Women with breast arterial calcification detected on mammograms face an approximately 50% increase in risk of cardiovascular events and mortality, according to a recent study.

In this single-center, retrospective study, researchers evaluated 18,092 women (mean age 56.8 years) who underwent screening mammography between 2007-2016. The study population had prevalent cardiovascular risk factors including diabetes (13%), hypertension (36%), and hyperlipidemia (40%).

Using an AI-based scoring system (cmAngio, CureMetrix) validated with 94% sensitivity and 96% specificity, researchers found BAC present in 23% of participants. Among those with BAC, the median score was 15 (IQR: 4-50), with scores distributed across quartiles: 60.4% in first quartile [1-25], 15.2% in second quartile [26-50], 12.1% in third quartile [51-75], and 12.3% in fourth quartile [76-100].

During median follow-up periods of 4.8 years for mortality and 4.3 years for composite outcomes, women with BAC showed significantly increased risks. Mortality occurred in 7.8% of women with BAC versus 2.3% without (adjusted hazard ratio [aHR], 1.49; 95% CI, 1.33-1.67). The composite outcome of myocardial infarction, heart failure, stroke, and mortality was observed in 12.4% of women with BAC versus 4.3% without (aHR, 1.56; 95% CI, 1.41-1.72). Each 10-point increase in BAC score increased mortality and composite outcome risk by 8% (aHR, 1.08; 95% CI, 1.06-1.11 and 1.06-1.10, respectively).

The findings, published in JACC: Advances, showed greater risk in younger women aged 40-59 years, suggesting BAC may be an early marker of cardiovascular disease (CVD) risk, preceding other established risk factors.

Study limitations include its retrospective design, reliance on ICD-10 codes allowing potential confounding and misclassification, incomplete follow-up, limited cause-specific mortality data, and single-center design with predominantly White population.

The study demonstrates the feasibility of automated BAC quantification using AI-based algorithms, providing an objective measure for CVD risk stratification. Integrating BAC assessment into routine mammographic reporting could enhance personalized risk assessment and early intervention strategies, particularly for women at elevated CVD risk. While the findings suggest an association, additional research is needed to confirm causality and evaluate clinical utility in guiding preventive therapies.

The research was partly funded by the National Heart, Lung, and Blood Institute T32 HL079891-11. Several authors served as consultants to or were employees of CureMetrix. Full disclosures can be found in the published study.