Breast Arterial Calcification as a Predictor for Future Cardiovascular Events and Mortality: A Systematic Review and...

Area of Science:

• Cardiovascular Medicine
• Radiology
• Preventive Cardiology

Background:

• Breast arterial calcification (BAC) is recognized as a potential indicator of cardiovascular disease (CVD).
• The prognostic value of BAC for incident mortality and major adverse cardiovascular events (MACEs) requires systematic evaluation.
• Understanding the influence of BAC assessment methods on its association with cardiovascular outcomes is crucial.

Purpose of the Study:

• To systematically evaluate the association between breast arterial calcification (BAC) and the risk of incident major adverse cardiovascular events (MACEs).
• To determine if the method used for BAC assessment impacts its association with MACEs and mortality.
• To explore BAC as a prognostic marker for mortality and CVD risk.

Main Methods:

• A comprehensive literature review of PubMed, MEDLINE, and EMBASE databases up to June 2025.
• Inclusion of 24 studies with 236,475 participants, analyzing BAC status against incident MACE (all-cause mortality, myocardial infarction, stroke, heart failure).
• Random-effects meta-analysis using hazard ratios (HRs) and subgroup analyses based on BAC measurement methods and mammography cohorts.

Main Results:

• BAC presence was significantly associated with increased all-cause mortality (HR, 1.32) and cardiovascular mortality (HR, 1.38).
• BAC also correlated with higher risks of heart failure (HR, 1.29), stroke (HR, 1.2), and myocardial infarction (HR, 1.2).
• Associations remained significant in screening mammography cohorts and were most pronounced with quantitative BAC assessment.

Conclusions:

• Breast arterial calcification serves as a valuable prognostic marker for mortality and cardiovascular disease (CVD) risk.
• The incidental finding of BAC on mammograms can facilitate the early identification of individuals at elevated CVD risk.
• Quantitative assessment of BAC may enhance its utility in risk stratification.