Abstract Body (Do not enter title and authors here): Background
Breast arterial calcification (BAC) assessment on screening mammogram is a promising tool to improve cardiovascular disease (CVD) risk evaluation.
Purpose
To evaluate the association between BAC and incident CVD in patients with and without CVD risk factors (RFs).
Methods
This single-center retrospective study included women aged 40–90 years who underwent screening mammograms from 2006 to 2016. BAC was quantified using an automated platform (cmAngio, CureMetrix). Primary outcome was all-cause death. Secondary outcomes were acute myocardial infarction (MI), heart failure (HF), stroke, and time to CVD composite event (MI, HF, stroke, or CVD-death). Patients were stratified by presence/absence of BAC (BAC+, BAC-) and CVD RFs [hypertension (HTN), hyperlipidemia (HLD), diabetes, chronic kidney disease, smoking history, antiplatelet use, or anti-HLD or anti-HTN therapy] at time of mammogram.
Results
Of 22,314 index mammograms included, mean age of participants was 55 ± 13 years. There were 780 CVD events (4.6%) in BAC- women and 765 (14.2%) in BAC+ women (p<0.001) over a median follow-up of 4.1 years [IQR 1.7, 6.5]. There were 486 deaths (2.9%) in BAC- women and 535 (9.9%) in BAC+ women (p<0.001) over a median follow-up of 5.8 years [IQR 3.3, 8.3]. Highest frequency of composite events and death occurred in the BAC+/RF+ group (18% and 12%, respectively).
In multivariable analyses, BAC+/RF- women were not at increased risk of CVD event or death compared to BAC-/RF- women. However, among RF+ women, BAC+ was linked with higher CVD risk (aHR 1.50, p<0.001) and mortality (aHR 1.44, p<0.001) than BAC-. Among RF+ women on anti-HLD therapy, BAC+ was linked with higher CVD risk (aHR 1.42, p<0.001) and mortality (aHR 1.28, p<0.001) than BAC- counterparts. Among BAC+/RF+ women, no anti-HLD therapy was linked with higher CVD risk (aHR 1.44, p<0.001) and death (aHR 1.46, p<0.001) than use of anti-HLD therapy. Among RF+ women on anti-HTN therapy, BAC+ was linked with higher CVD risk (aHR 1.55, p<0.001) and death (aHR 1.42, p<0.001) than BAC- counterparts. Among BAC+/RF+ women, no anti-HTN therapy was linked with higher CVD risk (aHR 1.28, p<0.001) and death (aHR 1.28, p<0.001) than use of anti-HTN therapy.
Conclusions
BAC is independently associated with increased death and CVD outcomes in women with CVD RFs, especially those not receiving anti-HTN or anti-HLD therapy. These findings suggest opportunities for using BAC to help guide clinical management of CVD risk.