Kaiser Permanente Division of Research, Oakland, CA (C.I., M.C., C.L., G.S.).
Kaiser Permanente Santa Clara Medical Center, CA (D.L.S.).
Circ Cardiovasc Imaging. 2022 Mar;15(3):e013526. doi: 10.1161/CIRCIMAGING.121.013526. Epub 2022 Mar 15.
Breast arterial calcification (BAC), a common incidental finding in mammography, has been shown to be associated with angiographic coronary artery disease and cardiovascular disease (CVD) outcomes. We aimed to (1) examine the association of BAC presence and quantity with hard atherosclerotic CVD (ASCVD) and global CVD; (2) ascertain model calibration, discrimination and reclassification of ASCVD risk; (3) assess the joint effect of BAC presence and 10-year pooled cohorts equations risk on ASCVD.
A cohort study of 5059 women aged 60-79 years recruited after attending mammography screening between October 2012 and February 2015 was conducted in a large health plan in Northern California, United States. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Prespecified end points were incident hard ASCVD and a composite of global CVD.
Twenty-six percent of women had BAC >0 mg. After a mean (SD) follow-up of 6.5 (1.6) years, we ascertained 155 (3.0%) ASCVD events and 427 (8.4%) global CVD events. In Cox regression adjusted for traditional CVD risk factors, BAC presence was associated with a 1.51 (95% CI, 1.08-2.11; =0.02) increased hazard of ASCVD and a 1.23 (95% CI, 1.002-1.52; =0.04) increased hazard of global CVD. While there was no evidence of dose-response association with ASCVD, a threshold effect was found for global CVD at very high BAC burden (95th percentile when BAC present). BAC status provided additional risk stratification of the pooled cohorts equations risk. We noted improvements in model calibration and reclassification of ASCVD: the overall net reclassification improvement was 0.12 (95% CI, 0.03-0.14; =0.01) and the bias-corrected clinical-net reclassification improvement was 0.11 (95% CI, 0.01-0.22; =0.04) after adding BAC status.
Our results indicate that BAC has potential utility for primary CVD prevention and, therefore, support the notion that BAC ought to be considered a risk-enhancing factor for ASCVD among postmenopausal women.
乳腺动脉钙化（BAC）是乳房 X 线照相术常见的偶然发现，已显示与血管造影冠状动脉疾病和心血管疾病（CVD）结局相关。我们旨在：（1）研究 BAC 存在和数量与硬动脉粥样硬化性 CVD（ASCVD）和全球 CVD 的关系；（2）确定 ASCVD 风险的模型校准、区分和再分类；（3）评估 BAC 存在和 10 年汇总队列方程风险对 ASCVD 的联合影响。
在美国加利福尼亚州北部的一个大型健康计划中，对 2012 年 10 月至 2015 年 2 月期间参加乳房 X 线照相术筛查的 5059 名年龄在 60-79 岁的女性进行了队列研究。使用数字乳房 X 线照相术确定 BAC 状态（存在与不存在）和数量（钙质量 mg）。预先指定的终点是新发硬 ASCVD 和全球 CVD 复合事件。
26%的女性有 BAC>0mg。在平均（标准差）随访 6.5（1.6）年后，我们确定了 155 例（3.0%）ASCVD 事件和 427 例（8.4%）全球 CVD 事件。在调整传统 CVD 危险因素的 Cox 回归中，BAC 存在与 ASCVD 的风险比增加 1.51（95%置信区间，1.08-2.11；=0.02）和全球 CVD 的风险比增加 1.23（95%置信区间，1.002-1.52；=0.04）相关。虽然与 ASCVD 没有剂量-反应关系的证据，但在极高 BAC 负担（当 BAC 存在时的第 95 百分位）时发现了一个阈值效应。BAC 状态为汇总队列方程风险提供了额外的风险分层。我们注意到模型校准和 ASCVD 再分类的改善：添加 BAC 状态后，总体净再分类改善为 0.12（95%置信区间，0.03-0.14；=0.01），校正偏倚的临床净再分类改善为 0.11（95%置信区间，0.01-0.22；=0.04）。
我们的结果表明 BAC 对 CVD 的一级预防具有潜在的作用，因此支持在绝经后女性中，将 BAC 视为 ASCVD 的增强风险因素的观点。
