A Systematic Review and Meta-Analysis of Breast Arterial Calcification and Its Association With Cardiovascular Disease and All-Cause Mortality

Abstract

Breast arterial calcification (BAC), detected on routine mammography, is the calcification of medial arteries. BAC has been suggested to be linked to cardiovascular disease (CVD) risk. A systematic search was done that identified studies examining BAC, CVD risk factors (diabetes, hypertension, dyslipidemia, smoking, obesity), cardiovascular outcomes [stroke, myocardial infarction (MI), heart failure (HF), cardiac mortality], and all-cause mortality. Additionally, an atherosclerotic CVD (ASCVD) composite outcomes including MI, stroke, and cardiac mortality was analyzed. A random-effects model was used to calculate risk ratios (RR) and odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed with Q values and I2 statistics. 45 studies were included in the final meta-analysis, representing 68,584 women. BAC prevalence was 17.1%. Among cross-sectional studies, BAC was associated with diabetes (OR: 1.97, 95% CI: 1.71-2.27, I2= 70.78%), hypertension (OR: 1.82, 95% CI: 1.52-2.18, I2 = 88.3%), and hyperlipidemia (OR: 1.24, 95% CI: 1.06-1.45, I2 = 76.4%). BAC was negatively associated with smoking (OR: 0.50, 95% CI: 0.41-0.61, I2 = 78.4%). BAC was associated with known CVD (OR: 2.71, 95% CI: 2.13-3.45, I2 = 76.7%). Among cohort studies, BAC was associated with incident stroke (RR: 2.05, 95% CI: 1.58-2.65, I2 = 50.8%), HF (RR: 2.14, 95% CI: 1.38-3.32, I2 = 87.1%), cardiac death (RR: 2.94, 95% CI: 1.32-6.54, I2 = 72.7%), ASCVD (RR: 1.58, 95% CI: 1.23-2.04 I2 = 81.9%) and all-cause mortality (RR: 2.04, 95% CI: 1.08-3.84, I2 = 96.78%). Significant interstudy heterogeneity in this meta-analysis is a limitation on confidence in the pooled results. In conclusion, BAC observed on mammography may serve as a marker for increased CVD risk and mortality in women; however, future research is needed to standardize BAC assessment and confirm its clinical utility in CVD risk stratification.

Keywords: atherosclerotic cardiovascular disease; breast arterial calcification; mammography.