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Breast arterial calcifications (BACs) found on screening mammography and their association with cardiovascular disease

Rotter, Michelle A. MD1; Schnatz, Peter F. DO1,2,3; Currier, Allen A. Jr MD4; O'Sullivan, David M. PhD5

doi: 10.1097/gme.0b013e3181405d0a

Objective: Breast arterial calcifications (BACs) are common but unreported findings on screening mammograms. This study correlated mammographically detected BACs with coronary artery disease (CAD) risk factors and a history of atherosclerotic cardiovascular disease (ASCVD), estimating the relative risk of ASCVD in patients with BACs.

Design: Women arriving for breast cancer screening mammography gave their consent to complete a questionnaire and to allow their mammograms to be analyzed independently for the presence of BACs by certified radiologists, who were blinded to the results of the questionnaire. The questionnaire assessed major risk factors for CAD and gathered information on hormone therapy use.

Results: Of the 1,919 women with results, 268 were BAC positive, giving a BAC prevalence of 14%. Five cardiovascular risk factors (age, hypertension, hypercholesteremia, diabetes mellitus, and menopause) were significantly more prevalent in the BAC-positive population (P < 0.001). The BAC-positive group also had a significantly higher (P < 0.001) occurrence of ASCVD events (angina, previous myocardial infarction, previous abnormal angiography, previous stroke, and previous coronary artery bypass graft). Multiple logistic regression analysis found BACs to be strongly associated with ASCVD events (odds ratio = 2.29, 95% CI: 1.40-3.74) as compared with other CAD risk factors (including hypertension, cigarette smoking, diabetes mellitus, age, and family history of ASCVD). The association of BAC with ASCVD was present even after accounting for age.

Conclusions: BACs are associated with an increased prevalence of both cardiovascular risk factors and cardiovascular morbidity. BACs may be a practical tool to use as a risk indicator for CAD in women.

Breast arterial calcifications are associated with an increased prevalence of both cardiovascular risk factors and cardiovascular morbidity.

From the Departments of 1Obstetrics and Gynecology and 2Internal Medicine, University of Connecticut School of Medicine, Farmington, CT; and 3Women's Life Center (Menopause Clinic), 4Jefferson Radiology, and 5Department of Research Administration, Hartford Hospital, Hartford, CT.

Received January 17, 2007; revised and accepted June 13, 2007.

Financial disclosure: None reported.

A presentation based on a portion of these data was given at the 15th Annual Meeting of The North American Menopause Society, Washington, DC, October 8, 2004, in abstract form. The complete data and results were presented as a Richardson prize paper at the American College of Obstetrics and Gynecology District I meeting, St. John's, US Virgin Islands, November 1, 2006. These data have not previously been published.

Address correspondence to: Peter F. Schnatz, DO, FACOG, Hartford Hospital, Conklin Building 203B, 80 Seymour Street, Hartford, CT 06102. E-mail:

©2008The North American Menopause Society