[Breast arterial calcifications and cardiovascular risk in women]

Cardiovascular (CV) diseases remain the leading cause of mortality in women and often present as the first clinical manifestation, highlighting the limitations of current risk scores. In this context, breast arterial calcifications (BACs), incidentally detected on screening mammography, are emerging as a potential biomarker of systemic CV risk. This narrative review summarizes the most recent evidence (2023-2026) on the association between BACs and CV outcomes, including observational studies, prospective and retrospective cohorts, meta-analyses, and investigations using artificial intelligence for automated quantification of calcific burden. Overall, the available data indicate that BACs are relatively common in screened populations and are independently associated with an increased risk of major CV events, including stroke, heart failure, atherosclerotic disease, and CV mortality. Recent meta-analyses confirm these associations and suggest a predominantly arteriosclerotic phenotype of vascular calcification. The introduction of artificial intelligence-based algorithms has improved BAC quantification and strengthened their prognostic value. However, no evidence currently demonstrates their incremental value beyond guideline-recommended CV risk scores, such as SCORE2 and SCORE2-OP. In conclusion, BACs represent a promising opportunistic marker of CV risk in women, as well as a tool for CV risk re-stratification, particularly in young women and/or those at low to intermediate risk. However, prospective studies are needed to define how BACs can be integrated into current CV risk stratification models.