AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Breast Arterial Calcification as a Predictor of Cardiovascular Risk : A Systematic Review and Meta Analysis
By Rao A, Ajavindu CN, Upadhyayula SK et al.
Introduction: Breast artery calcification(BAC), an incidental mammographic finding, reflects systemic vascular aging and chronic inflammation yet remains underutilized for cardiovascular disease(CVD) risk stratification. This systematic review and meta-analysis evaluates BAC prevalence, association with future cardiovascular events, and its incremental predictive value beyond the Pooled Cohort Equations(PCE) and PREVENT scores. Methods: PubMed was searched through June 2026. Eligible studies required a female cohort, BAC defined on mammography, a BAC-negative control group, and a reported effect size for cardiovascular risk or incident major adverse cardiovascular events(MACE), (refer fig 2 for PRISMA diagram). Study quality assessed by the Newcastle-Ottawa Scale. Meta-analysis used the DerSimonian-Laird random-effects model across three pre-specified pools: Pool A(longitudinal prognostic cohorts), Pool B (cross-sectional BAC vs. CAC), and Pool C(low-ASCVD-risk subgroup). Heterogeneity assessed using Cochran's Q and I ² , publication bias by Egger's test, and robustness by LOO. Results: Of 491 screened studies, 13 met inclusion criteria (N=170,122; mean age 56.9±10.6 years). BAC prevalence increased with age: approximately 8%(<50 years), 17.6% (50-59 years), 34.3% (60-69 years), and >61%(≥70 years). In the largest cohort, MACE incidence rose from 5.89 to 48.89 per 1,000 person-years in the presence vs. absence of BAC. BAC added incremental predictive value beyond both the Pooled Cohort Equations (C-statistic: 0.67→0.71, p=0.042; NRI +5%) and PREVENT scores (C-index Δ+0.02, p<0.001 in internal and external validation cohorts). BAC was particularly discriminating among women classified as low-to-intermediate risk, BAC-positive women with PCE-predicted risk <5% had an observed 10-year MACE rate of 18% vs. 7% in BAC-negative women. In Pool A (k=8, N=167,159), BAC independently predicted MACE (adjusted HRs: 1.57-3.29) with a pooled HR of 2.21 (95% CI: 1.80-2.71, p<0.001; I ² =85.4%) (ref table 1.1). In Pool B(k=4, N=2,664), BAC was associated with approximately 3-fold higher odds of concurrent CAC or atherosclerotic plaque, pooled OR 3.01 (95% CI: 1.39-6.53, p=0.005; I ² =76.5%) (refer table 1.2). In Pool C(k=3 estimates), among women with PCE-predicted risk <5%, BAC remained a significant MACE predictor with a pooled HR of 2.06 (95% CI: 1.55-2.75, p<0.001) (refer table 1.3) and observed 10-year MACE rates of 18% (BAC-positive) vs 7%(BAC-negative). Egger's significant in Pool A only ,LOO confirms all pools robust except Pool B sensitive to Azam 2024. Conclusion: Across 13 studies and >170,000 participants, BAC conferred an approximately 2.2 fold increased hazard of MACE after multivariable adjustment, supporting its role as a clinically actionable prognostic marker for CVD risk, particularly in women classified as low-to-intermediate risk by conventional scores.