An in-depth study of the association of breast arterial calcification with cardiovascular disease, its risk factors, and other chronic noncommunicable diseases: rationale and study protocol

Aim. To assess association between breast artery calcification (BAC) with ultrasound and biochemical markers of cardiovascular risk, asymptomatic and clinically expressed forms of cardiovascular diseases, as well as other chronic non-communicable diseases.

Material and methods. It is planned to include 300-400 women aged 40-74 years who underwent routine or diagnostic digital mammography at the National Medical Research Center for Therapy and Preventive Medicine and signed informed consent in a cross-sectional study. The groups will be formed on the case-control principle in a 1:1 ratio, considering age. The study protocol will include: physical examination; questionnaire to assess sociodemographic parameters, reproductive history, cardiovascular risk factors, comorbidities and drug therapy, probability of angina pectoris, intermittent claudication, history of stroke, risk of osteoporotic fractures; laboratory examination to determine parameters of lipid, carbohydrate, mineral metabolism, renal function, thyroid gland and presence of anemia; electrocardiography; duplex scanning of carotid and femoral arteries. Mammograms will be evaluated in a blinded manner by radiologists. Standard digital mammograms in craniocaudal and mediolateral projections will be analyzed. The severity of BAC will be determined using a 12-point scale.

Expected results. The data on the presence/absence of BAC and its severity will be compared with the ultrasound parameters of the atherosclerotic load of the peripheral arteries, which is a recognized marker of high cardiovascular risk, as well as traditional risk factors for cardiovascular diseases. The relationship of BAC with iron deficiency anemia, decreased bone mineral density, thyroid diseases, decreased glomerular filtration and other pathological conditions will be studied, which, according to previous studies conducted at the National Medical Research Center for Therapy and Preventive Medicine on a limited sample, can presumably be associated with the presence of BAC.

Conclusion. For Russian healthcare, the development of a methodology for assessing the probability of cardiovascular diseases as a part of a mammographic screening programs is an urgent task, but there are only a few domestic studies on the role of BAC as a marker of cardiovascular risk among women. If the hypothesis about the association between BAC and atheromatosis of the carotid and femoral arteries and other pathological conditions is confirmed, new opportunities will open up for the development and implementation of large-scale screening of cardiovascular diseases among the female population of Russia.

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