Hidden in Plain Sight: AI-Detected Breast Arterial Calcification as a Predictor of Cardiovascular Risk

The American Heart Association released the Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator in 2023.¹ PREVENT is designed to assess cardiovascular disease (CVD) risk by focusing on cardiovascular, kidney, and metabolic health to guide primary prevention therapy. PREVENT, however, lacks anatomic assessment of the vasculature, which limits CVD risk assessment to clinical and laboratory data.²

In contrast, breast arterial calcification (BAC) is an anatomical measure of calcium deposition in breast arteries.^3,4 BAC is associated with and predicts an increased risk of CVD, thereby raising awareness in women who are often underdiagnosed.⁵ Radiologists often detect BAC on routine mammograms, but practice guidelines do not require them to report this finding.^4,6 Reporting BAC status on routine mammograms may allow clinicians to identify women at increased risk of CVD and implement lifestyle or pharmacologic interventions to mitigate that risk.⁷

In March 2026, the European Heart Journal published a retrospective cohort study describing the use of an artificial intelligence (AI) model to quantify BAC in screening mammograms.² This study included screening mammograms from 123,762women from Emory University and Mayo Clinic who had no known CVD or major adverse cardiovascular event (MACE).

For patients at Emory University, researchers selected the earliest mammogram as the index mammogram, whereas all index mammograms from Mayo Clinic patients were from 2018. Index mammograms marked the start of the follow-up period, which continued until the first MACE, with a median duration of 7 years.

The AI model detected BAC in 16.1% of patients at Emory University and 20.6% of patients at Mayo Clinic and categorized severity as zero, mild, moderate, and severe based on quantitative measurements.² Higher incidence of MACE and all-cause mortality occurred as BAC severity increased.

The researchers verified the AI model’s accuracy by comparing its results with expert manual quantification of BAC.² The AI model closely matched expert measurements on the same images and performed consistently across mammograms from different scanners. Furthermore, for a subgroup of patients, data were available in medical records to calculate the PREVENT risk score. The researchers compared BAC with the PREVENT scores in this subgroup and found thatBAC added prognostic value beyond PREVENT for CVD risk prediction.In addition, moderate to severe BAC in women younger than 50 years old correlated with increased CVD risk.

This study results show that AI-based BAC quantification predicts CVD risk and adds prognostic value to the PREVENT score.² Incorporating BAC into clinical practice may support earlier preventive interventions, especially in women less than 50 years old, who could benefit from earlier formal risk assessment

Implications for Pharmacists

Consultant pharmacists are in a unique position to advocate for women’s cardiovascular health. They can raise awareness of BAC prognostic value within interdisciplinary teams, advocate for AI-based detection to promote automatic BAC reporting on routine mammograms, and lead initiatives to implement protocols for automatic BAC reporting in their institutions and follow up on these findings.

REFERENCES

1. The American Heart Association PREVENT online calculator. American Heart Association. Accessed April 14, 2026. https://professional.heart.org/en/guidelines-and-statements/prevent-calculator

2. Dapamede T, Urooj A, Joshi V, et al. Artificial intelligence-based quantification of breast arterial calcifications to predict cardiovascular morbidity and mortality. Eur Heart J. ‌2026;ehag128. doi:10.1093/eurheartj.ehag128

3. Yu C. Calcium in breast arteries predicts future cardiovascular disease. Penn State. December 10, 2025. Accessed April 14, 2026. https://www.psu.edu/news/research/story/calcium-breast-arteries-predicts-future-cardiovascular-disease

4. Mammograms may provide clues about women’s risk for cardiovascular disease. News release. American Heart Association. March 15, 2022. Accessed April 14, 2026. https://newsroom.heart.org/news/mammograms-may-provide-clues-about-womens-risk-for-cardiovascular-disease

5. Iribarren C, Chandra M, Lee C, et al. Breast arterial calcification: a novel cardiovascular risk enhancer among postmenopausal women. Circ. 2022;15(3). doi:10.1161/CIRCIMAGING.121.013526

6. Parikh NI, Cacciabaudo JM, Singh VP, Vincoff NS. Giving women what they want: reporting breast arterial calcification on mammograms at Northwell Health System. JACC. 2025;4(7).

7. Bui QM, Daniels LB. A review of the role of breast arterial calcification for cardiovascular risk stratification in women. Circ. 2019;139(8). doi:10.1161/CIRCULATOINAHA.118.038092