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Bone, Breast, and Coronary Artery Disease Study
Study Questions:
Does breast arterial calcification and low bone mass assist in the prediction of subclinical coronary artery disease (CAD) among asymptomatic women?
Methods:
Data from the BBC (Women Health Registry Study for Bone, Breast, and Coronary Artery Disease) were used for the present analysis. The registry was comprised of consecutive self-referred asymptomatic women ≥40 years who received dual-energy x-ray absorptiometry, digital mammography, and coronary computed tomography angiography as part of a general health evaluation performed at one medical center (Seoul National University Bundang Hospital) between March 2011 and February 2013. Participants with prior coronary arterial disease and/or a history of breast surgery were excluded from the present analysis. Predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated for each participant using the Pooled Cohort Equation, recalibrated for the Korean population (i.e., the Korean Risk Prediction Model). The participants were classified into groups according to the ASCVD risk at 10 years as follows: <5%, ≥5% but <7.5%, and ≥7.5%.
Results:
A total of 2,100 women (median age 52 years) were included in the present analysis. Breast arterial calcification was observed in 9.5% of participants, while 34.1% of the participants had low bone density. Coronary artery calcification (CAC) was present in 235 women (11.2%), with a score of 1-100 in 188 women (9.0%), 101-400 in 39 women (1.9%), and >400 in 8 women (0.4%). Coronary artery plaque (CAP) was present in 328 women (15.6%), with ≥50% diameter stenosis in 37 women (1.8%) and involving >4 segments in 18 women (0.9%). Women with CAC or CAP had more CV risk factors, higher 10-year ASCVD risk, greater breast arterial calcification, and were more likely to have osteopenia and osteoporosis compared to women without CAC or CAP. Both breast arterial calcification and low bone mass were found to be associated with the presence of CAC (unadjusted odds ratios [ORs], 3.54 and 2.22, respectively) and CAP (unadjusted ORs, 3.02 and 1.91, respectively). However, in the multivariable analysis, only breast arterial calcification and 10-year ASCVD score remained as independent predictors. For the prediction of CAC and CAP, the addition of breast arterial calcification added to the 10-year ASCVD risk significantly increased the areas under the curve (0.71 to 0.72, p = 0.016; and 0.66 to 0.68, p = 0.010, respectively) and resulted in net reclassification index improvements (0.304, p < 0.001; and 0.245, p < 0.001, respectively).
Conclusions:
The authors concluded that the presence and severity of breast arterial calcification and low bone mass were significantly associated with the risk of subclinical CAD in asymptomatic women. In particular, breast arterial calcification provides an independent and incremental value over conventional risk algorithms.
Perspective:
These data are intriguing, particularly the association of breast arterial calcification, in the prediction of subclinical CAD among women. Given the number of women who receive mammography each year, this information may prove helpful to clinicians. Further research is warranted to understand these findings in other populations and in regards to the potential association between breast arterial calcification and CVD events.
Keywords: Absorptiometry, Photon, Angiography, Atherosclerosis, Bone Density, Breast Diseases, Constriction, Pathologic, Coronary Artery Disease, Diagnostic Imaging, Mammography, Osteoporosis, Plaque, Atherosclerotic, Primary Prevention, Risk Factors, Tomography, X-Ray Computed, Women
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