Leveraging mammograms to improve cardiovascular risk assessment

Matthew Nudy, MD

A new analysis suggests clinicians could leverage insights from mammograms as part of their cardiovascular risk assessment in women.

Led by investigators at Penn State College of Medicine, results of the meta-analysis, which included data from 9 studies, suggest breast arterial calcification was associated with an elevated likelihood of stroke, cardiovascular death, atherosclerotic cardiovascular disease, and congestive heart failure.

“I think this study is important for primary care physicians, and also cardiologists, and really any clinician that looks at cardiovascular disease risk assessment,” explained study investigator Matthew Nudy, MD, assistant professor of Medicine and Public Health Sciences at Penn State College of Medicine, in an interview with HCPLive.

Building on previous data from investigators examining great arterial calcification found on mammography and risk of cardiovascular disease later in life. With this in mind, Nudy and colleagues designed a meta-analysis to assess longitudinal associations between breast arterial calcification and various cardiovascular endpoints. For the meta-analysis, investigators identified 2 prospective and 7 retrospective cohort studies assessing breast arterial calcification and development of cardiovascular disease.

Specific outcomes of interest for the study included the incidence of myocardial infarction, ischemic stroke, cardiac mortality, congestive heart failure, all-cause mortality, and a composite of atherosclerotic cardiovascular disease. Investigators noted odds ratios (OR) and 95% confidence intervals (CI) were calculated. Additionally, heterogeneity was assessed via I² values.

From the 9 studies, investigators obtained data for 46,958 women. This cohort had a mean age of 61.5 years, a mean follow-up of 11.5 years, and 16% had breast arterial calcification present on mammograms.

Upon analysis, results suggested the presence of breast arterial calcification was associated with a statistically significant increase in the likelihood of stroke (OR, 1.99; 95% CI, 1.41 to 2.82; P <.0001; I² = 37.11%), cardiac mortality (OR 3.04, 95%CI 1.36 to 6.81; P <.01; I² = 72.23%), atherosclerotic cardiovascular disease (OR, 1.87; 95% CI, 1.29 to 2.71; P <.001; I² = 68.28%), congestive heart failure (OR, 1.88; 95% CI, 1.41 to 2.51; P <.0001; I² = 32.43%), and all-cause mortality (OR, 1.87; 95% CI, 1.06 to 2.78; P <.05; I² = 93.59%). Investigators noted no such association was observed for breast arterial calcification and myocardial infarction (OR, 1.36; 95% CI, 0.689 to 2.7; P = .37; I² = 69.75%).

In the following interview, Nudy discusses key considerations for interpreting these data, future research needs to further understand the predictive value of breast arterial calcification on mammograms, and the limitations of this study.

This article was originally published by our sister publication HCPLive.

References:

1. Christensen E, Hillenbrand C, Xuezhi, et al. ASSOCIATION BETWEEN BREAST ARTERIAL CALCIFICATION, MORTALITY AND THE DEVELOPMENT OF CARDIOVASCULAR DISEASE: A SYSTEMATIC REVIEW AND META-ANALYSIS OF COHORT STUDIES. J Am Coll Cardiol. 2024 Apr, 83 (13_Supplement) 1726. https://doi.org/10.1016/S0735-1097(24)03716-1
2. Nudy M, Asmaro R, Jiang X, Schnatz PF. The association between incidentally found breast arterial calcification on routine screening mammography and the development of coronary artery disease and stroke: results of a 10-year prospective study. Menopause. 2022;29(12):1375-1380. doi:10.1097/GME.0000000000002088