Camouflaged cardiac alert: Correlation of breast arterial calcification with carotid intima media thickness for evaluation of cardiac risk

Abstract

Objectives: To determine the association between breast arterial calcification (BAC) and carotid intima-media thickness (C-IMT) and, in turn, predict the risk of cardiovascular events. To independently access its relationship with other co-morbidities like diabetes mellitus (DM), hypertension (HTN), and menopause with BAC. Material and Methods: A total of 540 patients (270 with BAC and 270 without BAC) in the age group of 40–60 years who underwent mammograms at our institution between April 2021 to October 2021 were included in the study. In addition, an ultrasound was performed to evaluate the intima-media thickness in bilateral common carotid arteries 1 cm proximal to the carotid bulb. The mean C-IMT between the two groups (patients with and without BAC) was compared to understand the relationship between C-IMT and BAC. The independent relationship of BAC was also evaluated with the risk of co-morbidities like DM, HTN, and menopause. Results: The median C-IMT was higher in the group with BAC (0.85 mm, interquartile range (IQR) = 0.2) than in the group without BAC (0.6 mm, IQR = 0.10), which is statistically highly significant with p < 0.001. Further analysis among subgroups of age and DM also revealed IMT to be significantly higher in the group with BAC (0.85 mm, IQR = 0.20) compared to those without BAC (0.6 mm, IQR = 0.15) (p < 0.001). The median age in patients with BAC was significantly higher (57 years, IQR = 10 years) than those without BAC (48 years, IQR = 11.8 years) (p < 0.001). In the group with BAC, a higher proportion of patients were diabetics, hypertensives and had attained menopause, then in the subgroup without BAC. Conclusion: Patients with BAC had higher C-IMT, which in turn correlates with a higher risk of cardiovascular events. Hence, the presence of BAC can be used as a substitute marker for identifying patients with a higher risk of cardiovascular events and for ruling out co-morbidities such as DM and HTN.