Breast Arterial Calcification May be a Marker for Atherosclerotic Cardiovascular Disease

A clinical doctor going over some test results with an elderly patient at the hospital.
A study was conducted to determine the relationship between breast arterial calcification and risk for atherosclerotic cardiovascular disease.

A cohort study found that breast arterial calcification (BAC) may be a risk factor for atherosclerotic cardiovascular disease (ASCVD). These findings were published in Circulation: Cardiovascular Imaging.

The Multiethnic Study of Breast Arterial Calcium Gradation and Cardiovascular Disease (MINERVA) is a large, ethnically diverse cohort of postmenopausal women which evaluated BAC and cardiovascular risk. Participants were recruited from Kaiser Permanente of Northern California and were aged 60-79 years between 2012 and 2015. Uncompressed mammogram images from 5059 participants were evaluated for BAC and related with cardiovascular outcomes.

Women with 0 mg BAC (n=3721) and more than 0 mg BAC (n=1338) were aged mean 65.2±4.2 and 67.1±4.8 years (P <.0001); 51.0% and 58.2% were White (P <.0001); 37.9% and 43.7% were using antihypertensive mediations (P =.0002); and 17.9% and 32.1% had 3 or more live births (P <.0001), respectively.

At a mean follow-up of 6.5 years, 3.0% of the study population had an ASCVD event and 8.4% a cardiovascular disease (CVD) event.

Among the ASCVD cohort, women with BAC of more than 0 mg had an age-adjusted rate for CVD death (1.65 vs 0.58 per 1000 person-years [py]; P =.0003) and ischemic stroke (2.74 vs 2.00 per 1000 py; P =.04) that was significantly higher compared with women without BAC.

Among the CVD cohort, rates of CVD death (1.56 vs 0.58 per 1000 py; P =.0006), cardiomyopathy (0.61 vs 0.20 per 1000 py; P =.03), deep vein thrombosis or pulmonary embolism (1.29 vs 0.88 per 1000 py; P =.04), peripheral arterial disease (4.82 vs 3.89 per 1000 py; P =.04), retinal vascular occlusion (0.31 vs 0.07 per 1000 py; P =.04), and cerebrovascular disease (3.54 vs 2.84 per 1000 py; P =.048) were higher among the women with BAC of more than 0 mg.

In a multivariate model, BAC of more than 0 mg was associated with increased risk for ASCVD (adjusted hazard ratio [aHR], 1.51; 95% CI, 1.08-2.11; P =.02) and CVD (aHR, 1.23; 95% CI, 1.002-1.52; P =.048). Stratified by tertile of BAC, compared with BAC of 0 mg, tertile 1 was associated with risk for ASCVD (aHR, 1.74; 95% CI, 1.09-2.77) and tertile 2 with CVD (aHR, 1.38; 95% CI, 1.02-1.85; P =.03).

Using a Cox regression analysis, 10-year risk for ASCVD was highest among women with 20% or more of BAC (aHR, 5.98; 95% CI, 2.74-13.03; P <.0001) and 5% to less than 20% of BAC (aHR, 4.19; 95% CI, 2.31-7.59; P<.0001) compared with BAC of 0 mg.

In a sensitivity analysis among women not using cholesterol lowering therapy, the relationship between ASCVD (P =.11) and CVD (P =.80) were no longer significant.

This study was limited by not assessing risk for specific CVD outcomes.

“..our analysis in a large, ethnically diverse cohort demonstrates that presence of BAC in mammograms is independently related to incident ASCVD and to global CVD, and therefore, adds to the body of evidence that assessment and reporting of BAC status has potential utility to change clinical practice and impact primary CVD prevention for women,” the investigators wrote. “Further research in large cohorts with longer follow-up period is needed to better delineate the dose-response association between BAC burden and CVD outcomes and to establish the value of BAC in women before age 60.”


Iribarren C, Chandra M, Lee C, et al. Breast arterial calcification: A novel cardiovascular risk enhancer among postmenopausal women. Circ Cardiovasc Imaging. Published online March 15, 2022. doi:10.1161/CIRCIMAGING.121.013526