Digital Mammography and Screening for Coronary Artery Disease

Margolies, Laurie; Salvatore, Mary M.; Hecht, Harvey S.; Kotkin, Sean; Yip, Rowena; Baber, Usman; Bishay, V.; Narula, Jagat; Yankelevitz, David F.; Henschke, Claudia I.

doi:10.1016/j.jcmg.2015.10.022

Cited by 104 publications

(74 citation statements)

References 23 publications

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“…При стандартном описании маммографии по шкале BI-RADS нормальная маммограмма с КМА имеет категорию 1 (отрицательная) или 2 (доброкачественная) [13], но чаще КМА не регистрируется вообще, как не имеющий отношение к диагностике рака молочной железы. Кальциноз артерий молочной железы Breast arteries calcification В ряде научных исследований для количественной оценки КМА применяется 12-балльная шкала, в которой учитывается число вовлеченных артерий, протяженность кальцинированных участков и их плотность [14,15]. Индекс КМА может иметь показатель от 0 до 12 для каждой молочной железы.…”

Section: патоморфология кальциноза маммарных артерийunclassified

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors

Bochkareva

Kim

Butina

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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1 Национальный медицинский исследовательский центр профилактической медицины Россия, 101990, Москва, Петроверигский пер., 10 2 Московский государственный медико-стоматологический университет им. А.И. Евдокимова Россия, 127473, Москва, ул. Делегатская, 20/1 3 Национальный медицинский исследовательский центр кардиологии Россия, 121552, Москва, 3-я Черепковская, 15АКальциноз артерий молочной железы (КМА) является формой кальциноза медиальной оболочки средних и мелких артерий (кальциноза Менкеберга), что отличает его от кальциноза, связанного с атеросклеротическим процессом и локализованного в интиме сосуда. Имеются данные о связи КМА с сердечно-сосудистыми заболеваниями (ССЗ), что позволяет рассматривать его в качестве нового маркера сердечнососудистого риска у женщин. Целью 1-й части обзора является анализ современной литературы, посвященной распространенности КМА, факторам, связанным с его возникновением, и ассоциации КМА с традиционными факторами риска ССЗ. По данным программ онкологического скрининга распространенность КМА составляет в среднем 12,7%, увеличивается с возрастом, достигая 50% у 80-летних женщин, не являясь при этом атрибутом «здорового старения», зависит от расовой и этнической принадлежности. Имеется связь с репродуктивной функцией, частота КМА возрастает в зависимости от количества рожденных детей, при грудном кормлении, в менопаузе, снижается на фоне гормонозаместительной терапии. Среди курящих женщин частота КМА парадоксальным образом в 2 раза меньше, чем у некурящих. Обнаружение КМА на маммограммах ассоциируется с состояниями, патогенетически связанными с ССЗ: увеличением частоты гиперлипидемии, диабета, хронической болезни почек, снижением костной массы. Имеется сильная корреляция КМА с коронарным кальцием -индикатором коронарного атеросклероза. В то же время отсутствует статистически значимая связь КМА с избыточной массой тела и ожирением, курением, имеется слабая связь с артериальной гипертонией, что может свидетельствовать о самостоятельной патофизиологической роли КМА в развитии сосудистой патологии, и позволяет рассматривать КМА в качестве независимого маркера для улучшения стратификации сердечно-сосудистого риска у женщин. Полагают, что КМА является маркером более генерализованной тенденции к развитию медиального кальциноза в других сосудистых областях, приводящей к системному увеличению артериальной жесткости, что способствует развитию ССЗ.Ключевые слова: кальциноз, артерии молочной железы, распространенность, факторы риска, сердечно-сосудистые заболевания.

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Section: патоморфология кальциноза маммарных артерийunclassified

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors

Bochkareva

Kim

Butina

et al. 2019

Racionalʹnaâ farmakoterapiâ v kardiologii

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“…More recently, a study by Margolies et al 4 provided the most detailed assessment of the association between BAC and CAC. The authors studied a convenience sample of 292 women referred for a mammogram who also underwent a clinically indicated nongated chest computed tomogram within a year of the mammogram.…”

Section: Breast Arterial Calcification Expanding the Reach Of Cardiovmentioning

confidence: 99%

“…If the patient does not already have a clear indication for a statin, then one could proceed to formal CAC testing. Margolies et al 4 reported a specificity and positive predictive value of BAC for CAC of 83 and 53, As with CAC screening, there is the theoretical concern that a diagnosis of BAC might have negative psychological consequences. Studies of adults who have undergone CAC testing have not substantiated such concerns.…”

Section: Breast Arterial Calcification Expanding the Reach Of Cardiovmentioning

confidence: 99%

Breast Arterial Calcification

Polonsky

Greenland

2017

Circulation

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A large proportion of cardiovascular events occur among women whose 10-year estimated atherosclerotic cardiovascular disease risk is <7.5%, and thus guidelines would not routinely recommend statins for such patients before their events.1 Additional strategies beyond the measurement of traditional risk factors are therefore needed to identify women who might benefit from medical therapy, based on unexpected higher risk. Coronary artery calcium (CAC) seen on a noncontrast chest computed tomogram is the most potent marker of subclinical cardiovascular disease (CVD), and has been shown to enhance risk prediction in women.1 However, CAC testing is usually not covered by insurance companies, limiting its widespread use as a screening tool for subclinical CVD.Given that millions of women undergo mammograms each year, there has been growing interest in whether the presence of breast arterial calcification (BAC), which is easily detected on a standard mammogram, could help inform cardiovascular risk assessment. Unlike CAC, which represents calcification in the intima, BAC is found along the circumference of the media giving it a tram-track appearance when the burden is severe (Figure). Some studies of BAC described it simply as present versus absent, whereas others attempted to use a semiquantitative assessment based on the density and extent of calcium in each artery, and the number of arteries involved.2 BAC prevalence varies widely depending on the population's age and comorbidities, ranging from 10% to 12% in healthier population-based cohort studies, to 60% to 70% among women >70 years of age or with chronic kidney disease. 2BAC is thought to develop primarily through pathways related to mineral metabolism and bone formation, but there may be a role for inflammation as well. Although traditional cardiovascular risk factors such as age, hypertension, and diabetes mellitus are associated with BAC presence, BAC has an inverse association with smoking, which is consistent with other studies of medial calcification.2 Reproductive factors such as parity and breastfeeding are also associated with BAC. 2Several observational studies have demonstrated that the presence of BAC provides important prognostic information related to cardiovascular risk. In a systematic review of the data related to BAC and CVD, Hendricks et al 2 cited studies that used either hospital admission data or municipal death records to examine the association of BAC and CVD events. The authors reported a hazard ratio of 1.32 (95% confidence interval [CI], 1.08-1.60) for incident coronary heart disease, 1.44 (95% CI, 1.02-2.05) for coronary heart disease mortality, 1.29 (95% CI, 1.01-1.66) for CVD mortality, and 1.52 (95% CI, 1.18-1.98) for heart failure. Exactly why BAC signifies an increased cardiovascular risk is not well understood. It may simply represent long-term exposure to known cardiovascular risk factors. BAC has also been shown to be indicative of medial calcification in other vascular beds. Medial calcification is known to increase vascular ...

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“…In another recent study, Margolies et al investigated the relationship of BAC with CAC in 292 women without known CAD who had undergone noncontrast chest CT for various clinical indications at a single institution in New York . Although most other studies used Agatston scoring, Margolies et al assigned a CACS based on the extent of calcification in the 4 main coronary arteries.…”

Section: Summary Of Literature On the Association Of Bac With Coronarmentioning

confidence: 99%

Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women

Ryan

Choi

et al. 2017

Clinical Cardiology

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Breast arterial calcification (BAC) is a type of medial artery calcification that can be seen incidentally on mammography. Studies have suggested association of BAC with cardiovascular risk factors, coronary artery disease (CAD), and cardiovascular morbidity and mortality. Recently published studies have also suggested a modest correlation of BAC with coronary artery calcium (CAC) scoring. Roughly 40 million mammograms are already performed annually in the United States with overlap in patients that undergo CAD screening via CAC scoring. Thus, identification of cardiovascular risk by demonstrating an association between BAC and CAC may enable an instrumental sex-specific methodology to identify asymptomatic women at risk for CAD. The purpose of this article is to review the current state of the literature for BAC and its association with CAC, to review contemporary breast cancer screening guidelines, and to discuss the clinical implications of these findings.

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Digital Mammography and Screening for Coronary Artery Disease

Abstract: There is a strong quantitative association of BAC with CAC. BAC is superior to standard cardiovascular risk factors. BAC is equivalent to both the FRS and PCE for the identification of high-risk women and is additive when women with established CAD are included.

Cited by 104 publications

References 23 publications

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors

Mammographic Screening as a Tool for Cardiovascular Risk Assessing. Part 1. Breast Arterial Calcification: Pathomorphology, Prevalence and Risk Factors

Breast Arterial Calcification

Breast arterial calcification association with coronary artery calcium scoring and implications for cardiovascular risk assessment in women

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