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Published on: August 28, 2018
Breast Arterial Calcification as a Predictor for Future Cardiovascular Events and Mortality: A Systematic Review and
Rhea Nandurkar1, Sheran Vasanthakumar1,2, Jack Stewart1
1Victorian Heart Institute, Monash University, Melbourne, Australia.
Insights
Breast arterial calcification (BAC) is a significant predictor of mortality and major adverse cardiovascular events (MACEs). Identifying BAC on screening mammograms can help detect individuals at high risk for cardiovascular disease (CVD).
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.
Objective:
Breast arterial calcification (BAC) is a surrogate marker of cardiovascular disease (CVD); however, its associations with incident mortality and major adverse cardiovascular events (MACEs) have not been systematically evaluated. The association between BAC and incident MACE and whether this is influenced by the method of BAC assessment was examined.
Methods:
PubMed, MEDLINE, and EMBASE were reviewed to June 2025 for studies comparing BAC status with incident MACE (composite of death, myocardial infarction [MI], stroke, heart failure). The primary outcome was all-cause mortality. Random-effects meta-analysis was performed using hazard ratios (HRs) with 95% CIs. Subgroup analysis was conducted by method of BAC measurement and restricted to screening mammography cohorts, PROSPERO registration (CRD42020202612).
Results:
Of 1118 studies screened, 24 were included (236 475 participants; mean age 58.5 years). Breast arterial calcification presence associated with all-cause mortality (HR, 1.32; 95% CI, 1.20-1.45; P <.0001) (follow-up 0.55-26 years). Increased risk was observed for cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.29; 95% CI, 1.20-1.37; P <.0001), stroke (HR, 1.2; 95% CI, 1.11-1.30; P <.0001), and MI (HR, 1.2; 95% CI, 1.15-1.26; P <.0001). When restricted to screening mammography cohorts without concurrent indications for cardiovascular investigation (5 studies, n = 85 647), associations remained significant for all-cause mortality (HR, 1.34; 95% CI, 1.14-1.58; P = .0004), cardiovascular mortality (HR, 1.38; 95% CI, 1.14-1.66; P = .0009), heart failure (HR, 1.48; 95% CI, 1.19-1.86; P = .0005), and stroke (HR, 1.34; 95% CI, 1.08-1.67; P = .008). Associations with incident outcomes were observed only in studies using quantitative BAC assessment (HR, 1.31; 95% CI, 1.19-1.44; P = .002).
Conclusion:
Breast arterial calcification is a promising prognostic marker of mortality and CVD risk. Recognition of this incidental finding may enable timely identification of at-risk individuals.
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