Breast arterial calcification seen on mammogram may predict ASCVD
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Breast arterial calcification seen on a routine mammogram may independently predict atherosclerotic CVD and global CVD risk for postmenopausal women, according to research published in Circulation: Cardiovascular Imaging.
Research suggests breast arterial calcification, a common incidental finding in mammography, may be associated with angiographic CAD and CV outcomes, and such calcification could be considered a risk-enhancing factor for ASCVD among postmenopausal women, Carlos Iribarren, MD, PhD, MPH, a research scientist at Kaiser Permanente Northern California Division of Research in Oakland, and colleagues wrote.
“Mammography, in addition to screening for early breast cancer, can provide clues about cardiovascular disease risk, so a single test that is universally accepted could address the two leading causes of death in women,” Iribarren told Healio. “In our study of over 5,000 postmenopausal women, those who had calcification in the arteries of the breast detected in their mammograms were 51% more likely to experience MI or stroke or to undergo a coronary revascularization procedure and were 23% more likely to develop any form of cardiovascular disease, including HF and diseases of the peripheral arteries.”
Mammogram data
Iribarren and colleagues analyzed data from 5,059 women aged 60 to 79 years recruited for the Multiethnic Study of Breast Arterial Calcium Gradation and Cardiovascular Disease (MINERVA) after attending a mammography screening from October 2012 to February 2015. Researchers assessed breast arterial calcification status (presence vs. absence) and quantity (calcium mass in milligrams) using digital mammograms. The primary outcomes were incident ASCVD and a composite of global CVD.
Within the cohort, 26.5% of women had breast arterial calcification. Compared with women with no calcification, those with calcification were older, more likely to be white or Hispanic and less likely to have a professional degree. Additionally, having any level of breast arterial calcification was associated with higher parity.
After a mean follow-up of 6.5 years, 3% of women experienced ASCVD events and 8.4% of women experienced global CVD events.
In analyses adjusted for traditional CVD risk factors, breast arterial calcification presence was associated with elevated risk for ASCVD (HR = 1.51; 95% CI, 1.08-2.11; P = .02) and global CVD (HR = 1.23; 95% CI, 1.002-1.52; P = .04).
The researchers did not observe a dose-response association with ASCVD; however, for women in the 95th percentile of breast arterial calcification, there was an association with global CVD risk.
Breast arterial calcification status provided additional risk stratification of the Pooled Cohort Equations risk, according to the researchers, who noted improvements in model calibration and reclassification of ASCVD. The overall net reclassification improvement was 0.12 (95% CI, 0.03-0.14; P = .01) and the bias-corrected clinical-net reclassification improvement was 0.11 (95% CI, 0.01-0.22; P = .04) after adding breast arterial calcification status.
Counsel based on CV risk
Iribarren said research shows women want to know whether mammography scans show the presence of breast arterial calcification so they are better informed on potential risk.
“Radiologists should include presence and severity of breast arterial calcification in the mammography report,” Iribarren told Healio. “A relatively small proportion already do, but more importantly, there is research showing that women overwhelmingly want this information provided to them and their primary care doctors.”
Iribarren said any counseling of women regarding presence of breast arterial calcification should be done in the context of overall CV risk.
“For women with low CV risk, breast arterial calcification presence should be a trigger to follow a healthy lifestyle, including a heart-healthy diet, avoiding smoking and exercising regularly,” Iribarren said. “For women with intermediate risk, breast arterial calcification should prompt a discussion with the doctor about initiating treatment for risk factors (cholesterol, blood pressure, diabetes) that are not well controlled by lifestyle alone. For women at high risk, breast arterial calcification should prompt a discussion with the doctor about intensifying and adhering to treatment.”
The researchers said more research is needed with longer follow-up to better delineate the dose-response association between breast arterial calcification burden and CVD outcomes and to establish the value of breast arterial calcification in women before age 60 years.
For more information:
Carlos Iribarren, MD, PhD, MPH, can be reached at carlos.iribarren@kp.org.
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