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분당서울대학교병원, 서울대학교 의과대학

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JACC-Cardiovasc. Imag., Available online 15 August 2018 | https://doi.org/10.1016/j.jcmg.2018.07.004 Prediction of Subclinical Coronary Artery Disease With Breast Arterial Calcification and Low Bone Mass in Asymptomatic Women: Registry for the Women Health Cohort for Breast, Bone, and Coronary Artery Disease Study

Yeonyee E. Yoon MD ^{a, f, *}, Kyoung Min Kim MD, PhD ^{b, f, *}, Jong Soo Han MD, MBA ^{c, g}, Si-Hyuck Kang MD ^{a, f}, Eun Ju Chun MD, PhD ^{d, h}, Soyeon Ahn PhD ^e, Sun Mi Kim MD, PhD ^{d, h}, Sang Il Choi MD, PhD ^{d, h}, Bo La Yun MD, PhD ^{d, h}, Jung-Won Suh MD, PhD ^{a, f}^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
^*Drs. Yoon and Kim contributed equally as first authors.

Address for correspondence: Bo La Yun MD, PhD, Dr. Jung-Won Suh

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.)

Key Words : breast arterial calcification, coronary artery calcification, coronary artery disease, osteopenia, osteoporosis

논문정보

형식Research article
게재일2018년 08월 (BRIC 등록일 2018-09-12)
연구진국내 연구진
분야 의약학 > 응용의학

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