JACC: Cardiovascular Imaging
Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic WomenRegistry for the Women Health Cohort for Breast, Bone, and Coronary Artery Disease Study
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Author + information
- Yeonyee E. Yoon, MDa,f,∗,
- Kyoung Min Kim, MD, PhDb,f,∗,
- Jong Soo Han, MD, MBAc,g,
- Si-Hyuck Kang, MDa,f,
- Eun Ju Chun, MD, PhDd,h,
- Soyeon Ahn, PhDe,
- Sun Mi Kim, MD, PhDd,h,
- Sang Il Choi, MD, PhDd,h,
- Bo La Yun, MD, PhDd,h,∗∗ (yunbola{at}gmail.com) and
- Jung-Won Suh, MD, PhDa,f,∗ (dasome2{at}snu.ac.kr)
- aDepartments of Cardiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- bDepartment of Endocrinology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- cDepartment of Health Promotion Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- dDepartment of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- eMedical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
- fDepartments of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- gDepartment of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- hDepartment of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
- ↵∗Address for correspondence:
Dr. Jung-Won Suh, Department of Internal Medicine, Cardiovascular Center, Seoul National University Bundang Hospital, Department of Internal Medicine, Seoul National University College of Medicine, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Korea. - ↵∗∗Dr. Bo La Yun, Department of Radiology, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Korea.
Graphical abstract
Abstract
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.)
- breast arterial calcification
- coronary artery calcification
- coronary artery disease
- osteopenia
- osteoporosis
Footnotes
↵∗ Drs. Yoon and Kim contributed equally as first authors.
Supported by National Research Foundation (NRF) of Korea grants NRF-2014R1A1A3051343 and NRF-2014R1A1A3051310 from the Basic Science Research Program sponsored by the Ministry of Science, ICT, and Future Planning, and Seoul National University Bundang Hospital Research Fund grant 02-2013-077. All authors have reported that they have no relationships with industry relevant to the contents of this paper to disclose.
- Received March 3, 2018.
- Revision received June 11, 2018.
- Accepted July 5, 2018.
- 2019 American College of Cardiology Foundation
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