Could Breast Arterial Calcification Predict the Risk of Coronary Artery Disease?
Could Breast Arterial Calcification Predict the Risk of Coronary Artery Disease?
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乳腺动脉钙化可以预测冠状动脉疾病的风险吗？
DOI：
10.1016/j.jcmg.2018.09.015
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发表时间：
2018-12
期刊：
影响因子：
--
通讯作者：
Liu You Shuo
中科院分区：
文献类型：
--
作者：
Lin Xiao;Yuan Ling Qing;Liu You Shuo
我们饶有兴趣地阅读了Yoon等人(1)最近发表在最近一期iJACC上的论文。作者报道，在一个连续无症状妇女的大队列中，乳房动脉钙化（BAC）的存在和严重程度是亚临床冠状动脉疾病（CAD）存在的重要预测因素，包括冠状动脉钙化和冠状动脉粥样硬化斑块，但骨密度（BMD） T评分和低骨量没有。我们赞扬作者进行了如此大规模和有趣的研究；然而，这项研究有几个问题。首先，该研究招募了2100名无症状的妇女，她们接受了双能x线吸收仪检测骨密度，其中1321名是绝经后妇女，这意味着三分之一的队列由绝经前妇女组成。此外，在他们的研究中，作者将骨密度T评分低于1.0定义为“骨质减少”，将骨密度T评分低于2.5定义为“骨质疏松”。但是，应该使用Z分数，而不是T分数，并且Z分数为À2。根据国际临床密度测定学会最近达成的共识，0或更低被定义为绝经前女性“低于预期年龄范围”(2)。因此，作者应该使用绝经前妇女的Z评分来评估骨密度。因此，我们建议作者将受试者分为绝经前和绝经后两组，分别使用Z或T评分。因此，绝经前妇女BMD与CAD的关系应根据Z评分再次分析。其次，本研究采用回顾性设计，发现BAC相对于传统的CAD临床危险因素具有独立且递增的价值。然而，另一项前瞻性健康保险携带与责任法案（Health Insurance Portability and accountability act）合规的病例对照研究(3)报告称，BAC与女性冠心病之间没有显著相关性。可能是不同类型的研究可以解释两项调查结果的差异。当女性进行乳房x光检查时，每次都能被告知控制冠心病的危险因素，如糖尿病、吸烟、缺乏运动、不良饮食和肥胖，这将有助于她们降低冠心病的风险，女性可以从预防信息中获得相当大的好处(4)。因此，研究心血管危险因素治疗或消失后BAC随时间的变化是非常有意义的。此外，女性对BAC的态度也是一个重要因素。如果临床医生能够帮助女性感到有能力参与自己的健康，并努力控制BAC的风险因素，而不是害怕，甚至害怕这些因素，那么BAC的检测可以作为降低未来心血管事件风险的动力来源。因此，如果作者能对BAC在预测冠心病风险中的作用进行前瞻性研究就更好了。
We read with great interest the recent paper by Yoon et al.(1) published in a recent issue of iJACC. The authors reported that, in a large cohort of consecutive asymptomatic women, the presence and severity of breast arterial calcification (BAC) were significant predictors of the presence of subclinical coronary artery disease (CAD), including coronary arterial calcification and coronary atherosclerotic plaque, but bone mineral density (BMD) T score and low bone mass did not. We commend the authors for performing such a large and interesting study; however, there are several concerns with this study. First, the study enrolled 2,100 asymptomatic women who underwent dual-energy X-ray absorptiometry to detect BMD, and 1,321 were postmenopausal women, which meant that one-third of the cohort consisted of premenopausal women. In addition, in their study, the authors defined “osteopenia” as a BMD T score below–1.0 and “osteoporosis” as a BMD T score below–2.5. However, Z scores, not T scores should be used, and a Z score of À2. 0 or lower is defined as “below the expected range for age” in women before menopause according to the recent consensus of the International Society for Clinical Densitometry (2). Thus, the authors should use Z scores for premenopausal women to evaluate BMD. Therefore, we suggest that the authors should divide the subjects into 2 groups: premenopausal and postmenopausal, and use Z or T scores for the different groups, respectively. Thus, the relationship between BMD and CAD in premenopausal women should be analyzed again according to Z score. Second, the present study was a retrospective design and found that BAC acted as an independent and incremental value over that of conventional clinical risk factors for CAD. However, another prospective Health Insurance Portability and AccountabilityAct-compliant and case-controlled study (3) reported that no significant correlation was observed between BAC and coronary heart disease in women. It may be that a different type of study could explain the differences in results between the 2 investigations. When women had a mammogram and could be counseled each time to control their risk factors of CAD, such as diabetes mellitus, smoking, physical inactivity, poor diet, and obesity, it would help them attenuate the risk of CAD and women could gain considerable benefits from prevention messages (4). Therefore, it is very meaningful to investigate how BAC changes over time when the cardiovascular risk factors were treated or disappeared. Moreover, the attitude toward BAC for women is also an important factor. If clinicians could help women feel empowered to engage in their health and make great effort to control the BAC risk factors rather than be afraid, even terrified, of those factors, then the detection of BAC could be used as a source of motivation to decrease the risk of future cardiovascular events. Therefore, it would be better if the authors had carried out a prospective study about the role of BAC in predicting the risk of CAD.
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