Arterial calcifications and cardiovascular risk

Dr Brigitte Raccah-Tebeka, Gynecology Department, Robert Debré Hospital, Paris, and Prof. Geneviève Plu-Bureau, Gynecologist, Head of Department, Port Royal Hospital, Paris, alert us to the importance of taking into account arterial calcifications diagnosed on mammography, to identify women potentially at greater risk of cardiovascular events.
These recent findings underline the importance of comprehensive management of women's health, and the need for cross-disciplinary care involving radiologists, gynecologists, vascular physicians, cardiologists and general practitioners.

Cardiovascular disease is now the leading cause of death in women, and it is crucial to identify emerging risk factors in addition to traditional ones. In the female population, these diseases are still underestimated, poorly detected and often treated late or incompletely. It is a chronic disease, punctuated by acute and sometimes fatal events, with a major role played by the environment, which has become deleterious to women's health over the last 50 years. Many traditional risk factors are now well known, including diabetes, hypertension, hypercholesterolemia, overweight or obesity, smoking...New factors, known as "emerging", have emerged more recently and concern women more specifically, such as polycystic ovary syndrome, endometriosis, hypertensive pathologies of pregnancy, diabetes of pregnancy, menopause, breast cancer, etc. Each risk factor, when identified, must be the subject of special attention and corrected whenever possible. The search for new risk factors continues, because the more of these that are identified, the more active the screening and prevention of cardiovascular disease will be.

In this respect, a new study published by a French team in a prestigious European journal of radiology tends to show that the existence of calcifications in the small arteries of the breasts, reported on a mammogram, is correlated with the presence of coronary artery calcifications.
A total of 507 women, with an average age of 62, were studied retrospectively. They had had both a mammogram (as part of screening or for a breast abnormality) and a chest CT scan (to screen for a cancerous or infectious pathology) between 2009 and 2018.
A score was assigned to the radiological examinations according to the existence or not and the importance of calcifications found on mammographic images and thoracic CT scans.
Compared with women without calcifications on their mammograms, those with the most calcifications also had more classic cardiovascular risk factors, such as a higher average age (72 versus 59), more arterial hypertension (66% versus 31%) and more renal insufficiency (21% versus 6%).
Moreover, the correspondence between score levels was very good, particularly in the youngest women (60 years). A high breast calcification score was significantly associated with a high coronary calcification score.
Identifying, analyzing and quantifying arterial calcifications on mammography images could, in the future, be a useful element for more accurately predicting the risk of coronary calcifications and cardiovascular risk, with therapeutic implications for prevention. This element, which until now has been rather neglected by clinicians due to a lack of understanding of its significance, should be the focus of particular attention when reading screening mammograms, in order to optimize the preventive management of women.


Reference
Minssen L, Doa TH, Quang AV, Martin L et al. Breast arterial calcificationson mammography: a new marker of cardiovascular risk in asymptomatic middle age women? Eur Radiol. 2022 ;32 :4889-4897.