A Novel Breast Arterial Calcification Age-Based Percentile Nomogram for the Incremental Prediction of Incidental Cardiovascular Events

Nerlekar, N; Soh, CH; Vasanthakumar, S; Goel, V; Mantey, R; Wang, J; Aldous, E; Nandurkar, R; Arnott, CG; Bui, QM; Watanabe, A; Nudy, M; Nicholls, SJ; Daniels, LB; Marwick, TH

doi:10.1016/j.jcmg.2026.03.008

Prevention & lipids

A Novel Breast Arterial Calcification Age-Based Percentile Nomogram for the Incremental Prediction of Incidental Cardiovascular Events

JACC Cardiovasc ImagingPublished 24 Apr 2026Retrospective cohort study

Main finding · MACE per 10-percentile increase in BACResultAdjusted hazard ratio 1.17 95% CI 1.015–1.019

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Authors' conclusion

Age-adjusted BAC independently predicts cardiovascular events beyond traditional ASCVD risk scores and reclassifies low- and intermediate-risk individuals.

Study context

Population: Women aged ≥40 years without known CVD undergoing screening mammography and atherosclerotic cardiovascular disease (ASCVD) risk assessment, US and Australia
Participants: 21,514 women

Exposure: Age-adjusted breast arterial calcification (BAC) percentile on screening mammography, beyond ASCVD risk score
Outcome: MACE:
Death
Ischemic heart disease
Stroke
HF
Follow-up: Mean 4.7 years

Methodological detailsmulticentre, BAC quantified by artificial intelligence (cmAngio research edition, CureMetrix Inc), expressed as age-adjusted percentiles

Multicentre
BAC quantified by artificial intelligence (cmAngio research edition, CureMetrix Inc), expressed as age-adjusted percentiles

Main finding

MACE per 10-percentile increase in BAC

Adjusted hazard ratio

1.17

95% CI 1.015–1.019

P < 0.001

As reported in the abstract

Major adverse cardiovascular events (MACE) events: 828 (3.8%)
BAC present: 22.7%

Observational data: associations, not effects.

Further findings

MACE by BAC percentile, low ASCVD risk (80% of cohort) (subgroup)

	← Lower risk ←→ Higher risk →	aHR (95% CI)	P value
BAC percentile less than median	0.20.5125	1.66 (1.35–2.04)	P < 0.001
BAC percentile more than median	0.20.5125	2.31 (1.82–2.93)	P < 0.001
	0.20.5125Adjusted hazard ratio (log scale)

MACE with BAC more than median, intermediate and high ASCVD risk (subgroups)

	← Lower risk ←→ Higher risk →	aHR (95% CI)	P value
BAC more than median, intermediate ASCVD risk	0.512	1.40 (1.07–1.82)	P = 0.01
BAC more than median, high ASCVD risk	0.512	1.65 (1.24–2.21)	P < 0.001
	0.512Adjusted hazard ratio (log scale)

Outcome	Δ C-statistic (95% CI)	P value
C-statistic of clinical model with addition of BACClinical model + BAC vs Clinical model · 0.67 to 0.71	0.04 (0.01–0.07)	P = 0.042

Each MACE component (competing risk models)

Associations remained significant for each MACE component: all P < 0.001

Reclassification with BAC added to ASCVD risk score

Individuals with MACE appropriately up-classified: 9%
Individuals without events down-classified: 3%
Net reclassification index: 5% ± 1%

Original publication

A Novel Breast Arterial Calcification Age-Based Percentile Nomogram for the Incremental Prediction of Incidental Cardiovascular Events. JACC Cardiovasc Imaging. Published 24 April 2026. doi:10.1016/j.jcmg.2026.03.008

Read the original article ↗

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