Breast Arterial Calcification is Associated with the Progression of Coronary Atherosclerosis in Asymptomatic Women: A Preliminary Retrospective Cohort Study

Abstract

We evaluated whether breast arterial calcification (BAC) is associated with the progression of coronary atherosclerosis in asymptomatic women. This retrospective observational cohort study analysed asymptomatic women from the BBC registry. In 126 consecutive women (age, 54.5 ± 7.0 years) who underwent BAC evaluation and repeated coronary computed tomography angiography (CCTA) examinations, the coronary arterial calcification score (CACS) and segment stenosis score (SSS) were evaluated to assess the progression of coronary arterial calcification (CAC) and coronary atherosclerotic plaque (CAP). CAC and CAP progression were observed in 42 (33.3%) and 26 (20.6%) women, respectively (median interscan time, 4.3 years), and were associated with the presence of BAC and a higher BAC score at baseline. Women with BAC demonstrated higher CAC and CAP progression rates and showed higher chances for CAC and CAP progression during follow-up (p < 0.001 for both). In multivariable analyses, the BAC score remained independently associated with both CAC and CAP progression rates after adjustment for clinical risk factors (β = 0.087, p = 0.029; and β = 0.020, p = 0.010, respectively) and with additional adjustment for baseline CACS (β = 0.080, p = 0.040; and β = 0.019, p = 0.012, respectively) or SSS (β = 0.079, p = 0.034; and β = 0.019, p = 0.011, respectively). Thus, BAC may be related to the progression of coronary atherosclerosis and its evaluation may facilitate decision-making.

Figure 1

Flow diagram of the study population selection. BBC Registry, Women Health Registry for Bone, Breast, and Coronary Artery Disease; CCTA, coronary computed tomographic angiography.

Figure 2

Progression of CAC (A) and CAP (B) according to the presence and absence of BAC. BAC, breast arterial calcification; CAC, coronary arterial calcification; CAP, coronary atherosclerotic plaque.

Figure 3

The cumulative proportion of CAC (A) and CAP (B) progression according to the presence and absence of BAC. BAC, breast arterial calcification; CAC, coronary arterial calcification; CAP, coronary atherosclerotic plaque.

Figure 4

Representative cases. A 63-year-old asymptomatic woman with a BAC score of 5 (yellow arrow heads) on screening mammography (A) demonstrated calcified plaque without significant stenosis (percent diameter stenosis, 10–20%) at the proximal LAD and mixed plaque (percent diameter stenosis, 10–20%) at the mid LAD (yellow arrow). (B) Three years later, she was referred to the emergency department with chest pain and underwent CCTA, which demonstrated progression of the mid LAD lesion (percent diameter stenosis, 90%; yellow arrow). (C) Invasive angiography also demonstrated the tight stenosis of the mid LAD (percent diameter stenosis, 90%) and percutaneous coronary intervention was performed. A 51-year-old asymptomatic woman without evidence of BAC (red arrow heads) on screening mammography (D) demonstrated calcified plaque (percent diameter stenosis, 30%) at the mid LAD (red arrow). (E) Five years later, she visited the outpatient clinic due to epigastric pain and underwent CCTA, which demonstrated no change in the mid LAD lesion (red arrow). (F) BAC, breast arterial calcification; CCTA, coronary computed tomographic angiography; LAD, left anterior descending artery.