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Prevention & lipidsCohort study

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

JACC Cardiovasc ImagingPublished

  • Retrospective cohort study
  • multicentre

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

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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 BAC percentile on screening mammography, beyond ASCVD risk score
Outcome
MACE:
  • Death
  • Ischemic heart disease
  • Stroke
  • HF
Follow-up
Mean 4.7 years

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)

ComparisonaHR (95% CI)P value
BAC percentile less than median1.66 (1.35–2.04)P < 0.001
BAC percentile more than median2.31 (1.82–2.93)P < 0.001

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

ComparisonaHR (95% CI)P value
BAC more than median, intermediate ASCVD risk1.40 (1.07–1.82)P = 0.01
BAC more than median, high ASCVD risk1.65 (1.24–2.21)P < 0.001
OutcomeΔ C-statistic (95% CI)P value
C-statistic of clinical model with addition of BAC · 0.67 to 0.710.04 (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
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Summarised from the published abstract; every number is checked against it