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Cao Q, Yang F, Lian X, Li X, Li Z. Analysis of risk factors for abdominal aortic calcification in dialysis patients and its influence on long-term recovery. J Investig Med 2023; 71:845-853. [PMID: 37485956 DOI: 10.1177/10815589231190565] [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] [Indexed: 07/25/2023]
Abstract
This study investigated the risk factors of abdominal aortic calcification (AAC) in patients with stage 5 chronic kidney disease (CKD) and the effects of AAC and different dialysis methods on the 3-year survival rate of patients with stage 5 CKD. A retrospective cohort study was conducted on stage 5 CKD patients who received dialysis treatment. The general data were collected, and all fasting venous blood samples were harvested before the first dialysis to detect biochemical markers. The AAC was evaluated by lateral abdominal X-ray. The patients were followed up with a cut-off date of March 31, 2022, with all-cause mortality as the endpoint event. A total of 205 patients were included. multivariable Cox regression analysis confirmed that AAC (hazard ratio (HR) = 2.173, 95% CI 1.029-4.588, p = 0.042), advanced age (HR = 1.061, 95% CI 1.031-1.093, p < 0.001), duration of dialysis (HR = 1.015, 95% CI 1.007-1.032, p < 0.001), diabetes (HR = 3.966, 95% CI 2.164-7.269, p < 0.001), and hypertension (HR = 1.897, 95% CI 1.089-3.303, p = 0.024) were independent risk factors for 3-year mortality. However, peritoneal dialysis (HR = 0.366, 95% CI 0.165-0.812, p = 0.013), high albumin (HR = 0.882, 95% CI 0.819-0.950, p = 0.001), and high hemoglobin (HR = 0.969, 95% CI 0.942-0.997, p = 0.031) were protective factors for 3-year mortality in stage 5 CKD patients. Increased age, long-term dialysis, high level of intact parathyroid hormone, diabetes, and hypertension are closely related to the occurrence of AAC in patients with stage 5 CKD. In addition, AAC is an independent risk factor for all-cause mortality in patients with stage 5 CKD.
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Affiliation(s)
- Qianying Cao
- Department of Nephrology, Beiiing Luhe Hospital, Capital Medical University, Beijing, China
| | - Fan Yang
- Department of Nephrology, Beiiing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiaoying Lian
- Department of Nephrology, Beiiing Luhe Hospital, Capital Medical University, Beijing, China
| | - Xiangnan Li
- Department of Geriatrics, Aerospace Center Hospital (ASCH), Beijing, China
| | - Zhongxin Li
- Department of Nephrology, Beiiing Luhe Hospital, Capital Medical University, Beijing, China
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2
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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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3
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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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Collado-Mesa F, Yepes MM, Arheart K. Breast Arterial Calcifications on Mammography: A Survey of Practicing Radiologists. JOURNAL OF BREAST IMAGING 2021; 3:438-447. [PMID: 38424788 DOI: 10.1093/jbi/wbab009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE To explore current practice patterns of reporting and issuing recommendations based on the presence of breast arterial calcifications on mammography and existing knowledge of their prevalence and associated factors. METHODS An online anonymous 19-question survey was distributed to 2583 practicing radiologists who were members of the Society of Breast Imaging. Questions covered demographics, breast imaging training, practice type, and knowledge regarding the epidemiology and potential clinical significance of breast arterial calcifications detected on mammograms. Differences between groups were calculated using the chi-square test or Fisher exact test. An α level of 0.05 was used to determine statistical significance. RESULTS Response rate was 22% (364/1662). The median age of respondents was 51 years (range: 29-76) and most were female (248/323, 77%). The most prevalent characteristics among respondents were as follows: 69% (223/323) had completed a breast imaging fellowship, 55% (179/323) were in private practice, 49% (158/323) practiced dedicated breast imaging, and 38% (124/323) had been in practice for more than 20 years. The prevalence of breast arterial calcifications was correctly estimated to be 1%-30% by 39% (125/323) of respondents. Most respondents correctly recognized the growing evidence of an association between breast arterial calcifications and coronary artery disease (275/323, 85%). However, only 15% (48/323) always reported the presence of these calcifications, and of those who report them at any time, only 0.7% (2/274) always issued recommendations. CONCLUSION There are differences in both knowledge of the epidemiology of breast arterial calcifications and practices around their reporting amongst breast radiologists.
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Affiliation(s)
- Fernando Collado-Mesa
- University of Miami Miller School of Medicine, Department of Radiology, Miami, FL, USA
| | - Monica M Yepes
- University of Miami Miller School of Medicine, Department of Radiology, Miami, FL, USA
| | - Kristopher Arheart
- University of Miami Miller School of Medicine, Department of Public Health Sciences, Miami, FL, USA
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AlGhamdi M, Abdel-Mottaleb M, Collado-Mesa F. DU-Net: Convolutional Network for the Detection of Arterial Calcifications in Mammograms. IEEE TRANSACTIONS ON MEDICAL IMAGING 2020; 39:3240-3249. [PMID: 32324546 DOI: 10.1109/tmi.2020.2989737] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Breast arterial calcifications (BACs) are part of several benign findings present on some mammograms. Previous studies have indicated that BAC may provide evidence of general atherosclerotic vascular disease, and potentially be a useful marker of cardiovascular disease (CVD). Currently, there is no technique in use for the automatic detection of BAC in mammograms. Since a majority of women over the age of 40 already undergo breast cancer screening with mammography, detecting BAC may offer a method to screen women for CVD in a way that is effective, efficient, and broad reaching, at no additional cost or radiation. In this paper, we present a deep learning approach for detecting BACs in mammograms. Inspired by the promising results achieved using the U-Net model in many biomedical segmentation problems and the DenseNet in semantic segmentation, we extend the U-Net model with dense connectivity to automatically detect BACs in mammograms. The presented model helps to facilitate the reuse of computation and improve the flow of gradients, leading to better accuracy and easier training of the model. We evaluate the performance using a set of full-field digital mammograms collected and prepared for this task from a publicly available dataset. Experimental results demonstrate that the presented model outperforms human experts as well as the other related deep learning models. This confirms the effectiveness of our model in the BACs detection task, which is a promising step in providing a cost-effective risk assessment tool for CVD.
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Is breast arterial calcification associated with coronary artery disease?-A systematic review and meta-analysis. PLoS One 2020; 15:e0236598. [PMID: 32722699 PMCID: PMC7386618 DOI: 10.1371/journal.pone.0236598] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/08/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is increasing evidence that breast arterial calcification (BAC), an incidental finding on 3-29% of mammograms, could be used to screen for coronary artery disease (CAD). We conducted a systematic review to assess the associations between BAC and CAD and its risk factors (hypertension, hypercholesterolemia, diabetes mellitus and smoking). METHODS AND FINDINGS MEDLINE and EMBASE databases and references of relevant papers were searched up to 18 February 2020 for English language studies that evaluated the associations of BAC and CAD and its risk factors. A single reviewer extracted all data and assessed study quality with verification by another independent reviewer, if required. Across 31 studies (n = 35,583; 3 longitudinal and 28 cross-sectional studies) that examined the association of BAC and CAD, the OR was 2.61 (95% CI 2.12-3.21; I2 = 71%). Sub-analysis of studies that graded BAC severity using the 4- (4 studies) or 12-point scale systems (3 studies) revealed an association with CAD and moderate-severe BAC (OR 4.83 (95%CI 1.50-15.54) and OR 2.95 (95%CI 1.49-5.84), respectively) but not mild BAC (OR 2.04 (95%CI 0.82-5.05) and OR 1.08 (95%CI 0.42-2.75), respectively). BAC was associated with hypertension (42 studies; n = 32,646; OR 1.80; 95% CI 1.47-2.21; I2 = 85%) and diabetes mellitus (51 studies; n = 53,464; OR 2.17; 95% CI 1.82-2.59; I2 = 75%) but not with hypercholesterolemia (OR 1.31; 95%CI 0.97-1.77; I2 = 67%). Smoking was inversely associated with BAC (35 studies; n = 40,002; OR 0.54; 95% CI 0.42-0.70; I2 = 83%). Studies mostly included symptomatic women. Marked heterogeneity existed and publication bias may be present. CONCLUSIONS BAC is associated with CAD, diabetes mellitus and hypertension and inversely associated with smoking. Whether BAC could screen for CAD cannot be determined from current published data due to the lack of larger prospective studies. A consensus approach to quantifying BAC may also facilitate further translation into clinical care. PROSPERO: CRD42020141644.
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Ma D, Yan H, Yang X, Yu Z, Ni Z, Fang W. Abdominal aortic calcification score as a predictor of clinical outcome in peritoneal dialysis patients: a prospective cohort study. BMC Nephrol 2020; 21:151. [PMID: 32349690 PMCID: PMC7191690 DOI: 10.1186/s12882-020-01822-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/21/2020] [Indexed: 12/11/2022] Open
Abstract
Background Abdominal aortic calcification assessed by X-ray is recommended to evaluate vascular calcification in dialysis patients. It has been shown that abdominal aortic calcification score (AACS) is a predictor of adverse outcomes in hemodialysis patients, but evidence regarding its prognostic value in peritoneal dialysis (PD) patients is still insufficient. We aimed to examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE) and mortality in PD patients. Methods Eligible patients undergoing PD between July 2011 and July 2014 were recruited. AACS was quantified using lateral lumbar radiography at recruitment. Patients were prospectively followed up until death, PD cessation, or to the end of the study (August 31, 2018). Both subdistribution hazards and cause-specific hazards models were used to evaluate the association between AACS and MACCE as well as mortality. Results 292 patients were enrolled, including 160 males (54.8%) with mean age 57.1 ± 15.2 years and median PD duration 28.4 (IQR 12.0, 57.8) months. Among them, 75 (25.7%) patients were comorbid with diabetes, and 94 (32.2%) patients had cardiovascular disease (CVD). The average AACS was 2.0 (0.0, 6.0). Patients were categorized on the tertiles of AACS (Low AACS group, AACS = 0, n = 125; Medium AACS group, AACS 1–4, n = 72; and High AACS group, AACS> 4, n = 95). AACS was associated with age (OR = 1.081, P < 0.001), PD duration (OR = 1.012, P = 0.003), CVD (OR = 1.919, P = 0.020) and diabetes (OR = 2.554, P = 0.002). During the follow-up period of 43.6 (24.6, 50.7) months, there were 65 MACCEs and 84 deaths. Significantly higher cumulative incidences of all-cause mortality (Log-rank = 35.992, P<0.001; Gray = 38.662, P < 0.001) and MACCE (Log-rank = 26.146, P<0.001; Gray = 27.810, P < 0.001) were observed in the upper AACS tertile. AACS was an independent predictor of all-cause mortality (HR = 2.438, 95% CI 1.246–4.772, P = 0.009; SHR = 2.323, 95%CI 1.229–4.389, P = 0.009) and MACCE (HR = 3.455, 95% CI 1.734–6.884, P < 0.001; SHR = 3.063, 95%CI 1.460–6.430, P = 0.003) in this study. Conclusions AACS was associated with age, PD duration, CVD and diabetes in PD patients. AACS could predict MACCE and all-cause mortality in this population. It thus might be a safe and feasible method to identify PD patients with adverse outcomes.
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Affiliation(s)
- Dahua Ma
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Hao Yan
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Xiaoxiao Yang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zanzhe Yu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China.,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China
| | - Wei Fang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160, Pujian Road, Pudong District, Shanghai, 200127, People's Republic of China. .,Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
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Yildiz A, Yildiz S, Toprak H, Kocas C. Correlation between Breast Arterial Calcification and the 10-year fatal cardiovascular risk by means of the SCORE Risk System. Pak J Med Sci 2018; 34:1341-1346. [PMID: 30559782 PMCID: PMC6290236 DOI: 10.12669/pjms.346.16031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objectives: The aim of this study was to investigate the relationship between Breast Arterial Calcification (BAC) on mammography and the 10-year fatal Cardiovascular Disease (CVD) risk by using SCORE risk system. Methods: The study was conducted from September 2013 to July 2014. A total of 66 women with BAC and 66 age-matched controls without BAC were analyzed. The groups were compared with respect to demographics, clinical, reproductive, laboratory parameters, and 10-year fatal CVD risk. Results: The mean ages of the women in the study was 54.0 years (40-85 years). Hypertension, systolic blood pressure, levels of serum total cholesterol and the calculated SCORE risk were higher in the BAC (+) group than in the BAC (-) group (p=0.04, p=0.031, p=0.046, and p=0.038 respectively). Multivariate analysis showed that none of them was independent factor of BAC on mammograms, only the 10-year fatal CVD risk was close to being statistically significant (OR:1.17, CI:0.98-1.38, p=0.06). Conclusion: BAC on mammography was found to be related to the 10-year fatal CVD risk as calculated by the SCORE risk score system. Additional large-scale prospective studies are required to further assess whether BAC can be considered a useful screening tool for CVD risk prediction in women who screened for breast cancer by mammography.
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Affiliation(s)
- Ahmet Yildiz
- Ahmet Yildiz, Istanbul University, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Seyma Yildiz
- Seyma Yildiz, MD. Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Huseyin Toprak
- Huseyin Toprak, MD. Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Cuneyt Kocas
- Cuneyt Kocas, MD. Istanbul University, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
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Erbil D, Onal EM, Demirel C, Sag AA, Dagel T, Afsar B, Covic A, Kanbay M. Can Incidental Vascular Calcifications at Mammography be Used as a Screening Biomarker for Heart and Kidney Disease? Angiology 2018; 70:210-219. [PMID: 29886750 DOI: 10.1177/0003319718779322] [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: 11/15/2022]
Abstract
Mammography is a screening test with extensive international application and financial infrastructure promoting accessibility and affordability. Designed specifically to detect microcalcifications, mammography is powered to detect calcifications in vessel walls. Breast arterial calcifications (BAC) are one of the most common incidental findings documented by mammography. This review considers the literature regarding BAC in relation to cardiovascular disease (CVD) and its risk factors. The aim is to assess the possibility of using BAC as an early surrogate imaging biomarker of CVD.
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Affiliation(s)
- Damla Erbil
- Koc University School of Medicine, Istanbul, Turkey
| | - Emine M Onal
- Koc University School of Medicine, Istanbul, Turkey
| | | | - Alan A Sag
- Division of Interventional Radiology, Department of Radiology, Eastern Virginia School of Medicine, Norfolk, VA, USA.,Medical Center Radiologists, Virginia Beach, VA, USA
| | - Tuncay Dagel
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Adrian Covic
- Department of Nephrology, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
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Disthabanchong S, Boongird S. Role of different imaging modalities of vascular calcification in predicting outcomes in chronic kidney disease. World J Nephrol 2017; 6:100-110. [PMID: 28540199 PMCID: PMC5424431 DOI: 10.5527/wjn.v6.i3.100] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 03/27/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
Vascular calcification (VC) is common among patients with chronic kidney disease (CKD). The severity of VC is associated with increased risk of cardiovascular events and mortality. Risk factors for VC include traditional cardiovascular risk factors as well as CKD-related risk factors such as increased calcium and phosphate load. VC is observed in arteries of all sizes from small arterioles to aorta, both in the intima and the media of arterial wall. Several imaging techniques have been utilized in the evaluation of the extent and the severity of VC. Plain radiographs are simple and readily available but with the limitation of decreased sensitivity and subjective and semi-quantitative quantification methods. Mammography, especially useful among women, offers a unique way to study breast arterial calcification, which is largely a medial-type calcification. Ultrasonography is suitable for calcification in superficial arteries. Analyses of wall thickness and lumen size are also possible. Computed tomography (CT) scan, the gold standard, is the most sensitive technique for evaluation of VC. CT scan of coronary artery calcification is not only useful for cardiovascular risk stratification but also offers an accurate and an objective analysis of the severity and progression.
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Karm D, Marks DS, Wein M, Kong AL. Benign Arterial Calcification on Screening Mammogram: A Marker for Coronary Artery Disease? J Womens Health (Larchmt) 2015; 24:795-800. [DOI: 10.1089/jwh.2014.4905] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Deborah Karm
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David S. Marks
- Division of Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Melissa Wein
- Department of Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Amanda L. Kong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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12
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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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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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Abstract
Breast arterial calcification (BAC), observed as an incidental finding on screening mammograms, represents degenerative calcific changes occurring in the mammary arteries, with increasing age. The aim of this review is to discuss relevant literature examining relation between BAC and atherosclerosis. After a thorough literature search, in OVID and PubMed, 199 studies were identified, of which 25 were relevant to our review. Data were abstracted from each study and statistical analysis was done, including calculation of odds ratios and construction of forest plots. A total of 35,542 patients were enrolled across 25 studies looking at an association between BAC and coronary artery disease, cardiovascular disease, stroke, cerebral artery disease, carotid and peripheral artery diseases, and coronary artery calcification. A majority of the studies showed a statistically significant relation between BAC and presence of coronary artery disease cardiovascular disease and associated mortality. Sensitivity of BAC in predicting cardiovascular events was low, but specificity was high. BAC was predictive of incident and prevalent stroke but not mortality of stroke. Similarly, BAC was predictive of cerebral, carotid, and peripheral artery diseases. The role of BAC as a surrogate marker of coronary and systemic atherosclerosis is currently uncertain. Its role may be further elucidated by more large-scale prospective studies and clinical experience.
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The clinical significance of medial arterial calcification in end-stage renal disease in women. Kidney Int 2014; 87:195-9. [PMID: 24869671 DOI: 10.1038/ki.2014.187] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/02/2014] [Accepted: 04/03/2014] [Indexed: 01/25/2023]
Abstract
Medial arterial calcification is common in advanced kidney disease but its impact on cardiovascular disease is uncertain because imaging techniques used to date cannot reliably distinguish it from atherosclerotic calcification. We have previously shown that breast arterial calcification (BAC) is exclusively medial and is a marker of generalized medial calcification in end-stage renal disease (ESRD). Therefore, the presence of BAC on mammograms in 202 women with ESRD (mean duration 4.1 years) was correlated with cardiovascular events to determine the clinical significance of medial arterial calcification. BAC was found in 58% of the study participants and was significantly associated with age, diabetes, and ESRD duration. Both coronary artery (27 vs. 15%) and peripheral arterial disease (PAD; 19 vs. 4%) were more likely in patients with BAC but only the latter persisted after accounting for other factors (odds ratio 4.6; 95% confidence interval 1.2-15). In 142 women without clinical events before mammography, BAC was associated with a greater incidence of new PAD events (13 vs. 3%) but not coronary artery disease events (11 vs. 11%). Thus, BAC is strongly and independently associated with PAD in women with ESRD and may be predictive of clinical events. This suggests that medial arterial calcification is a clinically significant lesion that may contribute to the accelerated PAD in ESRD.
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Nasser EJ, Iglésias ER, Ferreira JAS, Fernandes CE, Pompei LM. Association of breast vascular calcifications with low bone mass in postmenopausal women. Climacteric 2014; 17:486-91. [DOI: 10.3109/13697137.2013.869672] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Crystal P, Zelingher J, Crystal E. Breast arterial calcifications as a cardiovascular risk marker in women. Expert Rev Cardiovasc Ther 2014; 2:753-60. [PMID: 15350176 DOI: 10.1586/14779072.2.5.753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease and breast cancer are the two main causes of mortality in women. Mammography as a screening test for breast cancer is recommended for all women from the age of 40 to 50 years. Mammographically detected breast arterial calcifications are currently considered an incidental finding without clinical importance, since they are not associated with an increased risk of breast cancer. However, recent studies have shown that breast arterial calcifications on mammograms have been associated with cardiovascular risk factors and atherosclerotic cardiovascular disease. These results suggest that breast arterial calcifications, detected during routine mammography, are a noteworthy finding that could be valuable in identifying asymptomatic women at increased cardiovascular risk.
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Affiliation(s)
- Pavel Crystal
- Department of Radiology, Soroka University Medical Center, Beer-Sheva, Israel.
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Yildiz S, Toprak H, Aydin S, Bilgin M, Oktay V, Abaci O, Kocas C. The association of breast arterial calcification and metabolic syndrome. Clinics (Sao Paulo) 2014; 69:841-6. [PMID: 25627997 PMCID: PMC4286665 DOI: 10.6061/clinics/2014(12)09] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/23/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We investigated the relationship between metabolic syndrome and breast arterial calcification detected via mammography in a cohort of postmenopausal subjects. METHODS Among 837 patients referred to our radiology department for mammographic screening, 310 postmenopausal females (105 patients with and 205 patients without breast arterial calcification) aged 40 to 73 (mean 55.9 ± 8.4) years were included in this study. The groups were compared with respect to clinical characteristics and metabolic syndrome criteria. Univariate and multivariate analyses identified the factors related to breast arterial calcification. RESULTS Age, postmenopausal duration and the frequencies of diabetes mellitus, hypertension and metabolic syndrome were significantly higher in the subjects with breast arterial calcification than in those without (p<0.05). Multivariate analysis indicated that age (OR=1.3, 95% CI=1.1-1.6, p=0.001) and metabolic syndrome (OR=4.0, 95% CI=1.5-10.4, p=0.005) were independent predictors of breast arterial calcification detected via mammography. The independent predictors among the features of metabolic syndrome were low levels of high-density lipoproteins (OR=8.1, 95% CI=1.0-64.0, p=0.047) and high blood pressure (OR=8.7, 95% CI=1.5-49.7, p=0.014). CONCLUSIONS The likelihood of mammographic detection of breast arterial calcification increases with age and in the presence of hypertension or metabolic syndrome. For patients undergoing screening mammography who present with breast arterial calcification, the possibility of metabolic syndrome should be considered. These patients should be informed of their cardiovascular risk factors and counseled on appropriate lifestyle changes.
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Affiliation(s)
- Seyma Yildiz
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Huseyin Toprak
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Sinem Aydin
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Mehmet Bilgin
- Bezmialem Vakif University, Department of Radiology, Istanbul, Turkey
| | - Veysel Oktay
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Okay Abaci
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
| | - Cuneyt Kocas
- Istanbul Universty, Institute of Cardiology, Department of Cardiology, Istanbul, Turkey
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Bae MJ, Lee SY, Kim YJ, Lee JG, Jeong DW, Yi YH, Cho YH, Choi EJ, Choo KS. Association of Breast Arterial Calcifications, Metabolic Syndrome, and the 10-Year Coronary Heart Disease Risk: A Cross-Sectional Case-Control Study. J Womens Health (Larchmt) 2013; 22:625-30. [PMID: 23790228 DOI: 10.1089/jwh.2012.4148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Mi Jin Bae
- Department of Family Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Sang Yeoup Lee
- Department of Family Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
- Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, South Korea
- Family Medicine Clinic and Research Institute of Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Yun Jin Kim
- Department of Family Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Jeong Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Dong Wook Jeong
- Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, South Korea
| | - Yu Hyeon Yi
- Department of Family Medicine, Pusan National University School of Medicine, Medical Research Institute, Pusan National University Hospital, Pusan, South Korea
| | - Young Hye Cho
- Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, South Korea
| | - Eun Jung Choi
- Medical Education Unit and Medical Research Institute, Pusan National University School of Medicine, Yangsan, South Korea
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
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Abstract
Although mammography is primarily used for the detection of breast cancer, it can occasionally reveal breast abnormalities related to extramammary disease. Cardiovascular diseases such as congestive heart failure and central venous obstruction may manifest as venous engorgement and breast edema at mammography. Pathologic arterial calcifications seen at mammography can indicate an underlying risk factor for accelerated atherosclerosis such as chronic renal failure. Connective tissue diseases including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis-polymyositis, and systemic scleroderma typically manifest with bilateral axillary lymphadenopathy, and stromal calcifications are also seen in the latter three disease processes. Some diseases such as neurofibromatosis type 1 and filariasis may manifest with pathognomonic findings at mammography, whereas other systemic diseases such as Wegener granulomatosis, sarcoidosis, and amyloidosis can manifest as nonspecific breast masses that are indistinguishable from breast cancer and usually require tissue biopsy for confirmation. Knowledge of the imaging characteristics of various systemic diseases affecting the breast will aid the radiologist in differentiating systemic disease from suspect breast lesions, thereby helping ensure appropriate follow-up. Furthermore, recognition of systemic diseases such as Cowden syndrome that are associated with an increased risk of breast cancer will allow the radiologist to recommend appropriate surveillance.
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Affiliation(s)
- Mailan M Cao
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Hassan NA, D'Orsi ET, D'Orsi CJ, O'Neill WC. The risk for medial arterial calcification in CKD. Clin J Am Soc Nephrol 2011; 7:275-9. [PMID: 22156752 DOI: 10.2215/cjn.06490711] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES CKD is a risk factor for medial artery calcification, but the CKD stage at which this risk begins is unknown. Because breast arterial calcification (BAC) is a marker of generalized medial arterial calcification, mammography was used to detect medial arterial calcification in women with different CKD stages. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a retrospective, cross-sectional study of women with and without CKD matched for age and diabetes and identified from mammograms obtained in 2006-2011. BAC was scored as present or absent per visual inspection. RESULTS A total of 146 women with stage 3 CKD and 54 with stage 4/5 CKD were identified. An additional 21 patients with ESRD were identified and added to a previous cohort of 71 patients. Mean age was 64 years for CKD 3, 63 for CKD 4, and 59 for ESRD. Half of each group had diabetes. Compared with controls, the odds ratios for BAC were 1.44 in CKD 3 (95% confidence interval [CI], 0.82-2.53), 2.69 in CKD 4 (95% CI, 1.14-6.33), and 7.19 in ESRD (95% CI, 3.77-13.7) and did not differ with diabetic status or race. In a multivariable logistic model, age (P<0.001) and estimated GFR (P=0.005) were independent predictors of BAC. The odds ratio for BAC increased 4% for each milliliter per minute per 1.73 m(2) decrease in estimated GFR. The prevalence of BAC in CKD was increased in each decade of age over 49 years. CONCLUSIONS CKD is an independent risk factor for medial arterial calcification.
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Affiliation(s)
- Nada Abou Hassan
- Renal Division, Emory University School of Medicine, Atlanta, GA 30322, USA
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Ilica AT, Aydogan U, Guvenc I, Cayci T, Oren C, Onar T, Ugurel S, Saglam K. Risk factors associated with breast arterial calcifications. Acta Radiol 2011; 52:702-5. [PMID: 21586606 DOI: 10.1258/ar.2011.110034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND A number of studies have linked the presence of breast arterial calcifications (BACs) with an increased risk of diabetes, hypertension, coronary artery disease (CAD), and cardiovascular mortality. Because there is a well-established screening system for breast cancer, it has been proposed that the presence of BACs can be used as a warning sign indicating an increased risk of metabolic and vascular diseases. PURPOSE To determine the relation between BAC and early renal dysfunction. MATERIAL AND METHODS A retrospective review of 6118 mammograms identified 701 cases with BACs. Women with BACs were compared to a random selection of 362 women without BACs based on available laboratory data. Univariate analysis was conducted according to age groups. RESULTS The prevalence of BACs was 11.5% in our study. Hyperglycemia increased the odds of BACs by 8.1 (95% CI 3.0-22.1, P < 0.001) in the 50-59-year age group. The presence of an elevated blood urea nitrogen (BUN) and serum creatinine increased the odds of BACs by 2.6 (95% CI 1.2-6.0, P = 0.016) and 2.3 (95% CI 1.0-5.2, P = 0.045) in women ≥70 years of age. Hyperlipidemia was not a significant risk factor for BACs in any age group. CONCLUSION Our results support the view that the presence of BACs on mammography may be indicative of diabetes in middle-aged women. On the other hand, BACs are not very useful for predicting early renal dysfunction in women <70 years of age.
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Affiliation(s)
| | | | | | - Tuncer Cayci
- Department of Biochemistry, Gulhane Medical Academy, Ankara, Turkey
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Akinola RA, Ogbera OA, Onakoya JA, Enabulele CE, Fadeyibi IO. Mammograms and breast arterial calcifications: looking beyond breast cancer: a preliminary report. BMC Res Notes 2011; 4:207. [PMID: 21689453 PMCID: PMC3135549 DOI: 10.1186/1756-0500-4-207] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 06/20/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To find out the prevalence, clinical and biochemical correlates of Breast Artery Calcification (BAC) in the Nigerian women. FINDINGS This is a cross sectional study involving 54 consecutive adult female subjects sent to the Radiology Department of the Lagos State University Teaching Hospital (LASUTH), Ikeja-Lagos, Nigeria for screening and diagnostic mammography. The study was carried out for a period of five months.The prevalence of BAC was 20%. Ageing was found to be related to BAC. Cardiovascular risk factors including diabetes mellitus (DM), hypertension, obesity, alcohol ingestion, use of oral contraceptives and hormone replacement therapy, were not significantly related to the presence of BAC in this study. CONCLUSION This study showed that though the presence of BAC in a mammogram is related to age, it may not predict or serve as a significant marker for cardiovascular diseases (CVD) in women in our environment.
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Affiliation(s)
- Rachael A Akinola
- Department of Radiology, College of Medicine/Lagos State University Teaching Hospital (LASUTH), Ikeja- Lagos, Nigeria.
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Mammography as a Screening Tool for Diabetes. J Surg Res 2010; 159:528-31. [DOI: 10.1016/j.jss.2008.11.837] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2008] [Revised: 11/12/2008] [Accepted: 11/18/2008] [Indexed: 11/21/2022]
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Álvarez Tutor J, Álvarez Tutor E, Clint Lawrence J, Sauret J. Detección de calcificaciones mamarias arteriales mediante mamografía. ¿Se pueden considerar un factor de riesgo para la enfermedad cardiovascular? Semergen 2009. [DOI: 10.1016/s1138-3593(09)70925-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Calisir C, Yavas US, Erol N. The relationship between the breast arterial calcification detected by mammography and the hypertensive retinopathy in hypertensive women. Korean J Radiol 2009; 9:320-4. [PMID: 18682669 PMCID: PMC2627264 DOI: 10.3348/kjr.2008.9.4.320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective The purpose of this study was to investigate the relationship between the breast arterial calcification (BAC) detected by mammograms and the hypertensive retinopathy (HR) in hypertensive women who underwent ophthalmologic examination. Materials and Methods Screening mammography was performed in 99 hypertensive women and these women also underwent an ophthalmologic examination. The presence of arterial calcification and the number of calcified blood vessels in each breast were evaluated. The grade of HR was determined. The presence of BAC and the number of blood vessels involved was compared according to the presence of HR and the grade of HR. Results Among the 99 patients, HR was detected in 70 patients, and of these 70 patients, 42 patients had grade I HR and 28 had grade II HR. BAC was detected in 54 cases. Forty-six patients with HR (66%) and eight patients without HR (27%) were diagnosed with BAC after they underwent mammographic examination. The prevalence of BAC in the subjects who had HR was statistically higher than that in those subjects who did not have HR (p < 0.01). The grade of HR was not significantly associated with BAC (p > 0.05). The positive predictive value of the BAC detected on mammography for HR was 0.80 in those subjects who were ≥ 60 years old. Conclusion The detection of BAC by mammography is associated with an increased risk of HR, and particularly for patients after the age of 60. The findings of BAC may be related to hypertensive end-organ damage, and performing mammograms might contribute to predicting the presence of ophthalmologic hypertensive complications in these patients.
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Affiliation(s)
- Cuneyt Calisir
- Department of Radiology, Eskisehir Osmangazi University, Medical Faculty, Turkey.
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Association of breast arterial calcification and carotid intima-media thickness. Heart Vessels 2008; 23:376-82. [PMID: 19037584 DOI: 10.1007/s00380-008-1058-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Accepted: 03/21/2008] [Indexed: 10/21/2022]
Abstract
Breast arterial calcification (BAC) on mammography has been identified as calcific medial sclerosis of medium-sized breast arteries, and has been reported to be associated with cardiovascular risk factors, coronary artery disease, and cardiovascular mortality. Carotid intima-media thickness (C-IMT) is a well-known surrogate marker of atherosclerosis and predictor of cardiovascular morbidity and mortality. Consequently, the present study was designed to investigate the association between the presence of BAC on mammography and C-IMT. Twenty-five postmenopausal cases with BAC and 29 subjects without BAC on mammography were included in the study. Cardiovascular risk factors, number of childbirths, postmenopausal duration, and age at menopause were all noted besides detailed physical and laboratory examination. In the whole study population C-IMT was measured with B-mode ultrasound. The women with BAC had significantly increased number of childbirths, postmenopausal duration, frequency of diabetes mellitus, systolic blood pressure, fasting glucose, and CIMT (0.87 +/- 0.17 mm versus 0.60 +/- 0.19 mm) in comparison with the women without BAC (P < 0.05 for all). The C-IMT was correlated with age, number of childbirths, postmenopausal duration, presence of BAC, and serum triglyceride level (P < 0.05 for all). Independent predictors of C-IMT were the presence of BAC on mammography (beta = 0.463, P < 0.001) and serum triglyceride level (beta = 0.222, P = 0.042), whereas the only independent predictor of BAC was CIMT (chi(2) = 23.41, beta = 7.56, P = 0.004). Findings of the present study suggest that the BAC on mammography is independently associated with C-IMT. Screening mammographies merit to be evaluated for the presence of BAC, which might benefit cardiovascular preventive medicine in women by predicting atherosclerosis.
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Dale PS, Richards M, Mackie GC. Vascular calcifications on screening mammography identify women with increased risk of coronary artery disease and diabetes. Am J Surg 2008; 196:537-40. [PMID: 18809058 DOI: 10.1016/j.amjsurg.2008.06.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/01/2008] [Accepted: 06/01/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Mammographic breast arterial calcifications (BAC) have been reported in women with diabetes and coronary artery disease (CAD). This prospective study further investigates the clinical significance of BAC, CAD, and diabetes. METHODS Women undergoing screening mammography were prospectively evaluated for mammographic BAC. The association among BAC, CAD, and diabetes was statistically evaluated. RESULTS Of 1,000 consecutive women undergoing screening mammography, 181 had a history of CAD and/or diabetes. Of those women without diabetes or heart disease, 86 of 819 (10.5%) had BAC. One hundred forty women had diabetes, of whom 57 (40.7%) had BAC, and 72 women had CAD, of whom 36 (50%) had BAC. The association among BAC, CAD, and diabetes was highly significant (P <.0001, 95% confidence interval [CI]). The odds ratio of having diabetes or CAD with BAC is 4.3 and 3.6 times greater than the odds of having these diseases without BAC. COMMENTS This large prospective study indicated a significant association between BAC identified on screening mammography and a personal history of CAD and diabetes, indicating that screening mammography may identify women at increased risk for these diseases.
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Affiliation(s)
- Paul S Dale
- University of Missouri School of Medicine, Columbia, MO, USA.
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Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease. Menopause 2008; 15:276-81. [PMID: 17917612 DOI: 10.1097/gme.0b013e3181405d0a] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Breast arterial calcifications (BACs) are common but unreported findings on screening mammograms. This study correlated mammographically detected BACs with coronary artery disease (CAD) risk factors and a history of atherosclerotic cardiovascular disease (ASCVD), estimating the relative risk of ASCVD in patients with BACs. DESIGN Women arriving for breast cancer screening mammography gave their consent to complete a questionnaire and to allow their mammograms to be analyzed independently for the presence of BACs by certified radiologists, who were blinded to the results of the questionnaire. The questionnaire assessed major risk factors for CAD and gathered information on hormone therapy use. RESULTS Of the 1,919 women with results, 268 were BAC positive, giving a BAC prevalence of 14%. Five cardiovascular risk factors (age, hypertension, hypercholesteremia, diabetes mellitus, and menopause) were significantly more prevalent in the BAC-positive population (P < 0.001). The BAC-positive group also had a significantly higher (P < 0.001) occurrence of ASCVD events (angina, previous myocardial infarction, previous abnormal angiography, previous stroke, and previous coronary artery bypass graft). Multiple logistic regression analysis found BACs to be strongly associated with ASCVD events (odds ratio = 2.29, 95% CI: 1.40-3.74) as compared with other CAD risk factors (including hypertension, cigarette smoking, diabetes mellitus, age, and family history of ASCVD). The association of BAC with ASCVD was present even after accounting for age. CONCLUSIONS BACs are associated with an increased prevalence of both cardiovascular risk factors and cardiovascular morbidity. BACs may be a practical tool to use as a risk indicator for CAD in women.
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Mammography as a Screening Tool for Coronary Artery Disease. J Surg Res 2008; 148:1-6. [DOI: 10.1016/j.jss.2007.08.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Revised: 08/21/2007] [Accepted: 08/22/2007] [Indexed: 11/21/2022]
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Topal U, Kaderli A, Topal NB, Ozdemir B, Yeşilbursa D, Cordan J, Ediz B, Aydinlar A. Relationship between the arterial calcification detected in mammography and coronary artery disease. Eur J Radiol 2007; 63:391-5. [PMID: 17344011 DOI: 10.1016/j.ejrad.2007.01.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 01/25/2007] [Accepted: 01/26/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Arterial calcification is frequently encountered in mammography. The frequency of breast arterial calcification (BAC) increases with increasing age. Studies have shown that BAC is seen more frequently among the people who are under the risk of coronary artery diseases (CAD) such as diabetes and hypertension. The objective of this study is to investigate the relationship between the arterial calcification detected in mammography and the CAD. MATERIAL AND METHODS Screening mammography was performed in 123 women above the age of 40 years who had been examined with coronary angiography for the evaluation of CAD. The presence of BAC, number of affected vessels, and the distribution of calcification in the vessel wall were evaluated in the mammography. Subjects were questioned in terms of the cardiovasculary risk factors. The severity of CAD was evaluated according to the Gensini scoring. In addition, the number of blood vessels with stenosis of more than 50% was used as the vascular score. The correlation between Gensini and the vascular scores, and BAC was statistically evaluated using Mann-Whitney U and Kruskal-Wallis tests. RESULTS Eighty (65%) of 123 patients had CAD. BAC was detected in the mammography of 49 (39.8%) subjects. The ages and duration of menopause of the cases with BAC were significantly higher than those without BAC (p<0.001). There was an almost significant correlation between the BAC and Gensini scores (p=0.059). There was a significant increase in the frequency of BAC among subjects with more than two vessels with stenosis (p=0.033). CONCLUSION Frequency of BAC increases with increasing age. BAC is also frequently seen in subjects having severe coronary artery disease. Although increasing age may be a factor increasing the frequency of BAC, BAC may also be an indicator of CAD. Therefore, the mentioning of arterial calcification in mammography reports may be important in warning the clinician in terms of CAD.
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Affiliation(s)
- Ugur Topal
- Department of Radiology, Uludag University, Medical School, Görükle Campus, 16059 Bursa, Turkiye.
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Schnatz PF, Rotter MA, Hadley S, Currier AA, O'Sullivan DM. Hormonal therapy is associated with a lower prevalence of breast arterial calcification on mammography. Maturitas 2007; 57:154-60. [PMID: 17289309 DOI: 10.1016/j.maturitas.2006.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Revised: 12/06/2006] [Accepted: 12/06/2006] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To bring further understanding to the relationship between hormonal therapy (HT) and breast arterial calcification (BAC). METHODS Of women arriving for breast cancer screening mammography, 1995 consented to complete a survey and have their mammograms analyzed for the presence of BAC. The survey assessed HT use and major risk factors for CAD. RESULTS Of the 1919 women with complete data, there were 268 with BAC (14%). When categorized into three age groups, BAC was present in 40.7% of the women > or =65, 10.9% of those 55-64 and 3.0% of those <55. The > or =65 year-old group showed a nearly 50%-point lower prevalence of BAC among HT users compared with women who were not on HT (25.8% versus 74.2%, respectively, p=0.006). With age included as a continuous variable, past use of HT was significantly associated with a lower prevalence of BAC (p<0.03), while the presence of diabetes or a history of stroke were significantly associated with a higher prevalence of BAC (p<0.002). CONCLUSIONS Well-established cardiovascular risk factors (diabetes, stroke, and age) appear to be associated with a significantly higher incidence of BAC, while HT during the menopausal years appears to be associated with a significantly lower prevalence of BAC.
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Affiliation(s)
- Peter F Schnatz
- Department of ObGyn, The University of Connecticut School of Medicine, Farmington, CT, USA.
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Fiuza Ferreira EMP, Szejnfeld J, Faintuch S. Correlation between intramammary arterial calcifications and CAD. Acad Radiol 2007; 14:144-50. [PMID: 17236987 DOI: 10.1016/j.acra.2006.10.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 10/22/2006] [Accepted: 10/23/2006] [Indexed: 10/23/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the relationship between intramammary arterial calcifications detected by screening mammography and concomitant coronary artery disease, detected by coronary angiography. MATERIALS AND METHODS We retrospectively evaluated screening mammography and coronary angiography results of 131 consecutive patients, ages 42-81 years. Risk factors for coronary artery disease (hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity) were obtained from medical records to identify possible simultaneous risk factors for coronary artery disease. RESULTS Eighty-five women had coronary artery disease (41 with intramammary arterial calcifications and 44 without such calcifications) and 46 had normal coronary angiography (11 had intramammary arterial calcifications and 35 did not). A strong association between intramammary arterial calcifications and coronary artery disease was seen, with an OR of 2.96 and P = .006 in the raw model and OR of 4.6 in the adjusted one. The evaluated risk factors did not present as confounding variables. Most patients had only two risk factors or less. The most prevalent risk factor for coronary artery disease was hypertension, with significantly higher prevalence in the coronary artery disease group (P < .01). CONCLUSION A strong association exists between intramammary arterial calcifications and coronary artery disease. Therefore a mammographic finding of intramammary arterial calcification should receive more of the radiologists' attention and its presence should never be omitted from the final report.
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Affiliation(s)
- Eliane M P Fiuza Ferreira
- Department of Diagnostic Imaging, Saint Raphael Hospital, Mount Tabor Foundation, Salvador-BA, Brazil Av. São Rafael, 2152 São Marcos, Salvador-BA, Brazil CEP- 41256-90.
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Dale PS, Graham J, Nichols KW, Catchings T, Richards M. Mammography as a screening tool for peripheral vascular disease. Am J Surg 2006; 192:488-91. [PMID: 16978956 DOI: 10.1016/j.amjsurg.2006.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Revised: 07/11/2006] [Accepted: 07/11/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Peripheral vascular disease (PVD) is a progressive and debilitating disease often diagnosed only when patients become symptomatic. Currently there are no widespread screening tests available for the early detection of PVD. Patients with diabetes and coronary artery disease are known to have a higher incidence of PVD. Prior studies have indicated that benign vascular calcifications seen on routine screening mammogram are more prevalent in women with diabetes and coronary artery disease. The same association has not been shown for women with PVD. The purpose of this study was to identify an association between benign vascular calcifications identified on mammography and PVD. If such an association exists then screening mammography, already widely used as a screening tool for breast cancer, may identify women at high risk for PVD. METHODS To determine the incidence of vascular calcifications in our general screening population we prospectively evaluated consecutive routine screening mammograms for the presence of benign vascular calcifications. We then identified a population of women with PVD by using a computerized database maintained by the Division of Vascular Surgery. The population of women identified with PVD was categorized further to identify those women who had received routine screening mammogram within our hospital system. These mammograms were reviewed retrospectively with particular attention to the presence of vascular calcifications. All mammograms were reviewed by our dedicated mammographers. Statistical analysis of the study group using the chi-square test was performed to determine the association of PVD and mammographic vascular calcifications. RESULTS Prospective evaluation of 645 women undergoing consecutive routine screening mammography identified 123 (19%) with benign vascular calcifications. By using our PVD computerized database between the years 2002 and 2004 we identified 763 women with PVD. Of this group only 121 (15%) had undergone a routine screening mammogram in our hospital system. These mammograms were reviewed retrospectively by the same group evaluating the screening mammograms. On evaluation vascular calcifications were identified in 42% (51 of 121) of these women with PVD. Statistical analysis was performed using the chi-square test, odds ratio, and relative risk. A highly significant association was identified between PVD and the presence of mammographic vascular calcifications (P > .001). With a confidence interval of 95% the presence of benign vascular microcalcifications on routine screening mammogram identifies a significant risk for PVD with an odds ratio of 3.06. We showed through our analysis that women with calcifications are 2.19 times more likely to have PVD if microcalcifications are present. By using vascular calcifications identified on screening mammography as a means to identify women with PVD the sensitivity and specificity are 42% and 80%, respectively. The positive predictive value and the negative predictive value are 29% and 88%, respectively, with an accuracy of 75%. CONCLUSIONS This initial study indicates that the presence of vascular calcifications identified on routine screening mammogram is significantly higher in women with PVD and the lack of vascular calcifications on screening mammography correlates well with a negative history of PVD. We have identified a significant association with PVD and vascular calcifications in our patient population. Further studies are indicated to determine if screening mammography may become a widespread inexpensive screening tool to identify women at risk for PVD. Additional studies are underway at our institution to evaluate the association of PVD, diabetes and coronary artery disease, and vascular calcifications identified on routine screening mammography.
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Affiliation(s)
- Paul S Dale
- Department of Surgery, Division of Surgical Oncology, Ellis Fischel Cancer Center, 115 Business Loop 70 W., DC 116.94, University of Missouri School of Medicine, Columbia, MO 65203, USA.
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Taşkin F, Akdilli A, Karaman C, Unsal A, Köseoğlu K, Ergin F. Mammographically detected breast arterial calcifications: indicators for arteriosclerotic diseases? Eur J Radiol 2006; 60:250-5. [PMID: 16890393 DOI: 10.1016/j.ejrad.2006.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 06/16/2006] [Accepted: 06/27/2006] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine the prevalence of breast arterial calcifications (BAC) detected on mammography and search for conditions that may influence their existence. MATERIALS AND METHODS The mammograms of 6156 consecutive patients were reevaluated for the presence of BAC. Four hundred eighty-five women having BAC were enrolled in the patient group. Additionally, randomly selected 500 women, without BAC constituted the control group. Hospital records of the participants were reviewed for parity, menopausal status, oral contraceptive agent (OCA) usage, hormone replacement therapy (HRT) usage, presence of diabetes, hypertension, hyperlipidemia, albuminuria and history of myocardial infarction (MI). RESULTS Prevalence of BAC was 7.9% on mammograms. Ninety-four women were aged between 40 and 49 years, 165 were aged between 50 and 59 years and 226 were over 60 years among BAC positive 485 women. A significant relationship was found for the frequency of BAC versus age and HRT usage in all age groups (p<0.05). Similarly, significant relationships were also found for the frequency of BAC versus OCA usage, HRT usage, hyperlipidemia and diabetes in age group of 40-49 and in age group of 50-59, and for the frequency of BAC versus albuminuria in age group of 40-49, BAC versus history of myocardial infarction in age group of 59-59 and over 60 years (p<0.05). The correlations were not significant for the relationships of BAC with OCA usage, hyperlipidemia, diabetes and albuminuria in women over 60 years (p>0.05). CONCLUSION Most benign findings like BAC are not routinely reported during mammographic evaluation. Our study showed that, presence of BAC on mammography was strongly related to advancing age. However, these findings may signify a systemic risk and can be used as precautious indicators for undocumented systemic diseases, especially in premenopausal women.
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Affiliation(s)
- Füsun Taşkin
- Adnan Menderes University, Faculty of Medicine, Department of Radiology, 09100 Aydin, Turkey.
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Maas AHEM, van der Schouw YT, Beijerinck D, Deurenberg JJM, Mali WPTM, van der Graaf Y. Arterial calcifications seen on mammograms: cardiovascular risk factors, pregnancy, and lactation. Radiology 2006; 240:33-8. [PMID: 16720869 DOI: 10.1148/radiol.2401050170] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively assess if mammographic calcium deposits are related to coronary heart disease (CHD) risk factors and reproductive factors in a subset of women participating in the European Prospective Investigation into Cancer and Nutrition study. MATERIALS AND METHODS The study was approved by the institutional review board of the University Medical Center Utrecht; informed consent was obtained. Mammograms were evaluated by two radiologists for the presence of breast arterial calcifications (BAC) in the Prospect cohort, a breast cancer screening population of women aged 49-70 years (mean, 57 years) within the European Prospective Investigation into Cancer and Nutrition study. Cardiovascular risk factors and reproductive factors were examined for independent effects on the prevalence of BAC. Logistic regression analysis was performed. RESULTS BAC was present in 194 of 1699 (11%) women and increased with age to 20% in the highest quartile of age (mean, 66 years). The odds ratio was 4.7 in the highest versus the lowest quartile of age (95% confidence interval [CI], 2.9, 7.6). After adjustment for age, no significant association was found between BAC and traditional cardiovascular risk factors. Current smoking was inversely related to BAC (odds ratio, 0.6; 95% CI: 0.4, 0.9). BAC was prevalent in 2.5% of nulliparous women, in 9% of women with one or two children, and in 17% of women with three or more children (odds ratio, 7.2; 95% CI: 2.9, 18.0). Breast feeding after pregnancy was significantly associated with BAC in women who ever were pregnant (odds ratio, 2.2; 95% CI: 1.4, 3.6). CONCLUSION Calcifications in arteries on mammograms are associated with increasing age, pregnancy, and lactation but not with various cardiovascular risk factors.
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Affiliation(s)
- Angela H E M Maas
- Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW Zwolle, The Netherlands.
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Reddy J, Son H, Smith SJ, Paultre F, Mosca L. Prevalence of breast arterial calcifications in an ethnically diverse population of women. Ann Epidemiol 2005; 15:344-50. [PMID: 15840547 DOI: 10.1016/j.annepidem.2004.11.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2004] [Accepted: 11/29/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE Breast arterial calcifications (BAC) identified on routine mammography have been associated with coronary heart disease (CHD) risk factors including diabetes and hypertension, angiographically defined CHD, and increased cardiovascular mortality. Accumulating evidence suggests that the mammogram may be an important tool to identify women at risk for CHD, however, the epidemiology of BAC has been poorly defined and previous studies limited to white populations. METHODS The mammograms of 1905 consecutive women (51.2% Hispanic, 25.8% white, 15.3% black, 5.4% other, 2.2% Asian, ages 35-92 years) were evaluated for the presence of BAC and the number of calcified arteries. RESULTS The overall prevalence of BAC was 29.4% and was significantly higher for Hispanics compared with whites (34.5% vs. 24.0%, p=0.0002) and lower for Asians compared with whites (7.1% vs. 24.0%, p < 0.02). Among BAC-positive women aged 65 years or less, blacks had more calcified arteries than whites (p < 0.01). The presence of BAC increased with age (p for trend < 0.0001). In age-adjusted models, older Hispanics were more likely to be BAC-positive than whites of similar age (p < 0.02). CONCLUSION These results indicate that BAC varies significantly by age and race/ethnicity. These findings should be taken into consideration when designing future studies of BAC and CHD.
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Affiliation(s)
- Jhansi Reddy
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Alizad A, Whaley DH, Greenleaf JF, Fatemi M. Potential applications of vibro-acoustography in breast imaging. Technol Cancer Res Treat 2005; 4:151-8. [PMID: 15773784 DOI: 10.1177/153303460500400204] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Vibro-acoustography has gained interest in the recent years as a new modality for medical imaging. This method is based on low-frequency vibrations induced in the object by the radiation force of ultrasound. This paper focuses on potential applications of vibro-acoustography in breast imaging, including detection of microcalcifications, detection of arterial calcifications, and soft tissue imaging. In addition, we will briefly discuss our recent results of in vivo breast vibro-acoustography. Future developments and potential impact of vibro-acoustography in breast imaging are also discussed.
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Affiliation(s)
- Azra Alizad
- Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, 200 First Street, SW, Rochester, MN 55905, USA.
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José Fuster M, Sáez J, Orozco D, Merino J. Relación de las calcificaciones arteriales en el tejido mamario con el riesgo cardiovascular estimado en pacientes diabéticas. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72818-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cetin M, Cetin R, Tamer N, Kelekçi S. Breast arterial calcifications associated with diabetes and hypertension. J Diabetes Complications 2004; 18:363-6. [PMID: 15531187 DOI: 10.1016/j.jdiacomp.2004.04.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2003] [Revised: 04/19/2004] [Accepted: 04/20/2004] [Indexed: 10/26/2022]
Abstract
AIM To investigate the relationship between breast arterial calcifications (BACs) and systemic hypertension (HT) and diabetes mellitus (DM). METHODS Mammograms and patient records of 2406 women who were screened for breast cancer or had undergone diagnostic mammography were reviewed retrospectively. Mammograms were evaluated for the presence of arterial calcification and results were coded. Patients who had been using insulin or oral hypoglycemic agents were included in the diabetic group; patients who had been using antihypertensive agents were included in the hypertensive group. Diabetes was defined as use of oral hypoglycemic agents or insulin and hypertension was defined as use of antihypertensive agents. RESULTS The prevalence of BACs among diabetics (25.4) was higher than among hypertensives (17.6%). The prevalence in the nondiabetic, nonhypertensive (NDNH) group was lowest (7.3%). The prevalence increased with age. BAC was seen almost four times more in diabetic patients and three times more in hypertensive patients than in NDNH controls. CONCLUSION BACs are associated with diabetes and hypertension. BAC on a mammogram may indicate unsuspected diabetes or hypertension, especially after 59 years of age.
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Affiliation(s)
- Meltem Cetin
- Department of Radiology, Ankara Oncology Research and Training Hospital, Ankara, Turkey.
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Maas AHEM, van der Schouw YT, Mali WPTM, van der Graaf Y. Prevalence and determinants of breast arterial calcium in women at high risk of cardiovascular disease. Am J Cardiol 2004; 94:655-9. [PMID: 15342303 DOI: 10.1016/j.amjcard.2004.05.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2004] [Revised: 05/06/2004] [Accepted: 05/06/2004] [Indexed: 11/16/2022]
Abstract
Calcium deposits in breast arteries are commonly seen on mammograms, and their frequency increases with age, especially after menopause. The investigators studied the prevalence of breast arterial calcium in 600 women at high risk for cardiovascular events and assessed whether classic cardiovascular risk factors are independent determinants of these calcifications.
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Alizad A, Fatemi M, Whaley DH, Greenleaf JF. Application of vibro-acoustography for detection of calcified arteries in breast tissue. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:267-273. [PMID: 14992365 DOI: 10.7863/jum.2004.23.2.267] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE The relationship between breast arterial calcification and coronary artery calcification and stenosis is currently an area of active research. It has been suggested in the literature that calcified arteries in the breast may be positively correlated with coronary artery disease. The sensitivity of x-ray mammography, the main breast imaging method, is reduced in radiologically dense breasts. In a recent study, we showed that vibro-acoustography, a novel noninvasive imaging technique that is based on the dynamic response of the object to a vibrating force, can detect microcalcifications in the breast regardless of breast density. In this study, we examined the application of vibro-acoustography in detecting calcified arteries in breast tissue. METHODS Experiments were conducted on 207 postsurgical excised human breast tissue samples. Tissues specimens were imaged with a high-resolution x-ray mammography unit. Each sample with confirmed arterial calcification was then scanned by the vibro-acoustography system, and the resulting image was compared with the corresponding mammogram. We also studied the histologic characteristics of each sample to positively identify the disease and the presence of arterial calcification. RESULTS Initial mammograms clearly showed 14 calcified arteries. The corresponding vibro-acoustographic images showed all calcified arteries as fragmented linear structures. The vibro-acoustographic appearance of the arteries was highly correlated with their distinctive radiographic appearance, which allowed us to identify all the calcified arteries in the vibro-acoustographic images. CONCLUSIONS Vibro-acoustography can be used to detect calcified arteries in excised breast tissue. This method may eventually play a role in identifying individuals with an increased risk of coronary artery disease.
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Affiliation(s)
- Azra Alizad
- Department of Physiology and Biophysics, Ultrasound Research Laboratory, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
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Abstract
AIM To determine the age-specific prevalence of breast arterial calcifications in patients with systemic hypertension. METHODS The mammograms and patient records of 2406 women who underwent screening or diagnostic mammography were reviewed retrospectively. Mammograms were evaluated for the presence of arterial calcification and results were coded. Hypertension was defined as use of anti-hypertensive agents and diabetes was defined as use of oral hypoglycaemic agents or insulin. RESULTS The prevalence of breast arterial calcification among hypertensives (17.6%) was lower than among diabetics (25.4%). The prevalence in the non-diabetic, non-hypertensive group was lowest (7.3%). The prevalence increased with age in all three groups. The highest prevalence was found in diabetics older than 60 years (81.8%). Breast arterial calcification was not found among women younger than 40 years. CONCLUSION Breast arterial calcification is associated with hypertension and prevalence increases with age. Breast arterial calcification on mammograms may indicate unsuspected hypertension especially in non-diabetic patients.
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Affiliation(s)
- M Cetin
- Department of Radiology, Ankara Oncology Research and Training Hospital, Ankara, Turkey.
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Josefa Fuster Selva M, Orozco Beltrán D, Sáez Castán J, Merino Sánchez J. Relación entre las calcificaciones arteriales detectadas por mamografía y el grado de control y gravedad de la diabetes mellitus. Med Clin (Barc) 2004. [DOI: 10.1016/s0025-7753(04)74225-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bercovitch L, Schepps B, Koelliker S, Magro C, Terry S, Lebwohl M. Mammographic findings in pseudoxanthoma elasticum. J Am Acad Dermatol 2003; 48:359-66. [PMID: 12637915 DOI: 10.1067/mjd.2003.173] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND There have been isolated case reports of arterial and skin calcification in mammograms of patients with pseudoxanthoma elasticum (PXE), and unpublished anecdotes of many women with PXE undergoing breast biopsy for evaluation of microcalcifications. OBJECTIVE Our aim was to systematically evaluate mammography and breast pathology in PXE. METHODS The mammograms of 51 women with confirmed PXE were compared with those of a control sample of 109 women without PXE, noting each of the following characteristics on each mammogram: breast density, skin thickening, skin microcalcifications, vascular calcification, breast microcalcifications and macrocalcifications, and masses. The characteristics of the 2 samples were compared using the 2-tailed t test with a pooled estimate of variance. The indications for mammography and data for each of the mammographic findings were analyzed using the chi(2) test. Available breast biopsy material was reviewed. RESULTS The PXE and control groups were similar in age and indications for mammography. There was a statistically significant increase in skin thickening, vascular calcification, and breast microcalcifications in the PXE group (P <.001 each). Breast density, masses, macrocalcifications, and skin calcification did not differ statistically in the 2 groups, but no control patient had axillary calcification, or both vascular calcification and microcalcifications (P <.001). Nearly 1 in 7 of the patients with PXE demonstrated at least 3 of the following: microcalcifications, skin calcifications, vascular calcification, and skin thickening; whereas none of the control group did. Histopathologic findings of breast tissue showed calcification of dermal elastic fibers, subcutaneous arteries, and elastic fibers of the deep fascia and interlobular septae of the fat adjacent to breast parenchyma. CONCLUSION Breast microcalcification and arterial calcification are not rare in the normal population and are not of diagnostic value. The presence of both of these findings, especially with skin thickening or axillary skin calcification, should suggest a diagnosis of PXE. The majority of breast calcifications in PXE are benign.
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Affiliation(s)
- Lionel Bercovitch
- Department of Dermatology, Rhode Island Hospital and Brown Medical School, Providence, USA
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Crystal P, Crystal E, Leor J, Friger M, Katzinovitch G, Strano S. Breast artery calcium on routine mammography as a potential marker for increased risk of cardiovascular disease. Am J Cardiol 2000; 86:216-7. [PMID: 10913486 DOI: 10.1016/s0002-9149(00)00860-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P Crystal
- Comprehensive Breast Center, Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel.
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Sánchez Vidal MT, Rodríguez Díaz JC, García Pravia P, Vizoso Piñeiro F. [Arterial calcifications detected in mammographies]. Rev Clin Esp 2000; 200:48. [PMID: 10721294 DOI: 10.1016/s0014-2565(00)70555-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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