Hendriks Eva J E, Beulens Joline W J, de Jong Pim A, van der Schouw Yvonne T, Sun Wei-Ning, Wright C Michael, Criqui Michael H, Allison Matthew A, Ix Joachim H
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands.
Atherosclerosis. 2017 Apr;259:120-127. doi: 10.1016/j.atherosclerosis.2017.01.029. Epub 2017 Jan 30.
CVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac arteries with CVD risk factors and mortality.
We conducted a case-cohort study nested in a cohort of 5196 individuals who self-referred or were referred by a health care provider for whole body computed tomography (CT), including a random subcohort (n = 395) and total and CVD mortality cases (n = 298 and n = 90), who died during a median follow-up of 9.4 years. Arterial calcification in the breast, splenic, and internal and external iliac arteries on CT was scored using a simple visual score. AC and CAC were previously measured using the Agatston technique. Logistic regression models were made to study associations of CVD risk factors with calcification in the different vascular beds. Prentice-weighted Cox proportional hazards models adjusted for CVD risk factors, and calcification in other vascular beds, were used to study associations with mortality.
In the subcohort, the mean age was 56.6 years (SD 11.1) and 41.3% were female. The prevalence of calcification on CT, was 11.6% in the splenic, 47.9% in the internal iliac and 9.5% in the external iliac arteries, while 3.7% of women had breast artery calcification (BAC). Calcification in the splenic and iliac arteries was associated with calcification in the abdominal aorta but differentially associated with other CVD risk factors in logistic regression models. The prevalence of BAC was too low to fit these multivariable models. Calcification of the external iliac arteries was significantly associated with both all-cause and CVD mortality, but no longer significant when adjusted for CVD risk factors. Breast artery calcification was associated with both all-cause and CVD mortality independent of CVD risk factors and AAC and CAC (all-cause HR 5.67 [95% CI 1.50-21.41]).
Risk factors associated with calcification, and the association of calcification with risk of mortality differ across vascular beds, possibly reflecting different pathophysiology.
与冠状动脉钙化（CAC）和主动脉钙化（AC）相关的心血管疾病（CVD）风险已广为人知，但对于其他钙化动脉的了解较少。我们旨在评估乳腺动脉、脾动脉以及髂内动脉和髂外动脉钙化与CVD风险因素及死亡率之间的关联。
我们在一个由5196名自行转诊或由医疗保健提供者转诊进行全身计算机断层扫描（CT）的队列中开展了一项病例队列研究，该队列包括一个随机子队列（n = 395）以及全因死亡和CVD死亡病例（n = 298和n = 90），这些病例在9.4年的中位随访期内死亡。使用简单的视觉评分法对CT上乳腺动脉、脾动脉以及髂内动脉和髂外动脉的钙化进行评分。AC和CAC此前已使用阿加斯顿技术进行测量。采用逻辑回归模型研究不同血管床中CVD风险因素与钙化之间的关联。使用针对CVD风险因素以及其他血管床钙化进行调整的普伦蒂斯加权Cox比例风险模型来研究与死亡率之间的关联。
在子队列中，平均年龄为56.6岁（标准差11.1），女性占41.3%。CT上钙化的患病率在脾动脉中为11.6%，在髂内动脉中为47.9%，在髂外动脉中为9.5%，而3.7%的女性存在乳腺动脉钙化（BAC）。脾动脉和髂动脉钙化与腹主动脉钙化相关，但在逻辑回归模型中与其他CVD风险因素的关联存在差异。BAC的患病率过低，无法纳入这些多变量模型。髂外动脉钙化与全因死亡率和CVD死亡率均显著相关，但在调整CVD风险因素后不再显著。乳腺动脉钙化与全因死亡率和CVD死亡率均相关，且独立于CVD风险因素以及主动脉钙化和冠状动脉钙化（全因风险比5.67 [95%置信区间1.50 - 21.41]）。
与钙化相关的风险因素以及钙化与死亡风险的关联在不同血管床中有所不同，这可能反映了不同的病理生理学机制。
