Author + information
- Received July 29, 2015
- Revision received September 21, 2015
- Accepted October 5, 2015
- Published online April 1, 2016.
- Laurie Margolies, MD,
- Mary Salvatore, MD,
- Harvey S. Hecht, MD∗ (, )
- Sean Kotkin, MD,
- Rowena Yip, MPH,
- Usman Baber, MD,
- Vivian Bishay, MD,
- Jagat Narula, PhD, MD,
- David Yankelevitz, MD and
- Claudia Henschke, PhD, MD
- ↵∗Reprint requests and correspondence:
Dr. Harvey S. Hecht, Mount Sinai Saint Luke's Medical Center, 1111 Amsterdam Avenue, New York, New York 10025.
Objectives This study sought to determine if breast arterial calcification (BAC) on digital mammography predicts coronary artery calcification (CAC).
Background BAC is frequently noted but the quantitative relationships to CAC and risk factors are unknown.
Methods A total of 292 women with digital mammography and nongated computed tomography was evaluated. BAC was quantitatively evaluated (0 to 12) and CAC was measured on computed tomography using a 0 to 12 score; they were correlated with each other and the Framingham Risk Score (FRS) and the 2013 Cholesterol Guidelines Pooled Cohort Equations (PCE).
Results BAC was noted in 42.5% and was associated with increasing age (p < 0.0001), hypertension (p = 0.0007), and chronic kidney disease (p < 0.0001). The sensitivity, specificity, positive and negative predictive values, and accuracy of BAC >0 for CAC >0 were 63%, 76%, 70%, 69%, and 70%, respectively. All BAC variables were predictive of the CAC score (p < 0.0001). The multivariable odds ratio for CAC >0 was 3.2 for BAC 4 to 12, 2.0 for age, and 2.2 for hypertension. The agreements of FRS risk categories with CAC and BAC risk categories were 57% for CAC and 55% for BAC; the agreement was 47% for PCE risk categories for CAC and 54% by BAC. BAC >0 had area under the curve of 0.73 for identification of women with CAC >0, equivalent to both FRS (0.72) and PCE (0.71). BAC >0 increased the area under the curve curves for FRS (0.72 to 0.77; p = 0.15) and PCE (0.71 to 0.76; p = 0.11) for the identification of high-risk (4 to 12) CAC. With the inclusion of 33 women with established CAD, BAC >0 was significantly additive to both FRS (p = 0.02) and PCE (p = 0.04) for high-risk CAC.
Conclusions There is a strong quantitative association of BAC with CAC. BAC is superior to standard cardiovascular risk factors. BAC is equivalent to both the FRS and PCE for the identification of high-risk women and is additive when women with established CAD are included.
This study was supported in part by the Flight Attendants Medical Research Institute. Dr. Hecht is a consultant for Philips Medical Systems. Dr. Yankelevitz serves on the scientific advisory board (unpaid) for Give-A-Scan, Lung Cancer Alliance. Dr. Henschke is President of the Early Diagnosis and Treatment Research Foundation (unpaid). All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Daniel Berman, MD, served as Guest Editor for this paper.
- Received July 29, 2015.
- Revision received September 21, 2015.
- Accepted October 5, 2015.
- American College of Cardiology Foundation