Multiethnic Study of Breast Arterial Calcium Gradation and CVD

描述(申请人提供)：目前，乳房X光检查发现的乳腺动脉钙化(BAC)被认为是一种不具有临床重要性的偶然发现，因为它们与乳腺癌风险的增加无关。然而，乳房X线片上BAC的存在与几个(但不是所有)传统心血管疾病(CVD)危险因素以及流行和发生的CVD相关。因此，在常规乳房X光检查中发现的BAC是一个值得注意的发现，对于识别未来心血管疾病风险增加的无症状女性可能是更积极治疗的候选对象。此外，尽管数据非常有限，但种族/民族背景对女性亚临床动脉粥样硬化负担(即冠状动脉钙化)的衡量存在显著差异，对BAC也是如此。另一个值得注意的局限性是，以前关于生物活性碳的研究依赖于生物活性碳的缺失和存在；到目前为止，还没有研究确定生物活性碳的分级。3个具体目标是：1)建立一个年龄在60至79岁之间的多族裔队列(n=5400)，其中白人(n=1350；25%)、非裔美国人(n=1350；25%)、亚裔(n=1350；25%)和西班牙裔/拉丁裔(n=1350；25%)妇女具有同等的代表性。所有参与者将在北加州的三个Kaiser Permanente医疗中心进行常规筛查乳房X光检查(为期两年)时招募，并且在基线时将没有临床心血管疾病。将使用一种新的、有效的密度测量方法，使用数字乳房X光照片来估计BAC质量(以毫克为单位)；2)记录BAC质量的种族/民族差异，并检查BAC质量与社会人口背景、心血管疾病家族史、传统和新的心血管疾病危险因素、生殖健康因素、心理社会因素、选定的矿物质代谢因素、选定的药物使用(他汀类药物和含氮双膦酸盐)、乳房大小和睡眠相关因素的关系；3)阐明BAC质量在预测冠心病、脑血管疾病、心力衰竭、周围血管疾病和总心血管疾病中的作用，以及在基于传统危险因素的预测模型中加入BAC质量是否能改善对总CVD及其组成部分的风险分类。实现这些目标将为BAC质量作为评估心血管疾病风险的筛查工具的效用提供新的见解。

DESCRIPTION (provided by applicant): Currently, mammographically-detected breast arterial calcifications (BAC) are considered an incidental finding without clinical importance since they are not associated with increased risk of breast cancer. However, presence of BAC on mammography correlates with several (but not all) traditional cardiovascular disease (CVD) risk factors and with prevalent and incident CVD. Thus, BAC detected during routine mammography is a noteworthy finding that could be valuable in identifying asymptomatic women at increased future CVD risk that may be candidates for more aggressive management. In addition, there are notable differences in measures of subclinical atherosclerosis burden in women (i.e., coronary artery calcification) by race/ethnic background, and the same appears to be true for BAC, although data are very limited. Another noteworthy limitation of prior research on BAC is the reliance on absence vs. presence of BAC; no study to date has determined gradation of BAC. The 3 specific aims are: 1) To establish a multi- ethnic cohort (n=5,400) between the ages of 60 and 79 years with equal representation of white (n=1,350; 25%), African-American (n=1,350; 25%), Asian (n=1,350; 25%) and Hispanic/Latina (n=1,350; 25%) women. All participants will be recruited at the time of their regular screening mammography (over a 2 year period) at three Kaiser Permanente of Northern California medical centers and will be free of clinical CVD at baseline. A new, validated densitometry method will be used to estimate BAC mass (in milligrams) using digital mammograms; 2) To document race/ethnic variation in BAC mass and to examine associations of BAC mass with sociodemographic background, family history of CVD, traditional and novel CVD risk factors, reproductive health factors, psychosocial factors, selected mineral metabolism factors, selected medication use (statins and nitrogen-containing bisphosphonates), breast size and sleep-related factors; and 3) To elucidate the role of BAC mass in the prediction of coronary heart disease (CHD), cerebrovascular disease, heart failure, peripheral vascular disease and total CVD and to determine whether adding BAC mass to predictionmodels based on traditional risk factors improves classification of risk for total CVD and its components. Accomplishing these aims will provide novel insights into the utility of BAC mass as a screening tool to assess CVD risk.