Abstract 4369629: Breast Arterial Calcification Augments Risk Stratification Among Women with Cardiovascular Risk Factors

Background: Breast arterial calcification (BAC) assessment on screening mammogram is a promising tool to improve cardiovascular disease (CVD) risk evaluation. Purpose: To evaluate the association between BAC and incident CVD in patients with and without CVD risk factors (RFs). Methods: This single-center retrospective study included women aged 40–90 years who underwent screening mammograms from 2006 to 2016. BAC was quantified using an automated platform (cmAngio, CureMetrix). Primary outcome was all-cause death. Secondary outcomes were acute myocardial infarction (MI), heart failure (HF), stroke, and time to CVD composite event (MI, HF, stroke, or CVD-death). Patients were stratified by presence/absence of BAC (BAC+, BAC-) and CVD RFs [hypertension (HTN), hyperlipidemia (HLD), diabetes, chronic kidney disease, smoking history, antiplatelet use, or anti-HLD or anti-HTN therapy] at time of mammogram. Results: Of 22,314 index mammograms included, mean age of participants was 55 ± 13 years. There were 780 CVD events (4.6%) in BAC- women and 765 (14.2%) in BAC+ women (p<0.001) over a median follow-up of 4.1 years [IQR 1.7, 6.5]. There were 486 deaths (2.9%) in BAC- women and 535 (9.9%) in BAC+ women (p<0.001) over a median follow-up of 5.8 years [IQR 3.3, 8.3]. Highest frequency of composite events and death occurred in the BAC+/RF+ group (18% and 12%, respectively). In multivariable analyses, BAC+/RF- women were not at increased risk of CVD event or death compared to BAC-/RF- women. However, among RF+ women, BAC+ was linked with higher CVD risk (aHR 1.50, p<0.001) and mortality (aHR 1.44, p<0.001) than BAC-. Among RF+ women on anti-HLD therapy, BAC+ was linked with higher CVD risk (aHR 1.42, p<0.001) and mortality (aHR 1.28, p<0.001) than BAC- counterparts. Among BAC+/RF+ women, no anti-HLD therapy was linked with higher CVD risk (aHR 1.44, p<0.001) and death (aHR 1.46, p<0.001) than use of anti-HLD therapy. Among RF+ women on anti-HTN therapy, BAC+ was linked with higher CVD risk (aHR 1.55, p<0.001) and death (aHR 1.42, p<0.001) than BAC- counterparts. Among BAC+/RF+ women, no anti-HTN therapy was linked with higher CVD risk (aHR 1.28, p<0.001) and death (aHR 1.28, p<0.001) than use of anti-HTN therapy. Conclusions: BAC is independently associated with increased death and CVD outcomes in women with CVD RFs, especially those not receiving anti-HTN or anti-HLD therapy. These findings suggest opportunities for using BAC to help guide clinical management of CVD risk.