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Do breast arterial calcifications on mammography predict elevated risk of coronary artery disease?

      Abstract

      Purpose

      To determine whether breast arterial calcifications (BAC) seen on mammography correlates with coronary artery calcium score on coronary CT as it may serve as a potential marker for increased risk of developing symptomatic coronary artery disease (CAD).

      Materials and methods

      Retrospective review of the imaging database at our institution identified 145 female patients who underwent coronary CT within a year of screening or diagnostic mammography. The coronary calcium score on CT was calculated by multiplying area of calcification by weighted value assigned to its highest Hounsfield unit and summed for all lesions and expressed as Agaston score. Calculated scores were risk stratified for developing CAD as follows: 0—no risk; 1–10—minimal; 11–100—mild; 101–400—moderate; >400—high risk. Percentile distribution of calcium score adjusted by age, gender and race was calculated based on results of the Multi-Ethnic Study of Atherosclerosis (MESA), which excluded patient with diabetes and chronic renal disease. The mammograms were reviewed by MQSA-certified breast radiologists who were blinded to patients’ coronary calcium scores. Mammograms were interpreted for presence or absence of BAC. The calcium scores and corresponding percentiles were correlated with BAC on mammography. Cardiac risk factors such as, diabetes, hypertension, hyperlipidemia, family history of CAD and smoking, were recorded for each patient.

      Results

      BAC correlated with coronary calcium score of >11 (p = 0.0001), corresponding to mild or greater risk of developing CAD. Specifically, coronary calcium score of >11 was seen in 68% (25/37) of patients with BAC and 31% (34/108) of patients without BAC. Accounting for race, gender and age, presence of BAC showed statistically significant correlation with percentile scores of >25. Namely, 70.4% (19/27) of patients with BAC vs. 44.6% (41/92) of patient without BAC showed percentile score of >25 for developing CAD. Statistically significant association was observed of BAC with diabetes (p = 0.01) and chronic renal disease (p = 0.005). BAC showed no significant associated with hyperlipidemia, hypertension, smoking and family history of CAD.

      Conclusion

      BAC does predict coronary artery calcium score of >11, which indicates mild or greater risk of developing CAD. In addition, statistically significant correlation exists between BAC and cardiac risk factors, namely diabetes and chronic renal disease. Our study suggests that BAC on mammography can be utilized as a potential marker for increased risk of developing CAD.

      Keywords

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      References

        • Rosamond W.
        • Flegal K.
        • Friday G.
        • et al.
        Heart disease and stroke statistics: 2007 update—a report from the american heart association statistics committee and stroke statistics subcommittee.
        Circulation. 2007; 115: e69-e171
        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Borden W.B.
        • et al.
        Heart disease and stroke statisticsupdate: a report from the american heart association.
        Circulation. 2013; 127: 6-245
        • Myerburg R.J.
        Scientific gaps in the prediction and prevention of sudden cardiac death.
        J. Cardiovasc. Electrophysiol. 2002; 13: 709-723
        • Bairey Merz C.N.
        • Shaw L.J.
        • Reis S.E.
        • Bittner V.
        • Kelsey S.F.
        • Olson M.
        • et al.
        Insights from the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study: part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease.
        J. Am. Coll. Cardiol. 2006; : 47
        • Quyyumi A.A.
        Women and ischemic heart disease: pathophysiologic implications from the Women’s Ischemia Syndrome Evaluation (WISE) Study and future research steps.
        J. Am. Coll. Cardiol. 2006; : 47
        • Khot U.N.
        • Khot M.B.
        • Bajzer C.T.
        • Sapp S.K.
        • Ohman E.M.
        • Brener S.J.
        • et al.
        Prevalence of conventional risk factors in patients with coronary heart disease.
        JAMA. 2003; 290: 898-904
        • Greenland P.
        • Smith Jr., S.C.
        • Grundy S.M.
        Improving coronary heart disease risk assessment in asymptomatic people: role of traditional risk factors and noninvasive cardiovascular tests.
        Circulation. 2001; 104: 1863-1867
        • Lakoski S.G.
        • Greenland P.
        • Wong N.D.
        • Schreiner P.J.
        • Herrington D.M.
        • Kronmal R.A.
        • et al.
        Coronary artery calcium scores and risk for cardiovascular events in women classified as low risk based on framingham risk score: the multi-ethnic study of atherosclerosis (MESA).
        Arch. Intern. Med. 2007; 167: 2437-2442https://doi.org/10.1001/archinte.167.22.2437
        • Kondos G.T.
        • Hoff J.A.
        • Sevrukov A.
        • Daviglus M.L.
        • Garside D.B.
        • Devries S.S.
        • et al.
        Electron-beam tomography coronary artery calcium and cardiac events: a 37-month follow-up of 5635 initially asymptomatic low- to intermediate-risk adults.
        Circulation. 2003; 107: 2571-2576
        • Greenland P.G.
        • Bonow R.O.
        • Brundage G.H.
        • et al.
        ACCF/AHA 2007 clinical expert consensus document on coronary artery calcium scoring by computed tomography in global cardiovascular risk assessment and in evaluation of patients with chest pain.
        J. Am. Coll. Cardiol. 2007; 49: 378-402
        • Hendriks E.J.
        • de Jong P.A.
        • van der Graaf Y.
        • Mali W.P.
        • van der Schouw Y.T.
        • Beulens J.W.
        Breast arterial calcifications: a systematic review and meta-analysis of their determinants and their association with cardiovascular events.
        Atherosclerosis. 2015; 239: 11-20
        • Reddy J.
        • Son H.
        • Smith S.J.
        • Paultre F.
        • Mosca L.
        Prevalence of breast arterial calcifications in an ethnically diverse population of women.
        Ann. Epidemiol. 2005; 15: 344-350
        • Iribarren C.
        • Molloi S.
        Breast arterial calcification: a new marker of cardiovascular risk?.
        Curr. Cardiovasc. Risk Rep. 2013; 7: 126-135
        • van Noord P.A.
        • Beijerinck D.
        • Kemmeren J.M.
        • van der Graaf Y.
        Mammograms may convey more than breast cancer risk: breast arterial calcification and arterio-sclerotic related diseases in women of the DOM cohort.
        Eur. J. Cancer Prev. 1996; 5: 483-487
        • Kemmeren J.M.
        • van Noord P.A.
        • Beijerinck D.
        • Fracheboud J.
        • Banga J.D.
        • van der Graaf Y.
        Arterial calcification found on breast cancer screening mammograms and cardiovascular mortality in women: the DOM project. Doorlopend Onderzoek Morbiditeit en Mortaliteit.
        Am. J. Epidemiol. 1998; 147: 333-341
        • Iribarren C.
        • Go A.S.
        • Tolstykh I.
        • Sidney S.
        • Johnston S.C.
        • Spring D.B.
        Breast vascular calcification and risk of coronary heart disease, stroke, and heart failure.
        J. Womens Health. 2004; 13: 381-389
        • Oliveira E.L.
        • Freitas-Junior R.
        • Afiune-Neto A.
        • Murta E.F.
        • Ferro J.E.
        • Melo A.F.
        Vascular calcifications seen on mammography: an independent factor indicating coronary artery disease.
        Clinics. 2009; 64: 763-767
        • Schnatz P.F.
        • Marakovits K.A.
        • O'Sullivan D.M.
        The association of breast arterial calcification and coronary heart disease.
        Obstet. Gynecol. 2011; : 117
        • Newallo D.
        • Meinel F.
        • Schoepf U.J.
        • Baumann S.
        • De Cecco C.N.
        • Leddy R.J.
        • Vliegenthart R.
        • Mullmann H.
        • Hamm C.W.
        • Morriw P.B.
        • Renker M.
        Mammographic detection of breast arterial calcification as an independent predictor of coronary atherosclerotic disease in a single ethnic cohort of African American women.
        Atherosclerosis. 2015; 242: 218-221
        • Abi Rafeh N.
        • Castellanos M.R.
        • Khoueiry G.
        • Meghani M.
        • El-Sayegh S.
        • Wetz R.V.
        • Lafferty J.C.
        • et al.
        Association between coronary artery disease diagnosed by coronary angiography and breast arterial calcifications on mammography: meta-analysis of the data.
        J. Womens Health. 2012; 21: 1053-1058
        • Zgheib M.H.
        • Buchbinder S.S.
        • Abi Rafeh N.
        • Elya M.
        • Raia C.
        • Ahern K.
        • Smith M.C.
        • Costantino T.
        • Flory M.J.
        • Lafferty J.C.
        • Castellanos M.R.
        Breast arterial calcifications on mammograms do not predict coronary heart disease at coronary angiography.
        Radiology. 2010; 254: 367-373
        • Kim H.
        • Greenberg J.S.
        • Javitt M.C.
        Breast calcifications due to Monckeberg medial calcific sclerosis.
        Radiographics. 1999; 19: 1401-1403
        • Proudfoot D.
        • Shanahan C.M.
        Biology of calcification in vascular cells: intima vs media.
        Herz. 2001; 26: 245-251
        • Wallin R.
        • Wajih N.
        • Greenwood G.T.
        • Sane D.C.
        Arterial calcification: a review of mechanisms, animal models, and the prospects for therapy.
        Med. Res. Rev. 2001; 21: 274-301