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With the increase in the number of women undergoing mammography for breast cancer screening , interest is growing too in the use of breast artery calcification BAC detected by mammography as a nonivasive indicator for CAD in women.
Some studies have evaluated the association between BAC and atherosclerosis in postmenopausal women and suggested that BAC is associated with advancing age, hypertension, diabetes and microvascular chronic complications . The aim of this study was to determine whether BAC detected by mammography, already used as a screening test, has any association with the presence of CAD.
Another objective was to evaluate the association of BAC with the carotid IMT and with conventional as well as novel risk factors of atherosclerosis in the same population. Women undergoing coronary angiography to assess for the presence of CAD were screened for medical history and menopause status. Women meeting the eligibility criteria and confirmed as premenopausal were given Doppler ultrasonography to measure carotid IMT, and mammography to detect BAC.
Risk factors for atherosclerosis were assessed from questionnaire data, clinical examination and laboratory tests. Patients had been referred with a history of chest pain suspicious for CAD from history and physical examination.
This evaluation was done on women in Chamran Hospital, the biggest referral cardiac centre in Isfahan province in the Islamic Republic of Iran. All enrolled women were asked to fill out a personal history questionnaire including questions on age, parity, menopausal status, use of oral contraceptives or hormone replacement therapy and the presence of cardiovascular disease, parathyroid, breast, renal and other chronic diseases. Questions on history of smoking, diabetes, hypertension and hyperlipidaemia, family history of cardiovascular disease and use of medications were included.
Blood samples were obtained from all women. The remaining 84 premenopausal women were enrolled in the study and filled out the consent forms for further investigation.
Age range was 33—54 years. For each woman, weight, height, waist circumference and blood pressure were measured using the World Health Organization WHO standardized protocol . Body mass index BMI was computed as weight kg divided by height squared m2. Diabetes mellitus was defined as self-reported, physician diagnosed or the use of antidiabetic agents.
Blood samples were taken from all participants after a hour fast. Plasma malondialdehyde MDA , an antioxidant, was measured by high-pressure liquid chromatography. All analyses were done in the central laboratory of Isfahan Cardiovascular Research Centre which is standardized against the reference laboratory of the University Hospital of Leuven in Belgium.
Low-density lipoprotein LDL cholesterol was calculated from the Friedewald equation . Angiography: Coronary angiography was performed using Judkins techniques in standard projections. If there was significant controversy in their interpretation, a 4th cardiologist would review again. An experienced neurologist measured 6 well-defined arterial wall segments in both right and left carotid systems: the near wall and far wall of the proximal 1 cm of the internal carotid artery, the near wall and far wall of the carotid bifurcation, beginning at the tip of the flow divider, and extending 1 cm below this point and the near and far wall of the arterial segment, extending 1 cm below the tip of the flow divider into common carotid artery.
All measurements were recorded 3 times and the mean was used as the measure of carotid IMT [3,4]. Mammography: All mammograms were obtained using a Toshiba low X-ray mammography unit and Kodak industrial films . Craniocaudal and lateral views of each breast were performed. Then all views were interpreted by a single reading by an experienced radiologist who was blinded to the coronary artery angiography and carotid ultrasonography results. Mammograms were interpreted as BAC-positive if BAC was found on 1 of the 2 standard views in the right or left breast or both of them.
BAC was defined as continuous and intermittent parallel tracks or linear tubular calcification clearly associated with blood vessels . Data were presented as mean and standard deviation SD.
The statistical analysis was performed using SPSS, version The clinical parameters in patients with and without BAC were compared by the nonparametric Mann—Whitney test for continuous variables and the chi-squared test for categorical variables. Abnormal coronary angiographic findings were observed among 34 BAC was observed in 6 7. The most prominent risk factors in the total group were: history of hypertension When the data were analysed by BAC status, there were no significant differences between women with and without BAC missing values were omitted regarding age, smoking, history of hypertension and hyperlipidaemia, family history of CAD and the CAD risk factors serum Lp a , plasma malondialdehyde, serum CRP and left ventricular mass.
Metabolic syndrome was present in all of the patients with BAC compared with The evaluation of CAD in young women is important. Although the prevalence of CAD in premenopausal women is low, the case fatality rates for CAD have been shown to be higher for younger women . Despite increasing interest in gender-specific CAD, its risk factors and predictors, there is an apparent paucity of information regarding younger premenopausal women, because most studies have underrepresented women in general and young or premenopausal women in particular.
There is growing interest in the evaluation of CAD using noninvasive tests. These include carotid IMT, which is a simple, noninvasive and reproducible tool to evaluate atherosclerosis and thus predict CAD .
However, IMT is not yet considered a screening test. Mammography, a relatively inexpensive test which is increasingly used as a screening test for breast cancer, may also be a useful predictive tool for early detection of atherosclerosis among postmenopausal women [8,17]. Calcified deposits are a common feature in atherosclerosis. Several studies have shown that coronary and aortic calcifications are independently associated with an increased risk of cardiovascular disease .
However, fewer studies have reported the relationship between calcium deposits in other vessels, such as breast arteries, and atherosclerosis [19—22]. To our knowledge, this relationship has not been reported in the literature before. BAC on mammography may be a sign of coexisting diabetes mellitus , hypertension  or CAD [6,19—21], which have a higher prevalence in older women [19,20]. The increased prevalence of BAC in older patients with diabetes mellitus, hypertension and CAD may be related to the long duration of the disease, as arterial wall changes seen in elderly patients may be aggravated by the disease process.
This mechanism led us to select young women for the present study. A significant correlation has been reported between BAC and CAD in women aged less than 59 years, particularly among diabetics .
This disagrees with our main finding that BAC had no association with angiography-confirmed CAD in young premenopausal women. However, we investigated only women confirmed as premenopausal by their FSH level and the women were younger on average than women in the previous report. Furthermore, we found no significant relationship between age and the presence of BAC in premenopausal women. Some studies have reported on the relationship between the presence of BAC by mammography with the amount of coronary calcium detected by multislice computed tomography as a predictor for CAD rather than angiography-confirmed CAD .
Previous studies reported that novel CAD risk factors such as Lp a , CRP , fibrinogen and low levels of antioxidants are associated with CAD and some with coronary calcification [29,30] but not with BAC, particularly in young women. The current study specifically assessed the relationship of these risk factors with BAC in young premenopausal women and also found no significant relationships.
We noted that all the patients with BAC suffered from metabolic syndrome. The finding is an interesting one in this young population. An unexpected result in our study was the There were some limitations in this study, including the small sample size, the composition of the study population and the lack of other radiological data such as the size, number and location of BAC.
However, there were also some important strengths. These include the careful baseline measurements and the laboratory-based selection criteria for the whole study population. Also these correlations have been studied in young premenopausal women, while previous studies were mainly done on postmenopausal, and to a lesser degree on young, women but not on laboratory-confirmed premenopausal women.
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Eastern Mediterranean Health Journal Past issues Volume 15, Volume 15, issue 6 Association of breast artery calcification with coronary artery disease and carotid intima-media thickness in premenopausal women. Eastern Mediterranean Health Journal. Association of breast artery calcification with coronary artery disease and carotid intima-media thickness in premenopausal women.
PDF version N. The aim of this study was to determine whether BAC detected by mammography, already used as a screening test, has any association with the presence of CAD assessed by angiography in young, premenopausal Iranian women.
Methods Study design Women undergoing coronary angiography to assess for the presence of CAD were screened for medical history and menopause status. Data collection Clinical data For each woman, weight, height, waist circumference and blood pressure were measured using the World Health Organization WHO standardized protocol .
Laboratory data Blood samples were taken from all participants after a hour fast. Statistical analysis Data were presented as mean and standard deviation SD. Results Abnormal coronary angiographic findings were observed among 34 Discussion The evaluation of CAD in young women is important. References Sarraf-Zadegan N et al. The prevalence of coronary artery disease in an urban population in Isfahan, Iran.
Acta cardiologica, , 54 5 — Risk factors for coronary artery disease in Isfahan, Iran. European journal of public health, , —6.
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Medwave se preocupa por su privacidad y la seguridad de sus datos personales. Nivel de evidencia III. En nuestro medio se recomiendan las siguientes condiciones. Provoca aumento de volumen sensible y enrojecimiento de la piel. Si la mama es adiposa, tiene poco que ofrecer debido a la alta sensibilidad de la Mx en este grupo de pacientes. Esta probabilidad aumenta hasta un 3.
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