Providers may want to consider routine mammogram findings when assessing a woman’s risk for cardiovascular disease.

Researchers at Kaiser Permanente Northern California Division of Research found that the presence of breast arterial calcifications on scans were linked to higher likelihoods for CVD in post menopausal women. This calcium build-up is found in the middle layer of the breast arterial wall. While it shows up as white areas in the arteries on a mammogram, it is not thought to be a sign of cancer but can indicate stiffening in the arteries. It is typically related to aging, Type 2 diabetes, high blood pressure and inflammation.

In their study, the authors assessed health records for more than 5,000 women. While the patients had no prior history of CVD or breast cancer, those with breast arterial calcifications were 51% more likely to develop heart disease or have a stroke. These women were also 23% more likely to develop any type of CVD, including heart disease, stroke, heart failure and diseases of the peripheral arteries.

“Research has confirmed the calculators we currently use to assess an individual’s 10-year risk of developing cardiovascular disease are not as accurate in women as they are in men. In our current study, we evaluated if breast arterial calcification, which can be easily seen on a mammogram, provides more information about a woman’s risk of developing heart disease," said the study’s lead author Dr. Carlos Iribarren, a research scientist at the Kaiser Permanente Northern California Division of Research, in a statement.

Iribarren and his colleagues selected participants from over 200,000 patients who underwent mammograms as part of MINERVA (MultIethNic study of brEast aRterial calcium gradation and cardioVAscular disease), a large, racially and ethnically diverse cohort of postmenopausal women.

All had the same health insurance, were between 60 and 79 and were regularly screened annually at one of nine facilities under Kaiser Permanente of Northern California. The researchers then checked EHRs over the next 6.5 years for incidents of heart attack, stroke and other types of CVD. They found that breast arterial calcifications were more prevalent among women who identified as white or Hispanic and Latina. Black or Asian women were less likely to show signs of this calcium build-up. More research, they say, is needed to understand these variations.

Dr. Nieca Goldberg, a volunteer expert for the American Heart Association and medical director of Atria New York City, says that women may be unaware of their risk because they have not talked to their doctor about it, showed any symptoms of CVD or are not likely to get a heart evaluation for prevention. She advises them to consult their GYN's about their risk and pay attention to incidental findings of breast arterial calcification.

"Breast artery calcification is not part of our current risk calculators," she told HCB News. "This research is a wake-up call to the health system that we can no longer silo healthcare by diseases and service lines. Women are less aware of their risk for heart disease compared to breast cancer; here we have the perfect opportunity to address both breast and heart health."

In an accompanying editorial, another group of researchers said that identifying these calcifications could be signs of poor heart health in patients, and that clinicians should, in these cases, encourage lifestyle changes such as exercise and high-quality diets. “It is really important to note that the absence of breast arterial calcification did not translate into low risk, and should not be falsely reassuring when no breast arterial calcification is present. Optimal risk factor control is equally important for all women with and without breast arterial calcification,” said one of the editorial authors, Dr. Sadiya Khan, an assistant professor of medicine in cardiology at Northwestern University’s Feinberg School of Medicine in Chicago.

Iribarren says that the U.S. Preventive Services Task Force’s recent recommendation for women between 50 and 74 to get screened every two years may help detect this risk more frequently and earlier, and comes at no extra cost or radiation exposure. Under the guidelines, women between 40 and 49 who show individual risks may also be eligible for mammography and in turn, may be able to find out if they are at increased risk for CVD.

He adds that integrating this information in cardiovascular risk calculators is essential for accurately assessing and addressing CVD risk. “Currently, it is not the standard of care for breast arterial calcification visible on mammograms to be reported. Some radiologists do include this information on their mammography reports, but it’s not required. We hope that our study will encourage an update of the guidelines for reporting breast arterial calcification from routine mammograms.

The study was funded by the National Heart, Lung, and Blood Institute, a division of the National Institutes of Health.

The findings were published in Circulation: Cardiovascular Imaging, a peer-reviewed journal of the American Heart Association.