Breast Arterial Calcification

A large proportion of cardiovascular events occur among women whose 10-year estimated atherosclerotic cardiovascular disease risk is u003c7.5%, and thus guidelines would not routinely recommend statins for such patients before their events.1 Additional strategies beyond the measurement of traditional risk factors are therefore needed to identify women who might benefit from medical therapy, based on unexpected higher risk. Coronary artery calcium (CAC) seen on a noncontrast chest computed tomogram is the most potent marker of subclinical cardiovascular disease (CVD), and has been shown to enhance risk prediction in women.1 However, CAC testing is usually not covered by insurance companies, limiting its widespread use as a screening tool for subclinical CVD.Given that millions of women undergo mammograms each year, there has been growing interest in whether the presence of breast arterial calcification (BAC), which is easily detected on a standard mammogram, could help inform cardiovascular risk assessment. Unlike CAC, which represents calcification in the intima, BAC is found along the circumference of the media giving it a tram-track appearance when the burden is severe (Figure). Some studies of BAC described it simply as present versus absent, whereas others attempted to use a semiquantitative assessment based on the density and extent of calcium in each artery, and the number of arteries involved.2 BAC prevalence varies widely depending on the population’s age and comorbidities, ranging from 10% to 12% in healthier population-based cohort studies, to 60% to 70% among women u003e70 years of age or with chronic kidney disease.2 BAC is thought to develop primarily through pathways related to mineral metabolism and bone formation, but there may be a role for inflammation as well. Although traditional cardiovascular risk factors such as age, hypertension, and diabetes mellitus are associated with BAC presence, BAC has an inverse association with …