Rationale and Objectives
To evaluate the relationship between intramammary arterial calcifications detected by screening mammography and concomitant coronary artery disease, detected by coronary angiography.
Materials and Methods
We retrospectively evaluated screening mammography and coronary angiography results of 131 consecutive patients, ages 42–81 years. Risk factors for coronary artery disease (hypertension, diabetes mellitus, dyslipidemia, smoking, and obesity) were obtained from medical records to identify possible simultaneous risk factors for coronary artery disease.
Results
Eighty-five women had coronary artery disease (41 with intramammary arterial calcifications and 44 without such calcifications) and 46 had normal coronary angiography (11 had intramammary arterial calcifications and 35 did not). A strong association between intramammary arterial calcifications and coronary artery disease was seen, with an OR of 2.96 and P = .006 in the raw model and OR of 4.6 in the adjusted one. The evaluated risk factors did not present as confounding variables. Most patients had only two risk factors or less. The most prevalent risk factor for coronary artery disease was hypertension, with significantly higher prevalence in the coronary artery disease group ( P < .01).
Conclusion
A strong association exists between intramammary arterial calcifications and coronary artery disease. Therefore a mammographic finding of intramammary arterial calcification should receive more of the radiologists’ attention and its presence should never be omitted from the final report.
Coronary artery disease (CAD) and cancer are the leading causes of female death ( ). Mammography is employed as a breast cancer screening method in the United States and several other Western countries in women older than 40 years of age ( ). Intramammary arterial calcifications (IMAC) detected in mammograms are frequently not included in final reports because this considered a benign finding that is not relevant to the diagnosis of breast cancer ( ). In the last 20 years, studies have correlated IMAC to risk factors for cardiovascular disease (CVD), therefore suggesting an indirect relationship between IMAC and CVD ( ). IMAC was also associated with increased CVD mortality ( ). The purpose of this study is to verify whether IMAC may represent a predictor of underlying CAD, using coronary angiography as a gold standard.
Materials and methods
A total of 131 consecutive female patients ages 42–81 years (mean, 61 years) who underwent coronary angiography between October 2001 and April 2005 and also underwent mammography within 1 year of the coronary angiography were included in the study. All patients were admitted to one institution and received coronary angiography for suspected heart disease, mostly ischemic heart disease. This study was approved by the Institutional Review Board, and informed consent was waived because of the study’s retrospective design. Patient confidentiality was preserved following institutional and national regulations. After retrieval of angiography and mammography reports, patients were divided into group A (abnormal coronary angiography) and B (normal angiography). Group A was subdivided into patients with mild, moderate, and severe CAD.
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Results
Patient Features and Risk Factors for CAD
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Table 1
Clinical Profile of Patients who had Coronary Angiography
Risk Factors Total ( n = 131) Group A ( n = 85) Group B ( n = 46) Age 61.1 ± 9.08 61.9 ± 9.08 59.7 ± 8.99 NS Hypertension 116 80 (94.1%) 36 (78.2%)P < .01 Diabetes mellitus 38 29 (34.1%) 9 (19.5%)P = .07 Dyslipidemia 88 61 (71.7%) 27 (58.6%) NS Smoking 19 13 (15.2%) 6 (13.0%) NS Obesity 29 16 (18.8%) 13 (28.2%) NS Intramammary arterial calcifications 52 41 (48.2%) 11 (23.9%)P < .01
NS: not significant.
Group A: women with coronary artery disease.
Group B: women without coronary artery disease.
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Mammography Results
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Table 2
Mammography Results
Coronary Artery Disease Intramammary Arterial Calcifications Present Absent Total Present 41 44 85 Absent 11 35 46 Total 52 79 131
P = .006
OR = 2.96 CI 95% (1.25–7.30)
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Table 3
Odds Ratio and Respective Confidence Interval (95%) for the Association Between IMAC and CAD
IMAC Absent OR ⁎ Present OR (CI 95%) ⁎ Model 1 † CAD 1.00 2.97 (1.33–6.60) Model 2 ‡ CAD 1.00 3.74 (1.50–9.30) Model 3 § CAD 1.00 4.02 (1.60–10.12) Model 4 ∥ CAD 1.00 4.60 (1.65–12.83)
CAD: coronary artery disease; IMAC: intramammary arterial calcifications.
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Table 4
Prevalence of Risk Factors in Women With and Without IMAC
Risk factors Total ( n = 131) IMAC+ ( n = 52) IMAC– ( n = 79) Hypertension 116 46 (88.4%) 70 (88.6%) NS DM 36 18 (34.6%) 20 (25.3%) NS Dyslipidemia 88 32 (61.5%) 56 (70.8%) NS Smoking 19 1 (1.92%) 18 (22.7%)P < .001 Obesity 29 7 (13.4%) 22 (27.8%)P = .05 CAD 85 41 (78.8%) 44 (55.7%)P < .01
IMAC: intramammary arterial calcifications; DM: diabetes mellitus; CAD: coronary artery disease.
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Coronary Angiography Results
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Table 5
Patient Distribution by Age
Age range IMAC Total Present Absent CAD+ CAD– CAD+ CAD– 40–50 y 0 1 10 (59%) 7 18 51–60 y 9 (100%) 0 19 (56%) 15 43 61–70 y 17 (71%) 7 15 (55%) 12 51 71–80 y 15 (83%) 3 0 1 19 Total 41 11 44 35 131
IMAC: intramammary arterial calcifications; DM: diabetes mellitus; CAD: coronary artery disease.
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Table 6
Comparison Between IMAC Intensity and CAD Severity
CAD IMAC Absent Mild Moderate Intense Total Absent 35 4 6 1 46 Mild 10 3 5 1 19 Moderate 4 1 4 — 9 Severe 30 18 7 2 57 Total 79 26 22 4 131
IMAC: intramammary arterial calcifications; DM: diabetes mellitus; CAD: coronary artery disease.
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Discussion
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