无症状女性中乳腺动脉钙化和低骨量对亚临床冠状动脉疾病的预测：BBC 研究妇女健康队列登记。
Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women: Registry for the Women Health Cohort for the BBC Study.
机构信息
Departments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Endocrinology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea; Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
出版信息
JACC Cardiovasc Imaging. 2019 Jul;12(7 Pt 1):1202-1211. doi: 10.1016/j.jcmg.2018.07.004. Epub 2018 Aug 15.
OBJECTIVES
This study sought to determine whether evaluations of breast arterial calcification (BAC) and low bone mass (LBM) could improve the ability to predict subclinical coronary artery disease (CAD) in asymptomatic women.
BACKGROUND
An improved risk stratification strategy beyond the measurement of conventional risk factors is needed to identify women at high risk of CAD.
METHODS
The BBC (Women Health Registry Study for Bone, Breast, and Coronary Artery Disease) enrolled 2,100 asymptomatic women who underwent dual-energy X-ray absorptiometry, digital mammography, and coronary computed tomography angiography. We assessed the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk and evaluated the presence and severity of BAC, LBM, coronary artery calcification (CAC), and coronary atherosclerotic plaque (CAP).
RESULTS
CAC and CAP were found in 11.2% and 15.6% of participants, respectively. In women with CAC or CAP, increasing trends in the presence and severity of both BAC and LBM were observed. Both BAC and LBM were found to be associated with the presence of CAC (unadjusted odds ratios [OR]: 3.54 and 2.22, respectively) and CAP (unadjusted OR: 3.02 and 1.91, respectively). However, in multivariate analysis, only the presence of BAC and BAC score remained as independent predictors. For the prediction of CAC and CAP, addition of the BAC presence to the 10-year ASCVD risk significantly increased the areas under the curve (area under the curve: 0.71 to 0.72; p = 0.016; and area under the curve: 0.66 to 0.68; p = 0.010; respectively) and resulted in net reclassification index improvements (area under the curve: 0.304; p <0.001; and area under the curve: 0.245; p <0.001; respectively).
CONCLUSIONS
The presence and severity of BAC and LBM were significantly associated with the risk of subclinical CAD in asymptomatic women. BAC evaluation especially provides an independent and incremental value over conventional risk algorithms. (Women Health Cohort for Breast, Bone and Coronary Artery Disease [BBC]; NCT03235622).
目的
本研究旨在确定评估乳腺动脉钙化（BAC）和低骨量（LBM）能否提高预测无症状女性亚临床冠状动脉疾病（CAD）的能力。
背景
需要一种超越常规风险因素测量的改进风险分层策略，以识别具有高 CAD 风险的女性。
方法
BBC（女性健康登记研究：骨骼、乳房和冠状动脉疾病）纳入了 2100 名无症状女性，她们接受了双能 X 射线吸收法、数字乳房 X 线摄影和冠状动脉计算机断层扫描血管造影。我们评估了预测的 10 年动脉粥样硬化性心血管疾病（ASCVD）风险，并评估了 BAC、LBM、冠状动脉钙化（CAC）和冠状动脉粥样硬化斑块（CAP）的存在和严重程度。
结果
CAC 和 CAP 在分别在 11.2%和 15.6%的参与者中发现。在有 CAC 或 CAP 的女性中，观察到 BAC 和 LBM 的存在和严重程度呈递增趋势。BAC 和 LBM 均与 CAC 的存在相关（未调整的优势比[OR]：3.54 和 2.22）和 CAP（未调整的 OR：3.02 和 1.91）。然而，在多变量分析中，只有 BAC 的存在和 BAC 评分仍然是独立的预测因素。对于 CAC 和 CAP 的预测，将 BAC 的存在加入到 10 年 ASCVD 风险中显著增加了曲线下面积（曲线下面积：0.71 至 0.72；p=0.016；和曲线下面积：0.66 至 0.68；p=0.010），并导致净重新分类指数改善（曲线下面积：0.304；p<0.001；和曲线下面积：0.245；p<0.001）。
结论
在无症状女性中，BAC 和 LBM 的存在和严重程度与亚临床 CAD 的风险显著相关。BAC 评估尤其提供了独立且递增的常规风险算法价值。（女性健康乳房、骨骼和冠状动脉疾病队列研究[BBC]；NCT03235622）。
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