To determine whether breast arterial calcifications (BAC) seen on mammography correlates
with coronary artery calcium score on coronary CT as it may serve as a potential marker
for increased risk of developing symptomatic coronary artery disease (CAD).
Materials and methods
Retrospective review of the imaging database at our institution identified 145 female
patients who underwent coronary CT within a year of screening or diagnostic mammography.
The coronary calcium score on CT was calculated by multiplying area of calcification
by weighted value assigned to its highest Hounsfield unit and summed for all lesions
and expressed as Agaston score. Calculated scores were risk stratified for developing
CAD as follows: 0—no risk; 1–10—minimal; 11–100—mild; 101–400—moderate; >400—high
risk. Percentile distribution of calcium score adjusted by age, gender and race was
calculated based on results of the Multi-Ethnic Study of Atherosclerosis (MESA), which
excluded patient with diabetes and chronic renal disease. The mammograms were reviewed
by MQSA-certified breast radiologists who were blinded to patients’ coronary calcium
scores. Mammograms were interpreted for presence or absence of BAC. The calcium scores
and corresponding percentiles were correlated with BAC on mammography. Cardiac risk
factors such as, diabetes, hypertension, hyperlipidemia, family history of CAD and
smoking, were recorded for each patient.
BAC correlated with coronary calcium score of >11 (p = 0.0001), corresponding to mild or greater risk of developing CAD. Specifically, coronary
calcium score of >11 was seen in 68% (25/37) of patients with BAC and 31% (34/108)
of patients without BAC. Accounting for race, gender and age, presence of BAC showed
statistically significant correlation with percentile scores of >25. Namely, 70.4%
(19/27) of patients with BAC vs. 44.6% (41/92) of patient without BAC showed percentile
score of >25 for developing CAD. Statistically significant association was observed
of BAC with diabetes (p = 0.01) and chronic renal disease (p = 0.005). BAC showed no significant associated with hyperlipidemia, hypertension, smoking
and family history of CAD.
BAC does predict coronary artery calcium score of >11, which indicates mild or greater
risk of developing CAD. In addition, statistically significant correlation exists
between BAC and cardiac risk factors, namely diabetes and chronic renal disease. Our
study suggests that BAC on mammography can be utilized as a potential marker for increased
risk of developing CAD.