Breast arterial calcification a new risk marker for cardiovascular disease!

Breast arterial calcification a new risk marker for cardiovascular disease!

Coronary artery calcification noted on computed tomographic (CT) evaluation is a well known marker of coronary artery disease. A study published in Circulation: Cardiovascular Imaging evaluated the relation between breast arterial calcification noted on routine mammography and atherosclerotic cardiovascular disease [1]. Mammography is a routine screening test for cancer, done regularly for post menopausal females. The study had 5059 women between 60 to 79 years of age. They were recruited after mammography screening during 2012 – 2015 period.

Breast arterial calcification was determined using digital mammograms. Presence or absence and the quantity in milligrams if present were noted. Just over a quarter of the women had breast arterial calcification in the study. After a mean follow up period of 6.5 years, 3% had atherosclerotic cardiovascular disease events. Global cardiovascular disease events were noted in 8.4%. After adjusting for traditional cardiovascular risk factors, hazard ratio for atherosclerotic cardiovascular disease events was 1.51 and that for global cardiovascular disease 1.23. Authors suggested that breast arterial calcification has a potential utility for primary prevention of cardiovascular disease.

An accompanying editorial pointed out that this was a cohort with more than a quarter of them having a graduate or professional degree [2]. Compared to the national average of around 50% of corresponding women on lipid lowering treatment, 75% of those with breast arterial calcification were already on lipid lowering treatment. This would suggest that this was a well-treated population of insured persons from the MINERVA (Multiethnic Study of Breast arterial Calcium Gradation and Cardiovascular Disease) cohort study [3]. The mean breast arterial calcification mass was 12 mg, with a range from 0 to 342 mg. The question now is whether breast arterial calcification should be incorporated in the screening guidelines for cardiovascular disease.

References

1. Iribarren C, Chandra M, Lee L, Sanchez G, Sam DL, Azamian FF, Cho H, Ding H, Wong ND, Molloi S. Breast Arterial Calcification: a Novel Cardiovascular Risk Enhancer Among Postmenopausal Women. Circ Cardiovasc Imaging. 2022;  doi: 10.1161/CIRCIMAGING.121.013526. Epub 2022 Mar 15.
2. Cameron NA, Khan SS. Leveraging Mammography as a Unique Opportunity for Cardiovascular Health Promotion. Circ Cardiovasc Imaging. 2022;  doi: 10.1161/CIRCIMAGING.122.013977. Epub 2022 Mar 15.
3. Iribarren C, Sanchez G, Husson G, Levine-Hall T, Quesenberry C, Sam DL, Maier J, Chaudhary RS, Patel M, Sadeghi B, Javan H, Cho HM, Ding H, Molloi S. MultIethNic Study of BrEast ARterial Calcium Gradation and CardioVAscular Disease: cohort recruitment and baseline characteristics. Ann Epidemiol. 2018 Jan;28(1):41-47.e12. doi: 10.1016/j.annepidem.2017.11.007. Epub 2017 Dec 5. PMID: 29246501.