Breast arterial calcifications and cardiovascular risk: the BAKER case-control study

Breast arterial calcifications (BAC) are a sex-specific imaging biomarker for cardiovascular disease (CVD) risk stratification. The BAKER prospective case-control study aimed to evaluate the association between BAC and CVD risk factors, with a secondary analysis on breast density (BD) and CVD risk factors. Women showing BAC and age- and BD-matched controls referred for mammography were prospectively enroled. We recorded anthropometric/clinical variables and traditional CVD risk factors; BD was classified as low (BI-RADS a , b ) or high ( c , d ). BAC presence was defined as any mammographically visible calcifications along an identifiable arterial structure, and BAC length was manually measured on bilateral mediolateral oblique views. Univariate group comparisons and correlation analyses were performed. Seventy-two women with BAC and 72 controls were enroled (median age 73.5 years, IQR 62.5–78). Women with BAC had a younger menopausal age ( p = 0.008) and a positive association with breastfeeding ( p = 0.026) and parity ( p = 0.043). BAC length correlated inversely with HDL cholesterol levels ( p = 0.009). In exploratory analyses, low BD was associated with a less favourable cardiometabolic profile, including lower HDL cholesterol ( p = 0.017), higher systolic blood pressure ( p = 0.004), higher use of antihypertensive medications ( p < 0.001) and higher Framingham risk score ( p < 0.001). In this case-control study, BAC were associated with reproductive and menopause-related factors, while BAC length showed an inverse association with HDL cholesterol. Exploratory analyses linked low BD to a less favourable cardiometabolic profile. These findings support further longitudinal evaluation of mammographic markers for women’s cardiovascular risk assessment. Question In this prospective case–control study, women with BAC were compared with age- and BD-matched controls to explore associations with cardiovascular risk factors . Findings BAC presence was associated with younger age at menopause and reproductive history, while BAC length showed a weak inverse correlation with HDL cholesterol . Relevance statement Exploratory analyses suggested that low BD may be associated with a less favourable cardiometabolic profile, supporting further longitudinal investigation of mammographic markers in women’s cardiovascular risk assessment .