Tayon, Kevin G.

Abstract Background. Cardiovascular disease is a leading cause of death among women with breast cancer, and the 2026 ACC/AHA dyslipidemia guideline endorses coronary artery calcium (CAC) scoring to guide statin therapy before cardiotoxic treatment. Breast cancer patients routinely undergo staging 18 F-fluorodeoxyglucose PET/CT, whose low- dose CT visualizes the coronary arteries, thus enabling CAC quantification at no additional cost or radiation. Methods In this single-center retrospective study, consecutive women with newly diagnosed breast cancer undergoing staging 18 F-FDG PET/CT (2009–2021) had semi- automated Agatston CAC scoring performed on the low-dose CT and were stratified by CAC presence (CAC-P) versus absence (CAC-A). We assessed a composite of cardiac diagnostic testing (stress testing, coronary CT angiography, invasive angiography), clinical events, and reclassification of statin eligibility per ACC/AHA guideline thresholds in a prevention-eligible subgroup. Results Among 276 women (mean age 55.5 years; median follow-up 7.1 years), CAC was present in 68 (25%) but was clinically reported in only 5.4%. CAC-P was associated with more cardiac testing (34% vs 12%; age-adjusted hazard ratio 2.75, 95% CI 1.43–5.28) and, though underpowered, with more atherosclerotic events (7.4% vs 1.4%), but not with the all-cause composite. In the prevention-eligible subgroup (n=39), CAC scoring would have changed statin eligibility in 64%, initiating therapy in 62% of CAC-P women and supporting de-prescribing in 67% of CAC-A women. Conclusions CAC can be feasibly quantified from staging PET/CT in women with breast cancer and would frequently reclassify statin eligibility at no additional cost or radiation, yet is rarely reported.

Apply It! By reading this article, you will: • Understand how commonly used cardiorespiratory fitness prediction equations can misclassify fitness in both high-performance and clinical populations. • Learn how common prediction equations were developed and why the population of prediction equation studies matters when interpreting estimated cardiorespiratory fitness and percent-predicted values. • Recognize how to critically assess the suitability of a given cardiorespiratory fitness equation based on your client’s or patient’s characteristics.

A man in his mid-30s with a history of Crohn disease presented with several years of intermittent, nonexertional chest pressure. What would you do next?

In this case series study, pulmonary artery systolic, diastolic, and mean pressures of 2 participants with obesity and heart failure with preserved ejection fraction were measured at zero gravity during parabolic flight to assess the effect of external constraint on left ventricular filling pressures.