title: Calcification of the splenic, iliac, and breast arteries and risk of all-cause and cardiovascular mortality.
abstract: CVD risks associated with coronary artery calcification (CAC) and aortic calcification (AC) are well known, but less is known about other calcified arteries. We aimed to assess the associations of arterial calcification in the breast, splenic, and internal and external iliac arteries with CVD risk factors and mortality.
  
  
  
  We conducted a case-cohort study nested in a cohort of 5196 individuals who self-referred or were referred by a health care provider for whole body computed tomography (CT), including a random subcohort (n = 395) and total and CVD mortality cases (n = 298 and n = 90), who died during a median follow-up of 9.4 years. Arterial calcification in the breast, splenic, and internal and external iliac arteries on CT was scored using a simple visual score. AC and CAC were previously measured using the Agatston technique. Logistic regression models were made to study associations of CVD risk factors with calcification in the different vascular beds. Prentice-weighted Cox proportional hazards models adjusted for CVD risk factors, and calcification in other vascular beds, were used to study associations with mortality.
  
  
  
  In the subcohort, the mean age was 56.6 years (SD 11.1) and 41.3% were female. The prevalence of calcification on CT, was 11.6% in the splenic, 47.9% in the internal iliac and 9.5% in the external iliac arteries, while 3.7% of women had breast artery calcification (BAC). Calcification in the splenic and iliac arteries was associated with calcification in the abdominal aorta but differentially associated with other CVD risk factors in logistic regression models. The prevalence of BAC was too low to fit these multivariable models. Calcification of the external iliac arteries was significantly associated with both all-cause and CVD mortality, but no longer significant when adjusted for CVD risk factors. Breast artery calcification was associated with both all-cause and CVD mortality independent of CVD risk factors and AAC and CAC (all-cause HR 5.67 [95% CI 1.50-21.41]).
  
  
  
  Risk factors associated with calcification, and the association of calcification with risk of mortality differ across vascular beds, possibly reflecting different pathophysiology.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Eva J E
authors.initials: EJ
authors.lastname: Hendriks
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: Joline W J
authors.initials: JW
authors.lastname: Beulens
authors.affiliation: Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Pim A
authors.initials: PA
authors.lastname: de Jong
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: Y.T.vanderSchouw@umcutrecht.nl.
authors.forename: Yvonne T
authors.initials: YT
authors.lastname: van der Schouw
authors.affiliation: Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Wei-Ning
authors.initials: WN
authors.lastname: Sun
authors.affiliation: Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA, USA; Scripps Health, La Jolla, CA, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: Wright
authors.affiliation: Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA, USA.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.affiliation: Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA, USA; Division of Nephrology, Department of Medicine, School of Medicine, University of California, San Diego, CA, USA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.affiliation: Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, CA, USA; Division of Nephrology, Department of Medicine, School of Medicine, University of California, San Diego, CA, USA; Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA.
authors.forename: Joachim H
authors.initials: JH
authors.lastname: Ix
mesh_terms: D000368:Aged; D001940:Breast / Q000098:blood supply*; D002140:California / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000401:mortality*; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D013157:Splenic Artery / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000401:mortality*; D051598:Whole Body Imaging
keywords: Cardiovascular risk factors; Mortality; Vascular calcification