Radiographic markers of cardiovascular risk based on digital mammograms: a cross-sectional study

BACKGROUND: Studies have demonstrated an association between cardiovascular risk and mammographic density and breast arterial calcification. However, their combined impact remains poorly understood. AIM: This study aimed to evaluate the correlation between mammographic density, breast artery calcification, and cardiovascular risk category in asymptomatic women aged ≥40 years. METHODS: This retrospective, single-center, selective study included women who underwent preventive screening mammography at the University Clinic of Lomonosov Moscow State University between 2019 and 2023. The Systematic Coronary Risk Evaluation 2 was used to determine cardiovascular risk categories. A radiologist evaluated mammograms at a workstation to obtain data on mammographic density and glandular calcifications. The data were analyzed using a machine learning technique called Uniform Manifold Approximation and Projection. Univariate logistic regression was employed to calculate odds ratios and 95% confidence intervals. The reference group included mammograms showing high breast density and no calcifications. The odds ratio for each selected group is presented relative to the reference. The contingency tables were assessed using Pearson’s chi-squared (χ2) test. The significance level for all tested hypotheses was set at 0.05. RESULTS: The mammograms of 1030 women aged 40–89 years were evaluated. Based on the study results, eight groups (G7–G0) were formed, depending on combinations of the following criteria: high or low glandular density, presence or absence of vascular and nonvascular calcification, and extent of calcification. Women with low mammographic density and vascular calcifications in more than one quadrant were found to have a 75% likelihood of high or extremely high cardiovascular risk. The probability exceeded 90% for a combination of vascular and nonvascular calcifications in two or more quadrants. CONCLUSION: A correlation was found between calcifications, mammographic density, and cardiovascular risk category.