A Systematic Review and Meta-Analysis of Breast Arterial Calcification and Its Association With Cardiovascular...

Breast arterial calcification (BAC), detected on routine mammography, is the calcification of medial arteries. BAC has been suggested to be linked to cardiovascular disease (CVD) risk. A systematic search was done that identified studies examining BAC, CVD risk factors (diabetes, hypertension, dyslipidemia, smoking, obesity), cardiovascular outcomes [stroke, myocardial infarction (MI), heart failure (HF), cardiac mortality], and all-cause mortality. Additionally, an atherosclerotic CVD (ASCVD) composite outcomes including MI, stroke, and cardiac mortality was analyzed. A random-effects model was used to calculate risk ratios (RR) and odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with Q values and I2 statistics. 45 studies were included in the final meta-analysis, representing 68,584 women. BAC prevalence was 17.1%. Among cross-sectional studies, BAC was associated with diabetes (OR: 1.97, 95% CI: 1.71-2.27, I2= 70.78%), hypertension (OR: 1.82, 95% CI: 1.52-2.18, I2 = 88.3%), and hyperlipidemia (OR: 1.24, 95% CI: 1.06-1.45, I2 = 76.4%). BAC was negatively associated with smoking (OR: 0.50, 95% CI: 0.41-0.61, I2 = 78.4%). BAC was associated with known CVD (OR: 2.71, 95% CI: 2.13-3.45, I2 = 76.7%). Among cohort studies, BAC was associated with incident stroke (RR: 2.05, 95% CI: 1.58-2.65, I2 = 50.8%), HF (RR: 2.14, 95% CI: 1.38-3.32, I2 = 87.1%), cardiac death (RR: 2.94, 95% CI: 1.32-6.54, I2 = 72.7%), ASCVD (RR: 1.58, 95% CI: 1.23-2.04 I2 = 81.9%) and all-cause mortality (RR: 2.04, 95% CI: 1.08-3.84, I2 = 96.78%). Significant interstudy heterogeneity in this meta-analysis is a limitation on confidence in the pooled results. In conclusion, BAC observed on mammography may serve as a marker for increased CVD risk and mortality in women; however, future research is needed to standardize BAC assessment and confirm its clinical utility in CVD risk stratification.