Hendriks Eva J E, de Jong Pim A, van der Graaf Yolanda, Mali Willem P Th M, van der Schouw Yvonne T, Beulens Joline W J
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Atherosclerosis. 2015 Mar;239(1):11-20. doi: 10.1016/j.atherosclerosis.2014.12.035. Epub 2014 Dec 24.
Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to evaluate and summarize the available evidence on the associations of BAC with cardiovascular risk factors and cardiovascular risk.
A systematic literature review and meta-analysis were conducted. Embase and PubMed databases were searched. After critical appraisal, odds ratios were extracted from studies of moderate or good quality that examined risk factors for BAC or associations of BAC with cardiovascular disease. Random effects model meta-analyses were used to calculate pooled odds ratios and 95% confidence intervals (95%CIs).
BAC prevalence is around 12.7% among women in breast cancer screening programs. Increasing age (pooled OR 2.98 [95%CI 2.31-3.85] for every 10 years), diabetes (pooled OR: 1.88 [95%CI 1.36-2.59]) and parity as opposed to nulliparity (pooled OR 3.43 [95%CI 2.23-5.27]) are associated with higher BAC prevalence. Smoking is associated with lower BAC prevalence (pooled OR 0.48 [95%CI 0.39-0.60]). No associations were found with hypertension, obesity or dyslipidemia. Although longitudinal studies (n = 3) were scarce, BAC appear to be associated with an increased risk of cardiovascular disease events (adjusted hazard ratios for coronary heart disease ranging from 1.32 [95%CI 1.08-1.60] to 1.44 [95%CI1.02-2.05]).
BAC appear to be associated with an increased risk of cardiovascular disease events, while only being associated with some of the known cardiovascular risk factors, illustrating that medial arterial calcification might contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process.
乳腺动脉钙化（BAC）在乳腺钼靶检查中经常被观察到，是血管中层钙化，因此是动脉硬化的一种表现。我们的目的是评估和总结关于BAC与心血管危险因素及心血管风险之间关联的现有证据。
进行了一项系统的文献综述和荟萃分析。检索了Embase和PubMed数据库。经过严格评估后，从中度或高质量的研究中提取比值比，这些研究考察了BAC的危险因素或BAC与心血管疾病的关联。采用随机效应模型荟萃分析来计算合并比值比和95%置信区间（95%CI）。
在乳腺癌筛查项目中的女性中，BAC患病率约为12.7%。年龄增加（每10年合并比值比为2.98 [95%CI 2.31 - 3.85]）、糖尿病（合并比值比：1.88 [95%CI 1.36 - 2.59]）以及经产与未生育相比（合并比值比3.43 [95%CI 2.23 - 5.27]）与更高的BAC患病率相关。吸烟与较低的BAC患病率相关（合并比值比0.48 [95%CI 0.39 - 0.60]）。未发现与高血压、肥胖或血脂异常有关联。尽管纵向研究（n = 3）较少，但BAC似乎与心血管疾病事件风险增加有关（冠心病的调整后风险比范围为1.32 [95%CI 1.08 - 1.60]至1.44 [95%CI 1.02 - 2.05]）。
BAC似乎与心血管疾病事件风险增加有关，而仅与一些已知的心血管危险因素相关，这表明血管中层钙化可能通过一条与内膜动脉粥样硬化过程不同的途径导致心血管疾病。
