Matthew Nudy, MD, discusses breast arterial calcification and cardiovascular risk

Breast arterial calcification detected during mammography reflects medial layer arterial calcification. According to Matthew Nudy, MD, cardiologist and assistant professor of Medicine and Public Health Sciences at Penn State College of Medicine, “a breast arterial calcification identified on a mammogram is a medial layer artery calcification.”

Nudy stated that this presentation is different from calcification patterns found in coronary imaging. “It’s also known as a mockingbird calcification, and it’s important to know that this is different than other calcifications that we can pick up on imaging tests.”

Coronary artery calcium visualized on chest computed tomography is typically an intimal calcification that may contribute to luminal narrowing, whereas medial arterial calcification is associated with vascular stiffening and represents cumulative cardiovascular risk burden.

Study findings

In the reported analysis, investigators evaluated women who had breast arterial calcification and generated age-adjusted percentiles that were stratified into tertiles. “What we found was that back progression into those tertiles resulted in an increased risk of cardiovascular disease and also death.”

Researchers also evaluated the rate of change. “We analyzed a 10 percentile unit per year increase, and what we found was that that was associated with a 24% relative increased risk of the hazards of a major adverse cardiovascular event, and also a 38% relative increase in the hazards of death,” and “both of those were statistically significant.”

A combined endpoint yielded a similar association.

Interpretation for successive mammograms

Progression over time may have clinical significance. Nudy explained that when a woman who previously did not have identifiable calcification develops breast arterial calcification on a subsequent mammogram, this “represents new sub clinical cardiovascular disease.”

He added that clinicians should consider the patient at potentially increased cardiovascular risk and perform a cardiovascular risk assessment.

Potential role for artificial intelligence

Artificial intelligence detection tools may standardize reporting across imaging practices. “There is a role for the artificial intelligence-based detection and reporting of breast arterial calcification,” Nudy noted, adding that this approach could standardize identification, reporting, and severity classification and may be feasible at scale.

Risk assessment considerations

Breast arterial calcification may represent an opportunity to reassess modifiable risk factors. “This allows an ideal opportunity to perform a cardiovascular risk assessment,” stated Nudy.

Clinicians may use existing cardiovascular risk calculators, including the pooled cohort equation or the American Heart Association PREVENT equation.

Nudy recommended checking cholesterol levels and blood pressure. “If they meet criteria to be on a statin medication to reduce cardiovascular risk, then that would be good to recommend and good to take,” and blood pressure control should be addressed when indicated.

Lifestyle-related interventions such as diet improvement, weight management, reduced alcohol consumption, and smoking cessation may also be relevant.