Breast arterial calcification rates in screening mammography patients without a history of major adverse cardiovascular events (MACEs).

BACKGROUND

Breast arterial calcification (BAC), detected by digital mammography, has been strongly associated with coronary artery disease (CAD). Meta-analyses have estimated BAC prevalence to range from 12.7%-17.1%, yet these estimates include women with known cardiovascular conditions. The percentage of women in a screening population with BAC who might benefit from formal cardiovascular evaluation is unknown.

OBJECTIVE

To determine the prevalence of, and factors associated with BAC in a sample of patients without a history of coronary artery disease (CAD), prior myocardial infarction or heart failure, prior stroke or TIA, atrial fibrillation or angina with or without prescribed nitroglycerin (i.e., without a Major Adverse Cardiovascular Event +, named MACE+). And to clarify the percentage of mammography patients who could benefit from cardiovascular assessment.

METHODS

4304 mammography patients without MACE+ history were enrolled. BAC presence/absence and demographic/medical history information was collected.

RESULTS

BAC prevalence was 8.04%. Age was a significant risk factor for BAC. Age-adjusted analyses revealed: 1) increased BAC prevalence in Black and Hispanic women, 2) decreased BAC prevalence in Ashkenazi women and women with current HRT use, and 3) no association between BAC prevalence and menopausal status, age of menarche, or breast density.

CONCLUSIONS

An 8% BAC prevalence suggests that more than half of women with BAC likely have no history of diagnosed cardiovascular conditions, and BAC might be the first indication they should be referred for formal cardiovascular evaluation. For the 1 in 12 women without MACE+ but with BAC, communicating BAC results could alert them to cardiovascular concerns and encourage them seek out preventive cardiology care, making BAC communication an important public health intervention.