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Breast arterial calcification may flag heart disease. (Established Markers Pose Much Higher Risk).

CHICAGO -- Researchers have identified the threshold level of breast arterial calcification that's associated with a 20% increased risk for coronary artery disease in women.

Calcium deposits in the arteries of the breast therefore may be another useful marker for detecting coronary artery disease in women, especially in those with no symptoms, Dr. Kirk Doerger said at the annual meeting of the Radiological Society of North America.

"We're already performing mammograms on many women over the age of 50 looking for breast cancer. If we can detect any evidence of coronary artery disease, that's great information," said Dr. Doerger, a resident in the department of radiology at the Mayo Clinic, Rochester, Minn.

"We think there is a strong enough correlation that we can recommend that radiolologists comment on breast arterial calcifications when they see them on mammograms. Patients should then have a risk assessment for coronary artery disease that would include a history and physical, focused on diabetes, smoking, hypertension, and high cholesterol" he said.

Other studies have suggested an association between the presence of calcified breast arteries and heart disease risk, he said, but this was the first to grade breast arterial calcification and stenosis.

Despite the finding, Dr. Doerger was quick to point out that a positive history of diabetes, hypertension, hypercholesterolemia, and cigarette smoking pose far greater risks of coronary artery disease than does the presence of breast arterial calcification.

For the study mammograms of 1,803 patients who underwent coronary angiography and mammography within 1 year of each other at the Mayo Clinic between 1991 and 2001 were retrospectively reviewed. Patients, aged 65 on average, were defined as having coronary artery disease if they had a stenosis of 50% or more as seen on angiogram.

Breast arterial calcifications were scored by counting the number of calcified arterial distributions in each breast and then recorded as 0-3 for each breast. A breast arterial calcification score was established by averaging the numbers for the two breasts. Investigators also collected clinical information on patient history of diabetes, hypertension, smoking history, and high cholesterol.

Of the women studied, 819 or 45%, had coronary artery stenosis that exceeded 50%. Breast arterial calcification was observed in 844 patients or 47%.

A breast arterial calcification score of 1.5 or greater was seen in 405 patients or 23%. A score of 2.5 or greater was observed in 160 patients or 9%.

After adjusting for age, the risk for coronary artery disease in women with a breast arterial calcification score of 1.5 or greater was 20%, Dr. Doerger said.

As expected, age positively correlated with breast arterial calcification but negatively correlated with breast density. Age also positively correlated with stenosis.

Other clinical factors were more important than calcification. For example, the presence of diabetes put women in the study at a 110% increased risk of having coronary artery disease, as did hypertension. Hypercholesterolemia posed an 80% increased risk, while cigarette smoking posed a 50% increased risk.

A limitation of the study, he noted, included the fact that half of the patients had stenosis that was 50% or greater. "That's a little more than three times higher than the estimated amount of stenosis in the general population of Minnesota," he said.
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Author:Brunk, Doug
Publication:OB GYN News
Date:Jan 15, 2003
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