title: Digital Mammography and Screening for Coronary Artery Disease.
abstract: OBJECTIVE
  This study sought to determine if breast arterial calcification (BAC) on digital mammography predicts coronary artery calcification (CAC).
  
  
  BACKGROUND
  BAC is frequently noted but the quantitative relationships to CAC and risk factors are unknown.
  
  
  METHODS
  A total of 292 women with digital mammography and nongated computed tomography was evaluated. BAC was quantitatively evaluated (0 to 12) and CAC was measured on computed tomography using a 0 to 12 score; they were correlated with each other and the Framingham Risk Score (FRS) and the 2013 Cholesterol Guidelines Pooled Cohort Equations (PCE).
  
  
  RESULTS
  BAC was noted in 42.5% and was associated with increasing age (p < 0.0001), hypertension (p = 0.0007), and chronic kidney disease (p < 0.0001). The sensitivity, specificity, positive and negative predictive values, and accuracy of BAC >0 for CAC >0 were 63%, 76%, 70%, 69%, and 70%, respectively. All BAC variables were predictive of the CAC score (p < 0.0001). The multivariable odds ratio for CAC >0 was 3.2 for BAC 4 to 12, 2.0 for age, and 2.2 for hypertension. The agreements of FRS risk categories with CAC and BAC risk categories were 57% for CAC and 55% for BAC; the agreement was 47% for PCE risk categories for CAC and 54% by BAC. BAC >0 had area under the curve of 0.73 for identification of women with CAC >0, equivalent to both FRS (0.72) and PCE (0.71). BAC >0 increased the area under the curve curves for FRS (0.72 to 0.77; p = 0.15) and PCE (0.71 to 0.76; p = 0.11) for the identification of high-risk (4 to 12) CAC. With the inclusion of 33 women with established CAD, BAC >0 was significantly additive to both FRS (p = 0.02) and PCE (p = 0.04) for high-risk CAC.
  
  
  CONCLUSIONS
  There is a strong quantitative association of BAC with CAC. BAC is superior to standard cardiovascular risk factors. BAC is equivalent to both the FRS and PCE for the identification of high-risk women and is additive when women with established CAD are included.
authors.forename: Laurie
authors.initials: L
authors.lastname: Margolies
authors.forename: Mary
authors.initials: M
authors.lastname: Salvatore
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Hecht
authors.forename: Sean
authors.initials: S
authors.lastname: Kotkin
authors.forename: Rowena
authors.initials: R
authors.lastname: Yip
authors.forename: Usman
authors.initials: U
authors.lastname: Baber
authors.forename: Vivian
authors.initials: V
authors.lastname: Bishay
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
authors.forename: David
authors.initials: D
authors.lastname: Yankelevitz
authors.forename: Claudia
authors.initials: C
authors.lastname: Henschke
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D019540:Area Under Curve; D001158:Arteries / Q000000981:diagnostic imaging*; D001940:Breast / Q000098:blood supply*; D001941:Breast Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000379:methods*; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging*