Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women

Abstract

Background: Breast arterial calcification (BAC), a common incidental finding in mammography, has been shown to be associated with angiographic coronary artery disease and cardiovascular disease (CVD) outcomes. We aimed to (1) examine the association of BAC presence and quantity with hard atherosclerotic CVD (ASCVD) and global CVD; (2) ascertain model calibration, discrimination and reclassification of ASCVD risk; (3) assess the joint effect of BAC presence and 10-year pooled cohorts equations risk on ASCVD. Methods: A cohort study of 5059 women aged 60-79 years recruited after attending mammography screening between October 2012 and February 2015 was conducted in a large health plan in Northern California, United States. BAC status (presence versus absence) and quantity (calcium mass mg) was determined using digital mammograms. Prespecified end points were incident hard ASCVD and a composite of global CVD. Results: Twenty-six percent of women had BAC >0 mg. After a mean (SD) follow-up of 6.5 (1.6) years, we ascertained 155 (3.0%) ASCVD events and 427 (8.4%) global CVD events. In Cox regression adjusted for traditional CVD risk factors, BAC presence was associated with a 1.51 (95% CI, 1.08–2.11; P =0.02) increased hazard of ASCVD and a 1.23 (95% CI, 1.002–1.52; P =0.04) increased hazard of global CVD. While there was no evidence of dose-response association with ASCVD, a threshold effect was found for global CVD at very high BAC burden (95th percentile when BAC present). BAC status provided additional risk stratification of the pooled cohorts equations risk. We noted improvements in model calibration and reclassification of ASCVD: the overall net reclassification improvement was 0.12 (95% CI, 0.03–0.14; P =0.01) and the bias-corrected clinical-net reclassification improvement was 0.11 (95% CI, 0.01–0.22; P =0.04) after adding BAC status. Conclusions: Our results indicate that BAC has potential utility for primary CVD prevention and, therefore, support the notion that BAC ought to be considered a risk-enhancing factor for ASCVD among postmenopausal women.

The association between incidentally found breast arterial calcification on routine screening mammography and the development of coronary artery disease and stroke: results of a 10-year prospective study

“…After a mean follow-up of 6.5 years, BAC presence was associated with an increased risk of atherosclerotic CVD events (hazard ratio, 1.51; 95% CI, 1.13-2.20) and global CVD (HR, 1.23; 95% CI, 1.002-1.52) after controlling for the traditional CVD risk factors. Atherosclerotic CVD was a composite outcome comprising acute myocardial infarction, ischemic stroke, or CVD death, and global CVD was a composite outcome comprising ischemic heart disease, cerebrovascular disease, heart failure, cardiomyopathy, deep vein thrombosis/pulmonary embolism, cardiac arrest, peripheral vascular disease, retinal vascular occlusion, and CVD death 11 . In addition, our results are consistent with prior retrospective studies.…”

Breast Arterial Calcifications as A Predictor of Cardiovascular Risk: A Systematic Review

“…We did not have any data to understand the quantity of BAC and its association with CVD. Albeit, one study in our synthesis reported by [21] noted that there was a threshold effect of BAC above the 95 th centile being strongly predictive of CVD, which points further studies in the direction of developing a robust and relevant scoring system for BAC beyond presence or absence on mammography. Second, the association of BAC and CVD could have been merely incidental, with no causality proven in our study.…”

“…Three studies were cohorts, and patients were enrolled prospectively [18]- [20]. Three studies were conducted longitudinally, two prospective [21], [22] and one retrospective [23]. Reference [23] Reference [22] Reference [20] Reference [18] Reference [19] Reference [21] Study The odds of developing CVD among BAC+ participants were 1.32 (95% CI: 1.08-1.60) (22), 2.29 (95% CI: 1.40-3.74) (18), and 2.54 (95% CI: 1.03-6.30) (20) in a prospective longitudinal cohort and two prospective cohorts, respectively.…”

“…Three studies were conducted longitudinally, two prospective [21], [22] and one retrospective [23]. Reference [23] Reference [22] Reference [20] Reference [18] Reference [19] Reference [21] Study The odds of developing CVD among BAC+ participants were 1.32 (95% CI: 1.08-1.60) (22), 2.29 (95% CI: 1.40-3.74) (18), and 2.54 (95% CI: 1.03-6.30) (20) in a prospective longitudinal cohort and two prospective cohorts, respectively. In a prospective longitudinal observational study, the hazard or likelihood ratio of developing CVD was 1.23 (95% CI, 1.00-1.52) (21).…”

Breast arterial calcification is a risk factor for cardiovascular disease

“…New research shows that in postmenopausal women, detecting breast arterial calcification on breast mammograms is associated with a higher risk of cardiovascular disease. The findings were published in Circulation: Cardiovascular Imaging 1 …”