A Review of the Role of Breast Arterial Calcification for Cardiovascular Risk Stratification in Women.

Cardiovascular disease continues to be the leading cause of death among women in the United States. One of the barriers to improving cardiovascular disease outcomes in women is the lack of reliable, effective screening modalities. Breast arterial calcification has emerged as a potential risk stratification tool. Localized deposition in the media of the artery, known as Mönckeberg medial calcific sclerosis, is notably different from the intimal atherosclerotic process commonly associated with coronary artery disease. Nonetheless, studies favor a correlation between breast arterial calcification and cardiovascular risk factors or coronary artery disease, defined as coronary artery calcification on computed tomography scan or both nonobstructive and obstructive lesions on angiography. Since a majority of women over the age of 40 undergo yearly breast cancer screening with mammography, measurement of breast arterial calcification may offer a personalized, noninvasive approach to risk-stratify women for cardiovascular disease at no additional cost or radiation. Mammography has the potential to alter the course of the leading cause of death in women, heart disease, through the evaluation of breast arterial calcification and identification of opportunities for prevention. Current evidence supports the universal reporting of breast arterial calcifications and personalized patient-provider discussions to more aggressively treat cardiac risk factors through targeted medical therapies or healthy lifestyle changes.

Arterioesclerosis de Monckeberg en vasos uterinos: un interesante hallazgo incidental / Arteriosclerose de Monckeberg nos vasos uterinos: um achado incidental interessante / Monckeberg arteriosclerosis in uterine vessels: an interesting incidental finding

Se realizó la comunicación de un caso clínico-patológico, diagnosticado en el Hospital Docente Clínico Quirúrgico "Joaquín Albarrán" de La Habana. En dicha entidad se presentó en una paciente femenina de 85 años de edad con antecedentes de diabetes mellitus tipo 2, ingresada por cuadro de insuficiencia arterial de miembro inferior izquierdo por lo cual se le realizan amputación supracondilia y al tercer día de su estadía hospitalaria, fallece. En la autopsia se arribó al diagnóstico anatomopatológico de arterioesclerosis de Mönckeberg de vasos del útero. Esta es una forma de arterioesclerosis muy relacionada con la senectud, pero factores de riesgo como diabetes mellitus y la enfermedad renal crónica pueden contribuir de forma directa en su desarrollo y progresión. Su diagnóstico es un hallazgo incidental en muestras histopatológicas(AU)

A clinical-pathological case was reported, diagnosed at the Joaquín Albarrán Clinical Surgical Teaching Hospital in Havana. In this entity, an 85-year-old female patient with a history of type 2 diabetes mellitus was presented, admitted due to arterial insufficiency of the lower left limb, for which she underwent supracondylar amputation and died on the third day of her hospital stay. At the autopsy, the pathological diagnosis of Mönckeberg arteriosclerosis of vessels of the uterus was reached. This is a form of arteriosclerosis closely related to old age, but risk factors such as diabetes mellitus and chronic kidney disease can directly contribute to its development and progression. Its diagnosis is an incidental finding in histopathological samples(AU)

Um caso clínico-patológico foi relatado, diagnosticado no Hospital de Clínica Cirúrgica "Joaquín Albarrán" em Havana. Nessa entidade, apresentou-se uma paciente de 85 anos, com história de diabetes mellitus tipo 2, internada por insuficiência arterial do membro inferior esquerdo, para a qual sofreu amputação aupracondiliana e faleceu no terceiro dia de internação. Na autopsia, o diagnóstico patológico da arteriosclerose de Mönckeberg de navios do útero foi conseguido. Essa é uma forma de arteriosclerose intimamente relacionada à velhice, mas fatores de risco como diabetes mellitus e doença renal crônica podem contribuir diretamente para seu desenvolvimento e progressão. Seu diagnóstico é um achado incidental em amostras histopatológicas(AU)

Aplicación del sistema aterométrico en fallecidos por muerte violenta con aterosclerosis coronaria / Application of atherosclerosis indexing system in deceased subjects by violent death with coronary aterosclerosis

INTRODUCCIÓN: la alta morbimortalidad de causa aterosclerótica ha motivado múltiples investigaciones y en Cuba, el Sistema Aterométrico, permite caracterizar las lesiones ateroscleróticas en cualquier sector vascular. OBJETIVO: estudiar la aterosclerosis de los tres vasos coronarios principales en fallecidos por muerte violenta y clínica, analizando comparativamente las lesiones, teniendo en cuenta sexo y grupo de nivel aterosclerótico. MÉTODOS: se aplicó el Sistema Aterométrico para estudiar comparativamente coronaria derecha y coronaria izquierda en sus ramas descendente anterior y circunfleja, en una población de 108 fallecidos por muerte violenta y 472 por muerte clínica, agrupados también según nivel aterosclerótico y sexo. RESULTADOS: la mayor diferencia se encontró en las placas fibrosas del grupo de alto nivel aterosclerótico para la coronaria derecha, que llegó a ser de un 22,3 % mayor en los clínicos, siendo solamente del 17,5 % para la descendente anterior y de 20,3 % en la circunfleja. En este mismo grupo las placas fibrosas fueron 2,59 veces más frecuentes en la descendente anterior que en la coronaria derecha. Las placas fibrosas entre los sexos tuvieron poca diferencia, en ambos grupos, solamente alrededor de 1 % para los tres vasos coronarios. CONCLUSIONES: es mayor la aterosclerosis en los fallecidos por muerte clínica que en los fallecidos por muerte violenta, tanto en la población en su totalidad, como subdividida en los grupos de alto y bajo nivel aterosclerótico así como en hombres y mujeres, resultando el Sistema Aterométrico muy útil en la evaluación del proceso aterosclerótico en fallecidos por muerte violenta.

INTRODUCTION: the high morbidity and mortality of atherosclerotic causes has motivated multiple investigations and in Cuba, the atherometric system to characterize atherosclerotic lesions in any vascular sector. OBJECTIVE: Study atherosclerosis of the three main coronary vessels in violent deaths from clinical death and comparatively analyzing the injury, considering sex and level of atherosclerosis. METHODS: Atherometric system was used to comparatively study right and left coronary artery in their anterior descending coronary artery branches and circumflex, in a population of 108 violently dead subjects and 472 clinical dead subjects, also grouped according to atherosclerotic level and sex. RESULTS: The main difference was found in fibrous plaques of the atherosclerotic high level group for the right coronary, which reached 22.3% higher in clinical, and only 17.5% for the descending left anterior and 20.3% in the circumflex. In this same group, fibrous plaques were 2.59 times more frequent in the anterior descending coronary right. Fibrous plaques according to genders had little difference in both groups, only about 1% for the three coronary vessels. CONCLUSIONS: the atherosclerosis is higher clinical dead subjects than violently dead subjects, as much in the overall population, as subdivided in the groups of high and low atherosclerotic level, as in men and women, proving to be the very useful Atherometric System for assessing the atherosclerotic process in violently dead subjects.

Upper limb vascular calcification score as a predictor of mortality in diabetic hemodialysis patients.

OBJECTIVE: This study evaluated the correlation between an upper limb vascular calcification (Vc) score (VcS) and late all-cause mortality in diabetic hemodialysis patients with distal upper limb arteries medial wall sclerosis (Mönckeberg disease). METHODS: We retrospectively reviewed Vc in bilateral upper limb plain radiographs and in duplex ultrasound images performed before radial-cephalic fistula (RCF) creation in diabetic hemodialysis patients. Only medial linear calcifications outlining the vessel wall were considered positive on X-ray images, whereas for ultrasound reviews, only continuous highly echogenic plaques producing bright white echos with shadowing were considered to be medial calcification. A VcS was then applied in each patient. Every half of each of the three main arterial conduits (brachial, radial, and ulnar arteries) in each arm was counted as 1 if it contained ≥ 6 cm of linear calcification, whereas absence of calcification or minimum calcification (length <6 cm) was counted as 0. Long-term all-cause mortality was compared between patients with a low or moderate VcS <8 (group I), patients with a high VcS ≥ 8 (group II), and patients with VcS = 0 (control group). Kaplan-Meier statistics were used for comparisons among the groups. RESULTS: Nineteen patients had a VcS <8, 21 had VcS ≥ 8, and 43 patients had VcS = 0. The study patients had a mean age of 68 ± 10 years (range, 42-83 years; P = .23). Before early conversion to a RCF, dialysis therapy in 59 (71.1%) had already been initiated through central venous catheters (CVCs). The mean follow-up for groups I, II, and controls was 41.4 ± 41.2 months (range, 4-144 months), 34.15 ± 31.3 months (range, 1-108 months), and 66.7 ± 32.5 months (range, 12-126 months), respectively (P = .0009). Forty-seven patients died during the follow-up period (12 in group II and 24 in the controls; P = .88). Survival rates at 12, 24, 36, and 48 months were 78.3%, 65.7%, 54.8%, and 48.1% for group I; 75.2%, 58.8%, 49.3%, and 42% for group II; and 97.7%, 93.1%, 76.8%, and 71.8% for the control group, respectively (P = .013 for all groups; P = .044 for group II vs controls). Patients with (subgroups) or without CVCs at baseline had similar late mortality rates. Patients with CVCs/Vc had lower survival rates than those with CVCs/no Vc at 1 year (73.3% vs 96.5%) and at 3 years (47.7% vs 75.8%; P = .038). CVCs were related to increased risk of death only in subgroup II patients compared with the subcontrol group patients (75.4% vs 37.9% at 5 years, respectively; P = .034). CONCLUSIONS: Diabetic hemodialysis patients exposed to high levels of upper extremity arterial medial VcSs upon receiving RCFs have an increased long-term mortality risk compared with diabetic hemodialysis patients with no Vc and receiving the same access. Patients with CVCs/Vc had the lowest survival rates.

Correlation of pre-existing radial artery macrocalcifications with late patency of primary radiocephalic fistulas in diabetic hemodialysis patients.

OBJECTIVE: The aim of this study was to evaluate the impact of pre-existing radial artery macrocalcification (Mönckeberg type of arteriosclerosis) on patency rates of radiocephalic fistulas (RCFs) in diabetic end-stage renal disease (ESRD) patients undergoing hemodialysis. METHODS: In this observational prospective study, the long-term patency rates (primary outcome measures) of RCFs in ESRD diabetics who had Mönckeberg radial (±brachial) artery disease (calcified [C] group) were compared with those obtained in ESRD diabetics who had healthy, noncalcified vessels before RCF construction (healthy [H] group). Vessel calcification was assessed by plain two-dimensional radiography. For inclusion in the C-group, uniform linear railroad track-type macrocalcifications of at least 6 cm in length, in the medial wall of the radial artery ipsilateral to RCF creation, were required. Patients were included in the H-group if the radial artery ipsilateral to the RCF creation was free of any macrocalcification, of either intima or media type. Any intimal-like plaque with irregular and patchy distribution was an exclusion criterion for both groups. Patients in both groups also were required to have suitable upper limb vascular anatomy on the basis of ultrasound imaging before RCF creation (cephalic vein of minimum diameter of 1.6 mm, without stenosis or thrombosis in all outflow areas, and radial artery of minimum diameter of 1.5 mm, without proximal hemodynamically significant stenosis). Secondary outcome measures included all-cause mortality. Kaplan-Meier statistics were used for comparison between groups. RESULTS: The arm radiograph at the site of possible fistula construction showed abnormality in 39 patients (C-group, 47 RCFs), whereas 33 patients had noncalcified ("healthy") vascular anatomy (H-group, 40 RCFs). Mean duration of the diabetic disease at the time of RCF creation was 8.9 ± 5.6 years (range, 2-25 years) for the H-group and 14 ± 9.9 years (range, 1-40 years) for the C-group (P = .018). The mean follow-up period for H-group and C-group was 51.9 ± 35.9 months (range, 0.1-126 months) and 26.1 ± 31.6 months (range, 0.1-144 months), respectively (P = .0006). Forty-four patients died during the follow-up period. Primary patency rates at 12, 24, 36, and 48 months for C-group vs H-group were 50.2% vs 80%, 36.5% vs 72.3%, 32.4% vs 67.9%, and 29.1% vs 59.3% (P = .0019). Respective values for secondary patency rates were 52.4% vs 87.5%, 40.9% vs 82.4%, 36.6% vs 78.1%, and 33.2% vs 72.8% (P = .00064). Patient survival rates at 24 and 48 months were 56.1% and 46.4% for C-group and 92.4% and 67.4% for H-group, respectively (P = .05). CONCLUSIONS: ESRD diabetics with radial artery Mönckeberg calcifications receiving RCFs had worse late clinical outcomes compared with ESRD diabetics with healthy distal arm vessels receiving the same access. The long-term benefit of RCFs may be lost in diabetics with extensively calcified vessels, and preferably the brachial artery should be used instead.