Cardiovascular Diseases Clinical Trial
To test the hypothesis that breast arterial calcification (BAC) seen on mammograms can identify women with an increased risk of coronary artery disease (CAD).
BACKGROUND:
The study hypothesis is that breast arterial calcification (BAC) seen on mammograms can
identify women with an increased risk of coronary artery disease (CAD). Annual mammograms
are now routinely obtained on nearly 70% of women over forty years of age. The nearly 40
million examinations performed every year could be used to evaluate for BAC without any
additional cost or change in current mammographic techniques. Identification of women with
BAC has potential to substantially decrease the rate of heart attack and sudden death due to
CAD in asymptomatic women. Before BAC can be used in a clinical setting, the age-specific
prevalence of BAC needs to be fully defined using state of the art mammographic techniques.
BAC then needs to be compared with well understood CAD risk factors and measures of coronary
atherosclerosis. While this could be accomplished in a prospective study, the same goals can
be attained using data already acquired in the Epidemiology of Coronary Calcification (ECAC)
Study.
The study uses existing data on 612 non-high risk, non-referred women who are participants
in the community-based ECAC Study funded by NIH from 1991-2006. This database includes
traditional and newer coronary artery disease (CAD) risk factors and the results of electron
beam computed tomography (EBCT) examinations for CAC at a baseline examination. Most of the
women also have had risk factors and CAC measured during a follow-up examination, on
average, five years after baseline examinations. The women in the ECAC Study, who do not
have a history of myocardial infarction (MI) or stroke, represent the full age range
routinely evaluated with mammograms. Almost all these women have their usual care, including
annual mammograms, in Rochester, Minnesota.
DESIGN NARRATIVE:
The ECAC study has been instrumental in establishing the distribution of presence and
quantity of CAC as well as the predictors of CAC. The database includes clinical and
laboratory assessments of CAD risk factors, results of EBCTs, and findings on physical
examinations. It will ultimately include information on adverse clinical events. There are
612 female participants who had one or more mammograms during the 12-year history of that
study. Many women had 10 or more mammograms. The study will evaluate all of these mammograms
for BAC and compare the findings with information already in the database. The combination
of newly acquired data from mammograms with the existing data allows this to be a very
comprehensive study and still be completed in the two-year time period. The findings can
then be used to help design a future study to prospectively evaluate the impact of
instituting preventive and early therapeutic measures for CAD in asymptomatic women with the
appropriate features of BAC on mammography.
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