Reproductive factors and breast arterial calcification: a systematic review and meta-analysis

Abstract

Background

Breast arterial calcification (BAC) is a common incidental finding on screening mammography. Recent evidence suggests that BAC is associated with cardiovascular disease (CVD). We systematically reviewed the associations between BAC and reproductive factors (menopausal status, hormone replacement therapy [HRT] use, oral contraceptive [OC] use and parity).

Methods

MEDLINE and EMBASE databases, references of relevant papers and Web of Science were searched up to February 2020 for English-language studies that evaluated these associations. Study quality were determined and a random effects model was used to assess these associations.

Results

Nineteen observational studies (n = 47,249; three cohort studies, seven case–control studies, nine cross-sectional studies) were included. BAC was associated with menopause (nine studies; n = 15,870; odds ratio [OR] 2.67; 95% confidence interval [CI] 1.50–4.77) and parity (seven studies; n = 27,728; OR 2.50; 95% CI 1.68–3.71) and inversely with HRT use (10 studies; n = 33,156; OR 0.57; 95% CI 0.40–0.80). No association was found with OC use. Eleven studies were considered good in quality. Marked heterogeneity existed across all analyses.

Conclusions

BAC is associated with HRT use, menopause and parity. However, careful interpretation is required as marked heterogeneity existed across all analyses. Traditional cardiovascular risk factors may need to be taken into account in future investigations of associations between BAC and reproductive factors.

PROSPERO

CRD42020141644.

生殖因素与乳腺动脉钙化:系统回顾和荟萃分析 摘要

背景：乳腺动脉钙化(BAC)是乳腺钼靶检查中常见的偶然发现。最近的证据表明乳腺动脉硬化与心血管疾病(CVD)有关。我们系统地回顾了乳腺动脉硬化与生殖因素(绝经状态、激素疗法(HRT)、口服避孕药(OC)和胎次等之间的关系。

方法：截止2020年2月, 我们搜索了MEDLINE和EMBASE数据库、相关论文的参考文献及科学网的英文研究, 以寻找评估这些之间的关联。确定研究质量, 并使用随机效应模型来评估这些相关性。

结果：纳入19项观察性研究(n = 47,249；3个队列研究, 7个病例对照研究, 9个横断面研究)。乳腺动脉钙化与绝经相关(9项研究；n＝15870；比值比[OR] 2.67；95%置信区间[CI] 1.50-4.77)和胎次(7项研究；n＝27728；OR 2.50;95% CI 1.68-3.71), 而使用激素替代疗法则相反(10项研究；n＝33156；OR 0.57；95%置信区间0.40-0.80)。未发现乳腺动脉钙化与使用口服避孕药相关。11项研究被认为质量良好。所有分析均存在显著的异质性。

结论：乳腺动脉钙化与激素替代治疗、绝经和胎次等有关。然而, 需要仔细的解释, 因为在所有的分析中存在显著的异质性。在未来研究乳腺动脉钙化和生殖因素之间的关系时, 可能需要考虑传统的心血管危险因素。

Keywords:

• Breast arterial calcification
• cardiovascular disease
• menopause
• parity
• oral contraceptive
• hormone replacement therapy

Potential conflict of interest

The authors report no conflict of interest. The authors alone are responsible for the content and writing of the article.

Source of funding

No funding.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.