Study Finds Routine Mammography May be Useful For Heart Disease Screening
Additional Studies Explore STEMI and Stress Risk Factors

Routine mammography may be a useful tool to identify women at risk for heart disease, which may lead to earlier intervention, according to a study published March 24 in JACC: Cardiovascular Imaging. These findings will be presented at ACC.16 in Chicago and will be included in a special issue of JACC: Cardiovascular Imaging focused on imaging in women on April 4.

Laurie Margolies, MD, and colleagues evaluated 292 women who underwent a digital mammography and nongated computed tomography (CT) scan to measure breast arterial calcification (BAC) and coronary artery calcification (CAC). BAC was found in 42.5 percent of women and was associated with increased age and 70 percent of these women were also found to have CAC. Half of women under 60 years of age had BAC and younger women with BAC had an 83 percent chance of also having CAC. BAC appeared to be as strong a predictor for cardiovascular risk as show by the Framingham Risk Score and the 2013 Cholesterol Guidelines Pooled Cohort Equations. The overall accuracy of BAC for the presence of CAC was 70 percent, and 63 percent of those with CAC also had BAC.

“This study suggests that we should exploit available data that may provide surrogate information about the likelihood of subclinical coronary disease,” said Jagat Narula, DM, MD, PhD, MACC, a co-author of the study and editor-in-chief of JACC: Cardiovascular Imaging. “In this study, BAC was found to be equally predictive of subclinical atherosclerosis as the standard risk factors. It is important to stress that the data are not driven from the prospective study design and has inherent selection bias. Although we and others have seen a correlation between BAC and CAC, the mechanism of calcification in these vessels is different and the direct link is unresolved. However, when you have the availability of data that shows relationship to subclinical atherosclerosis, one must pay attention to it.”

A separate study that looked at risk profiles of patients presenting with ST elevation myocardial infarction (STEMI) found that patients are getting younger and more obese, despite increased awareness of risk factors. Amgad G. Mentias, MD, and colleagues found that among 3,914 patients from 1995 to 2014, the average age at STEMI decreased from 64 to 60 years and the prevalence of obesity increased from 31 to 40 percent. Rates of smoking, diabetes, high blood pressure and chronic obstructive pulmonary disease also increased significantly. Moving forward, the authors stress the importance of prevention, and note that primary care physicians and patients, not just cardiologists, should take ownership of cardiovascular health.

In addition, according to a study from Amorina Ishai, MD, and colleagues, patients with greater activity in the stress center of the brain may also be at greater risk for cardiovascular events. Positron emission tomography/CT scans from 293 patients were evaluated. Results showed that there was a 14-fold greater risk of cardiovascular events for every unit increase in measured brain stress activity. Over five years of follow-up, 35 percent of the patients in the high-stress center activity group later suffered a cardiovascular event, compared to just 5 percent of the low-stress center activity group. According to the authors, moving forward, future studies are needed to determine if treating stress and reducing the activation of the fear center of the brain may lead to less atherosclerotic inflammation and, ultimately, reduce cardiovascular events.

These findings from Mentias and Ishai will also be presented at ACC.16. 

Clinical Topics: Clinical Topic Collection: Dyslipidemia, Noninvasive Imaging, Prevention, Lipid Metabolism, Nonstatins, Computed Tomography, Nuclear Imaging, Hypertension, Smoking

Keywords: Atherosclerosis, Brain, Calcinosis, Cholesterol, Coronary Artery Disease, Diabetes Mellitus, Female, Hypertension, Inflammation, Mammography, Myocardial Infarction, Obesity, Physicians, Primary Care, Positron-Emission Tomography, Prevalence, Prospective Studies, Pulmonary Disease, Chronic Obstructive, Risk Factors, Smoking, Tomography, X-Ray Computed, ACC Annual Scientific Session


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