Relationship between the prevalence of breast arterial calcifications on mammography and coronary calcifications on Chest CT

Non-traditional risk factors predict coronary calcification in chronic kidney disease in a population-based cohort

Association of Lipoprotein Subfractions and Coronary Artery Calcium In Patient at Intermediate Cardiovascular Risk

Calcifications are part of the development of atherosclerosis; they occur exclusively in atherosclerotic arteries and are absent in the normal vessel wall.1 Studies have demonstrated calcification in both coronaries and aortic arteries to be a specific marker of underlying atherosclerosis in the respective vascular beds.1 Extensive evidence exist that men are more likely to have calcification in the coronary arteries2,3; however, whether similar difference exists in other vascular beds is not well established. The purpose of this study is to evaluate whether the lower risk of atherosclerosis observed in coronary circulation in women compared with men is also observed in thoracic aorta. This is a cross-sectional study on a consecutive sample of 8549 asymptomatic individuals (69% men, mean age: 52±9 years) patients who presented to a single EBT scanning facility for CHD risk stratification.4 A history of cigarette smoking was considered present if a subject was a current or former smoker. Dyslipidemia was coded as present for any individual self-reporting a history of high total cholesterol, high LDL, low HDL, and/or high triglycerides, or current use of lipid-lowering therapy. Patients were considered to have diabetes if they reported using oral hypoglycemic agents, insulin sensitizers, or subcutaneous insulin and hypertension if they reported a history of high blood pressure or used antihypertensive medications. A family history of CHD was considered premature if the immediate family (parents or siblings) experienced a fatal or nonfatal myocardial infarction before age of 55 years. Individuals …

The progression of coronary artery calcification in predialysis patients on calcium carbonate or sevelamer

Coronary artery calcium (CAC) scoring by computed tomography (CT) has been the subject of intense interest and critical scrutiny since it was first reported as a clinical tool in 1990.1 With improvements in study design, greater availability of coronary CT scanners, and increased attention to the posttest prognosis of patient samples and asymptomatic individuals who have undergone coronary CT, CAC measurement is now considered a potentially useful test for improving coronary risk assessment in selected intermediate-risk asymptomatic patients in whom high CAC scores signify increased cardiovascular risk beyond that predicted by conventional cardiovascular risk factors alone.2 Article p 1693 At the other end of the spectrum, does a very low CAC score signify very low risk? An American Heart Association writing group3 stated that a CAC score of zero (CAC=0; ie, no calcified plaque detected) indicated 1) that the presence of atherosclerotic plaque, including unstable or vulnerable plaque, was highly unlikely; 2) that the presence of significant luminal obstructive disease was highly unlikely (negative predictive value on the order of 95% to 99%); and 3) that the risk of a cardiovascular event in the next 2 to 5 years was quite low (0.1 per 100 person-years). In addition, at least 1 early study suggested that CAC=0 might be useful in the emergency room setting as a tool to rule out myocardial ischemia in symptomatic patients.4 A recent review article5 suggested the same conclusions. However, as pointed out by a different …

Primary prevention of coronary artery disease: let's start with calcium score.

Detecting Coronary Artery Calcium on Chest Radiographs: Can We Teach an Old Dog New Tricks?

Background: Breast arterial calcifications (BAC) are incidentally observed on screening mammography. BAC has been shown to be associated with the presence of coronary artery calcification (CAC) and increased risk of coronary artery disease (CAD). Given that population-based mammography is currently recommended to women, the evaluation of BAC may be important in identifying high-risk women without additional cost or radiation exposure. Aims: We sought to identify reproductive and cardiovascular risk factors associated with the presence of detectable BAC and CAC in women participated to mammography screening. Also, we aimed to determine the association between BAC and presence of CAC. Further, we investigated presence of BAC, CAC and estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD). Methods: In this cross-sectional study, reproductive history and CVD risk factors were obtained in 215 women ≥ 18 years of age that underwent mammography and cardiac computed tomographic angiography (CCTA) within 2 years of each other between January 2007 and September 2017 at Weill Cornell Medicine/ New York Presbyterian hospital (WCM/NYP). BAC was recorded in two ways: a binary scale (presence/absence) and a semi-quantitative scale (mild, moderate, severe). CAC was calculated using the Agatston method and was recorded as a binary variable (presence/absence). Information regarding reproductive history and CVD risk factors, medical history, and relevant demographics were obtained by chart review. Odds ratios (ORs) and 95% confidence intervals (CIs), with adjustment for age at study entry as a potential confounder, were estimated. The 10-year risk of atherosclerotic cardiovascular disease (ASCVD) was calculated using the Pooled Cohort Risk Equations. Results: The odds of presence of BAC increased with increasing age . Women age ≥60 had a near 6-fold higher odds of BAC (OR = 5.77; 95% CI = 2.45 to 16.00) compared with women <60 years old. Other factors associated with presence of BAC after controlling for age were diastolic blood pressure ≥80 ( P = 0.0008), systolic blood pressure ≥140 ( P = 0.0009), number of children (P = 0.01). Younger age at first birth (≤28 years) was associated with 3-fold higher odds of BAC compared with women with age at first birth >28 years. Except for age at study entry, the only factor associated with presence of CAC was hyperlipidemia ( P = 0.002). We found no association between presence of BAC with CAC. We observed women with presence of both BAC and CAC had the highest estimated 10-year risk of ASCVD: 18.54%, followed by presence of BAC but absence of CAC 11.65%, absence of BAC and presence of CAC 6.01%, and women with no BAC and no CAC presence had a mean 10-year risk of ASCVD of 5.25%. Conclusions: These findings support the value of BAC in identifying women at potentially increased risk of future cardiovascular disease without additional cost and radiation exposure.

Association of pulse wave velocity with vascular and valvular calcification in hemodialysis patients

Article, see p 1993 The clinician now has an overwhelming array of investigations at his or her disposal for patients with suspected coronary heart disease. These tests are used to diagnose or risk-stratify patients and thereby enable the clinician to treat their symptoms and reduce their future risk. Ultimately, these investigations either assess risk factors (eg, lipid, glucose, and C-reactive protein concentrations) and proxies for disease (eg, carotid intima-media thickness and coronary artery calcium score) or are looking to provide circumstantial downstream evidence of disease (eg, markers of ischemia and infarction: Q waves on an ECG, fibrosis on magnetic resonance imaging or functional stress testing). In this issue of Circulation , Budoff and colleagues1 compare 2 of the most widely used approaches, coronary artery calcium scoring and functional stress testing, within the framework of the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain). Coronary artery calcification is considered pathognomonic of atherosclerosis and has been a marker of coronary artery disease for millennia.2 Its presence is, however, a proxy of disease because it is induced in response to atherosclerosis, and, apart from rare calcific nodules, calcification does not directly cause ischemic heart disease events. Indeed, calcification appears to be an adaptive healing response to the necrotic atheromatous plaque whereby the body attempts to limit and contain the disease, much like the calcification of a caseating granuloma from mycobacterium tuberculosis infection. However, calcification does not directly relate to the degree of luminal or functional stenosis of the coronary artery, nor does it necessarily reflect the current status of the plaque because the calcification may be inactive, ongoing, or incomplete. Indeed, large areas of inert macrocalcification are associated with plaque stability, whereas spotty calcifications or microcalcifications are associated with high-risk plaques, probably because of incomplete calcification.3– …

Cardiovascular and All-Cause Mortality Risk by Coronary Artery Calcium Scores and Percentiles Among Older Adult Males and Females

Joint BrEast CAncer & CardiOvascular ScreeniNg: BEACON Study to Assess Opportunistic Cardiovascular Screening Using Breast Arterial Calcification on Mammography.

Relation of Thoracic Aortic Distensibility to Left Ventricular Area (from the Multi-Ethnic Study of Atherosclerosis [MESA

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

AIMTo assess the prevalence of breast arterial calcification (BAC) in patients who also underwent routine surveillance mammography, and to determine the association with cardiovascular risk factors, coronary artery calcification, and coronary artery disease on coronary computed tomography angiography (CCTA).MATERIALS AND METHODSFour hundred and five female participants were identified who had undergone CCTA and subsequent mammography in the SCOT-HEART randomised controlled trial of CCTA in patients with suspected stable angina. Mammograms were assessed visually for the presence and severity of BAC.RESULTSBAC was identified in 93 (23%) patients. Patients with BAC were slightly older (63±7 versus 59±8 years, p<0.001), with a higher cardiovascular risk score (19±11 versus 16±10, p=0.022) and were more likely to be non-smokers (73% versus 49%, p<0.001). In patients with BAC, coronary artery calcification was present in 58 patients (62%; relative risk [RR] 1.26, 95% confidence intervals [CI]: 1.04, 1.53; p=0.02), non-obstructive coronary artery disease in 58 (62%; RR 1.27, 95% CI: 1.04 to 1.54, p=0.02), and obstructive coronary artery disease in 19 (20%; RR 1.62, 95% CI: 0.98, 2.66; p=0.058). Patients without BAC were very unlikely to have severe coronary artery calcification (negative predictive value 95%) but the diagnostic accuracy of BAC to identify coronary artery disease was poor (AUC 0.547).CONCLUSIONAlthough BAC is associated with the presence and severity of coronary artery calcification, the diagnostic accuracy to identify patients with coronary artery disease or obstructive coronary artery disease is poor.