Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, USA.
Kidney Int. 2015 Jan;87(1):195-9. doi: 10.1038/ki.2014.187. Epub 2014 May 28.
Medial arterial calcification is common in advanced kidney disease but its impact on cardiovascular disease is uncertain because imaging techniques used to date cannot reliably distinguish it from atherosclerotic calcification. We have previously shown that breast arterial calcification (BAC) is exclusively medial and is a marker of generalized medial calcification in end-stage renal disease (ESRD). Therefore, the presence of BAC on mammograms in 202 women with ESRD (mean duration 4.1 years) was correlated with cardiovascular events to determine the clinical significance of medial arterial calcification. BAC was found in 58% of the study participants and was significantly associated with age, diabetes, and ESRD duration. Both coronary artery (27 vs. 15%) and peripheral arterial disease (PAD; 19 vs. 4%) were more likely in patients with BAC but only the latter persisted after accounting for other factors (odds ratio 4.6; 95% confidence interval 1.2-15). In 142 women without clinical events before mammography, BAC was associated with a greater incidence of new PAD events (13 vs. 3%) but not coronary artery disease events (11 vs. 11%). Thus, BAC is strongly and independently associated with PAD in women with ESRD and may be predictive of clinical events. This suggests that medial arterial calcification is a clinically significant lesion that may contribute to the accelerated PAD in ESRD.
动脉中层钙化在晚期肾病中很常见，但它对心血管疾病的影响尚不确定，因为迄今为止使用的成像技术无法可靠地区分它与动脉粥样硬化钙化。我们之前已经表明，乳腺动脉钙化（BAC）是纯粹的中层钙化，是终末期肾病（ESRD）中全身性中层钙化的标志物。因此，在 202 名患有 ESRD 的女性（平均病程 4.1 年）的乳房 X 光片中存在 BAC，与心血管事件相关，以确定中层动脉钙化的临床意义。研究参与者中有 58%发现了 BAC，并且与年龄、糖尿病和 ESRD 持续时间显著相关。患有 BAC 的患者更有可能患有冠状动脉疾病（27%比 15%）和外周动脉疾病（PAD；19%比 4%），但只有后者在考虑其他因素后仍然存在（比值比 4.6；95%置信区间 1.2-15）。在乳房 X 光检查前没有临床事件的 142 名女性中，BAC 与新的 PAD 事件（13%比 3%）的发生率增加相关，但与冠状动脉疾病事件（11%比 11%）无关。因此，BAC 与 ESRD 女性的 PAD 强烈且独立相关，可能是临床事件的预测因素。这表明中层动脉钙化是一种具有临床意义的病变，可能导致 ESRD 中 PAD 的加速。
