Most women with BACs have no MACE history

More than half of women with breast arterial calcifications (BACs) on mammography likely have no history of diagnosed cardiovascular conditions, according to research published June 7 in Clinical Imaging. 

A team led by Laurie Margolies, MD, from the Icahn School of Medicine at Mount Sinai in New York found an 8% BAC prevalence in their study of women with a major adverse cardiovascular event + (MACE+; these include prior myocardial infarction or heart failure, prior stroke or transient ischemic attack [TIA], atrial fibrillation, and angina with or without prescribed nitroglycerin). It also suggested that BACs could be the first sign that women should be referred for formal cardiovascular evaluation. 

“By providing these women with their BAC results, providers have the potential to improve population heart health in a cost-effective, noninvasive, and easy to disseminate manner,” the Margolies team wrote. 

The presence of BACs on mammograms is tied to coronary artery disease (CAD) risk in women. Data suggest that BAC prevalence ranges between 12.7% and 17.1%.  

The researchers highlighted that even if women without a history of cardiovascular disease (CVD) were the only patients referred for formal cardiovascular evaluation, many would be found to have significant CVD. However, they added that previous BAC-focused research included people who are likely to be more knowledgeable about their cardiovascular health. 

Margolies and colleagues studied the prevalence of BAC in women without a history of CAD, as well as without the MACE+ conditions. The researchers also evaluated factors tied to BAC and clarified the percentage of women who could benefit from cardiovascular assessment. 

Final analysis included 4,304 women without MACE+ who underwent mammography. Raw frequency analyses showed that 346 women (8.04%) that 8.04% had BAC on mammography. 

Compared to women who were 44 years or younger, the odds of exhibiting BAC increased for every decade of age. And race also plays a factor in BAC presence, the results showed. 

Higher body mass index (BMI) showed positive associations with BAC prevalence, and women who were childbearing age, post-menopausal, or had their first period at ages younger than 12 or older than 15 years also had higher odds of having a BAC. 

Finally, the researchers observed no significant ties between BAC prevalence and breast-specific characteristics, including the presence of implants or dense breast tissue. 

The results suggest that mammography could identify over 3.4 million women without MACE+ who could benefit from preventive cardiology care, the study authors highlighted. They added that most women with BACs have not had MACE+ occurrence and may not be likely to engage in cardiology care without BAC findings prompting such care. 

“Overall, future research is needed to take the next step and assess how providing women [especially MACE+ naïve women] with BAC knowledge influences medical intervention and/or lifestyle to potentially reduce future MACE occurrence,” the authors wrote. 

Read the full study here.