Study details and key findings

For the study, researchers analyzed data from over 120,000 patients who received mammograms at two major U.S. health systems. Overall, 7% of patients from the first health system had enough data in their medical records to calculate a standard cardiovascular risk score, and 28% from the second health system had enough data.

Using an AI algorithm, the researchers quantified the level of calcium deposits in patients' breast cancer scans and categorized them into four categories, which ranged from zero evidence of calcified arteries to severe calcification. Then, the researchers evaluated how predictive these categories were for major cardiovascular events among the patients, who were followed for a median of seven years.

Based on their analysis, the researchers found that greater breast arterial calcification (BAC) was associated with an increased risk of major cardiovascular events. Patients with mild BAC were around 30% more likely to have a major cardiovascular event compared to those without any BAC, and those with moderate were 70% more likely. Patients with severe calcification had the highest risk and were two to three times more likely to have a major cardiovascular event.

"We found that the more calcium visible in the breast arteries on a mammogram, the higher a woman's risk of a serious heart event such as a heart attack, stroke, or heart failure," said Hari Trivedi, an associate professor of radiology at Emory University and the study's leader. "This was true even in younger women under 50 — a group often considered low risk — and held up after accounting for other risk factors like diabetes and smoking." 

"For women, this means a mammogram you're already having could also provide important information about your heart health — prompting a conversation with your doctor about preventive steps such as cholesterol testing or medication," Trivedi said. "For clinicians, it offers a practical way to identify women at cardiovascular risk who are currently being missed."

Commentary

Cardiovascular disease is a leading cause of death for both men and women in the United States, but it is consistently underdiagnosed and undertreated in women. A recent report from the American Heart Association also found that rates of heart disease are expected to increase significantly for women and occur at a younger age over the next 25 years.

Separately, Lori Daniels, director of the cardiovascular ICU at the University of California, San Diego, said that showing patients their BAC on a scan may be more compelling than just showing them abstract cholesterol numbers from a lipid panel. 

"Sometimes when people see a visualization of what's going on in their arteries, something clicks and they get motivated," Daniels said.

According to the researchers, clinical trials on the approach are scheduled to begin later this year, and they hope that the findings could lead to new treatments or interventions.

"The stark reality is that as a woman, there is a chance that you might end up disadvantaged throughout your heart care journey," said Sonya Babu-Narayan, a consultant cardiologist and clinical director at the British Heart Foundation. "It's encouraging to see that using AI to leverage large-scale data from breast cancer screening could help identify women at risk of future cardiovascular disease."