Breast Artery Calcification for Primary Prevention of Major Adverse Cardiovascular Outcomes in Women

There is a critical need for improved primary prevention of major adverse cardiovascular events (MACE) among women. Breast artery calcification (BAC) can be detected on routine screening mammograms, which are recommended for women aged 40 to 74 years. It is not known if BAC predicts long-term MACE over 10 years in this group.

The objectives of the study were to determine the association of BAC with MACE over 10 years of follow-up among women age 40 to 75 years and to assess BAC and a risk modifier for primary prevention.

We performed a retrospective cohort study of consecutive women aged 40 to 75 without coronary artery disease who underwent a routine screening mammogram at Dartmouth Health from 2011 to 2012, and followed them for development of MACE over 10 years.

Among 1,216 women, 232 (19%) had BAC. Over 10 years of follow-up, 21% of women with BAC developed MACE compared to 11% women without BAC (P < 0.001). Among women with low (<5%) risk of MACE by pooled cohort equations, those with BAC had an 18% incidence of MACE, compared to 7% in women without BAC (OR: 2.8; 95% CI: 1.5-5.0; P = 0.001).

The use of the pooled cohort equations to risk stratify women for MACE underestimates risk in women with a low predicted risk. BAC is independently associated with an increased risk of MACE and may be useful as an incremental risk modifier.