40:648-653. [PMID: 28444996 DOI: 10.1002/clc.22702] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 12/19/2022] Open
Abstract
Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.
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Affiliation(s)
- Angela J Ryan
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Brian G Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Jannet F Lewis
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
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19
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Mordang JJ, Gubern-Mérida A, den Heeten G, Karssemeijer N. Reducing false positives of microcalcification detection systems by removal of breast arterial calcifications. Med Phys 2016; 43:1676. [PMID: 27036566 DOI: 10.1118/1.4943376] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In the past decades, computer-aided detection (CADe) systems have been developed to aid screening radiologists in the detection of malignant microcalcifications. These systems are useful to avoid perceptual oversights and can increase the radiologists' detection rate. However, due to the high number of false positives marked by these CADe systems, they are not yet suitable as an independent reader. Breast arterial calcifications (BACs) are one of the most frequent false positives marked by CADe systems. In this study, a method is proposed for the elimination of BACs as positive findings. Removal of these false positives will increase the performance of the CADe system in finding malignant microcalcifications. METHODS A multistage method is proposed for the removal of BAC findings. The first stage consists of a microcalcification candidate selection, segmentation and grouping of the microcalcifications, and classification to remove obvious false positives. In the second stage, a case-based selection is applied where cases are selected which contain BACs. In the final stage, BACs are removed from the selected cases. The BACs removal stage consists of a GentleBoost classifier trained on microcalcification features describing their shape, topology, and texture. Additionally, novel features are introduced to discriminate BACs from other positive findings. RESULTS The CADe system was evaluated with and without BACs removal. Here, both systems were applied on a validation set containing 1088 cases of which 95 cases contained malignant microcalcifications. After bootstrapping, free-response receiver operating characteristics and receiver operating characteristics analyses were carried out. Performance between the two systems was compared at 0.98 and 0.95 specificity. At a specificity of 0.98, the sensitivity increased from 37% to 52% and the sensitivity increased from 62% up to 76% at a specificity of 0.95. Partial areas under the curve in the specificity range of 0.8-1.0 were significantly different between the system without BACs removal and the system with BACs removal, 0.129 ± 0.009 versus 0.144 ± 0.008 (p<0.05), respectively. Additionally, the sensitivity at one false positive per 50 cases and one false positive per 25 cases increased as well, 37% versus 51% (p<0.05) and 58% versus 67% (p<0.05) sensitivity, respectively. Additionally, the CADe system with BACs removal reduces the number of false positives per case by 29% on average. The same sensitivity at one false positive per 50 cases in the CADe system without BACs removal can be achieved at one false positive per 80 cases in the CADe system with BACs removal. CONCLUSIONS By using dedicated algorithms to detect and remove breast arterial calcifications, the performance of CADe systems can be improved, in particular, at false positive rates representative for operating points used in screening.
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Affiliation(s)
- Jan-Jurre Mordang
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Albert Gubern-Mérida
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
| | - Gerard den Heeten
- The National Training Centre for Breast Cancer Screening, Nijmegen 6503 GJ, The Netherlands and Department of Radiology, Amsterdam Medical Center, Amsterdam 1100 DD, The Netherlands
| | - Nico Karssemeijer
- Diagnostic Image Analysis Group, Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen 6525 GA, The Netherlands
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20
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Zuin M, Rigatelli G, Scaranello F, Ribecco SG, Picariello C, Zuliani G, Faggian G, Zonzin P, Roncon L. Breast arterial calcifications on mammography and coronary artery disease: A new screening tool for cardiovascular disease? Int J Cardiol 2016; 220:310-1. [PMID: 27393837 DOI: 10.1016/j.ijcard.2016.06.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Marco Zuin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy; Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Gianluca Rigatelli
- Section of Adult Congenital and Adult Heart Disease, Cardiovascular Diagnosis and Endoluminal Interventions, Rovigo General Hospital, Rovigo, Italy
| | - Fiorenzo Scaranello
- Department of Radiology, Santa Maria della Misericordia Hospital Rovigo, Italy
| | | | - Claudio Picariello
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Giovanni Zuliani
- Section of Internal and Cardiopulmonary Medicine, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | | | - Pietro Zonzin
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Loris Roncon
- Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy.
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21
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Margolies L, Salvatore M, Hecht HS, Kotkin S, Yip R, Baber U, Bishay V, Narula J, Yankelevitz D, Henschke C. Digital Mammography and Screening for Coronary Artery Disease. JACC Cardiovasc Imaging 2016; 9:350-60. [DOI: 10.1016/j.jcmg.2015.10.022] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/21/2015] [Accepted: 10/05/2015] [Indexed: 11/25/2022]
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22
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Jiang X, Clark M, Singh RK, Juhn A, Schnatz PF. Association of breast arterial calcification with stroke and angiographically proven coronary artery disease: a meta-analysis. Menopause 2016; 22:136-43. [PMID: 25051292 DOI: 10.1097/gme.0000000000000300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE We conducted a meta-analysis of the current literature to deduce the strength of association between breast arterial calcification (BAC) and coronary artery disease (CAD) and/or stroke. METHODS PubMed, Google Scholar, ClinicalTrials.gov, and Ovid were searched for English-language literature up to August 2013 using the terms "breast arterial calcification," "breast vascular calcification," "coronary artery disease," "coronary heart disease," "cardiovascular disease," "abnormal coronary angiography," and "stroke." A hand search of the reference lists of key articles was performed to supplement the literature search. Our literature search revealed 75 articles for further abstract review. Limiting our search to articles that quantitatively assessed the correlation between BAC and stroke or angiographically proven CAD, we reviewed 35 full manuscripts. Of these articles, 14 were included in the final analysis. RESULTS We analyzed 10 cross-sectional studies (n = 3,952) with CAD as the primary outcome (diagnosed by coronary angiography). The odds ratio (95% CI) for CAD in those with BAC versus those without BAC is 3.86 (3.25-4.59) (P < 0.0001). For stroke, six cross-sectional studies were analyzed (n = 18,888). The odds ratio (95% CI) for stroke in those with BAC versus those without BAC is 1.54 (1.25-1.90) (P < 0.0001). CONCLUSIONS These results suggest that BAC is significantly associated with both CAD and stroke. Although more prospective studies are warranted to clarify whether BAC is truly a predictor of the future development of CAD and stroke, the concept that BAC is a benign finding is waning.
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Affiliation(s)
- Xuezhi Jiang
- From the 1Department of ObGyn, Reading Hospital, Reading, PA; 2Department of ObGyn, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA; 3Department of Internal Medicine, Reading Hospital, Reading, PA; and 4Department of Internal Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA
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23
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Newallo D, Meinel FG, Schoepf UJ, Baumann S, De Cecco CN, Leddy RJ, Vliegenthart R, Möllmann H, Hamm CW, Morris PB, Renker M. Mammographic detection of breast arterial calcification as an independent predictor of coronary atherosclerotic disease in a single ethnic cohort of African American women. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.07.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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24
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Mostafavi L, Marfori W, Arellano C, Tognolini A, Speier W, Adibi A, Ruehm SG. Prevalence of coronary artery disease evaluated by coronary CT angiography in women with mammographically detected breast arterial calcifications. PLoS One 2015; 10:e0122289. [PMID: 25856075 PMCID: PMC4391859 DOI: 10.1371/journal.pone.0122289] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/12/2015] [Indexed: 12/04/2022] Open
Abstract
To assess the correlation between breast arterial calcifications (BAC) on digital mammography and the extent of coronary artery disease (CAD) diagnosed with dual source coronary computed tomography angiography (CTA) in a population of women both symptomatic and asymptomatic for coronary artery disease. 100 consecutive women (aged 34 – 86 years) who underwent both coronary CTA and digital mammography were included in the study. Health records were reviewed to determine the presence of cardiovascular risk factors such as hypertension, hyperlipidemia, diabetes mellitus, and smoking. Digital mammograms were reviewed for the presence and degree of BAC, graded in terms of severity and extent. Coronary CTAs were reviewed for CAD, graded based on the extent of calcified and non-calcified plaque, and the degree of major vessel stenosis. A four point grading scale was used for both coronary CTA and mammography. The overall prevalence of positive BAC and CAD in the studied population were 12% and 29%, respectively. Ten of the 12 patients with moderate or advanced BAC on mammography demonstrated moderate to severe CAD as determined by coronary CTA. For all women, the positive predictive value of BAC for CAD was 0.83 and the negative predictive value was 0.78. The presence of BAC on mammography appears to correlate with CAD as determined by coronary CTA (Spearman’s rank correlation coefficient = 0.48, p<.000001). Using logistic regression, the inclusion of BAC as a feature in CAD predication significantly increased classification results (p=0.04).
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Affiliation(s)
- Leila Mostafavi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
- * E-mail:
| | - Wanda Marfori
- Department of Radiological Sciences, University of California Irvine, Irvine, CA, United States of America
| | - Cesar Arellano
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Alessia Tognolini
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - William Speier
- Medical Imaging Informatics, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Ali Adibi
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
| | - Stefan G. Ruehm
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States of America
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25
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Hendriks EJE, de Jong PA, van der Graaf Y, Mali WPTM, van der Schouw YT, Beulens JWJ. Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events. Atherosclerosis 2014; 239:11-20. [PMID: 25568948 DOI: 10.1016/j.atherosclerosis.2014.12.035] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/08/2014] [Accepted: 12/16/2014] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to evaluate and summarize the available evidence on the associations of BAC with cardiovascular risk factors and cardiovascular risk. METHODS A systematic literature review and meta-analysis were conducted. Embase and PubMed databases were searched. After critical appraisal, odds ratios were extracted from studies of moderate or good quality that examined risk factors for BAC or associations of BAC with cardiovascular disease. Random effects model meta-analyses were used to calculate pooled odds ratios and 95% confidence intervals (95%CIs). RESULTS BAC prevalence is around 12.7% among women in breast cancer screening programs. Increasing age (pooled OR 2.98 [95%CI 2.31-3.85] for every 10 years), diabetes (pooled OR: 1.88 [95%CI 1.36-2.59]) and parity as opposed to nulliparity (pooled OR 3.43 [95%CI 2.23-5.27]) are associated with higher BAC prevalence. Smoking is associated with lower BAC prevalence (pooled OR 0.48 [95%CI 0.39-0.60]). No associations were found with hypertension, obesity or dyslipidemia. Although longitudinal studies (n = 3) were scarce, BAC appear to be associated with an increased risk of cardiovascular disease events (adjusted hazard ratios for coronary heart disease ranging from 1.32 [95%CI 1.08-1.60] to 1.44 [95%CI1.02-2.05]). CONCLUSION BAC appear to be associated with an increased risk of cardiovascular disease events, while only being associated with some of the known cardiovascular risk factors, illustrating that medial arterial calcification might contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process.
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Affiliation(s)
- Eva J E Hendriks
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem P Th M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Yvonne T van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joline W J Beulens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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26
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Nicoll R, Henein MY. The predictive value of arterial and valvular calcification for mortality and cardiovascular events. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 3:1-5. [PMID: 29450162 PMCID: PMC5801264 DOI: 10.1016/j.ijchv.2014.02.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/01/2014] [Indexed: 11/16/2022]
Abstract
A review of the predictive ability of arterial and valvular calcification has shown an additive effect of calcification in more than 1 location in predicting mortality and coronary heart disease, with mitral annual calcification being a particularly strong predictor. In individual arteries and valves there is a clear association between calcification presence, extent and progression and future cardiovascular events and mortality in asymptomatic, symptomatic and high risk patients, although adjustment for calcification in other arterial beds generally renders associations non-significant. Furthermore, in acute coronary syndrome, culprit plaque is normally not calcified. This would tend to reduce the validity of calcification as a predictor and suggest that the association with cardiovascular events and mortality may not be causal. The association with stroke is less clear; carotid and intracranial artery calcification show little predictive ability, with symptomatic plaques tending to be uncalcified.
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Affiliation(s)
- Rachel Nicoll
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden.,Canterbury Christ Church University, Kent , UK
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Umea, Sweden.,Canterbury Christ Church University, Kent , UK
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