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Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study
Celestino Sardu1, Gianluca Gatta2, Gorizio Pieretti3
1Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy.
Insights
Lower breast density in pre-menopausal women is linked to increased major adverse cardiac events (MACEs). Screening mammography may help identify women at higher cardiovascular risk based on breast density.
Area of Science:
- Cardiology
- Radiology
- Endocrinology
Background:
- No prior studies have examined the association between breast adipose tissue and major adverse cardiac events (MACEs) in pre-menopausal women.
- Breast density, a measure of adipose tissue, is increasingly recognized for its potential role in cardiovascular risk assessment.
Purpose of the Study:
- To investigate the relationship between breast adipose tissue infiltration and the incidence of MACEs in pre-menopausal women.
- To determine if breast density is an independent predictor of cardiovascular outcomes in this demographic.
Main Methods:
- A prospective, multicenter cohort study involving pre-menopausal women over 40 without pre-existing cardiovascular disease or breast cancer.
- Participants underwent mammography for breast density assessment (categories A-D) and were followed for 10 years for MACEs.
- Propensity score matching was used to create comparable groups based on baseline breast density.
Main Results:
- A total of 3,272 women were analyzed after propensity score matching.
- Women with the lowest breast density (category A) exhibited significantly higher rates of MACEs compared to those with higher breast density.
- Lowest breast density was a predictor of MACEs, with a hazard ratio of 3.483 (95% CI: 1.476 to 8.257).
Conclusions:
- Higher breast adipose tissue (lower breast density) is associated with increased MACE rates in pre-menopausal women.
- Screening mammography could potentially be used to stage breast density and predict cardiovascular risk in overweight pre-menopausal women.
- Further research, including randomized clinical trials, is needed to validate these findings and explore underlying pathways.
Objectives:
This study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women.
Background:
To our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women.
Methods:
Prospective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition.
Results:
The propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation.
Conclusions:
Among pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217).
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