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What a mammogram can tell you about your heart

Can your mammogram detect early warning signs of heart disease? Research suggests this is possible, says Sarah Rinehart, M.D., a cardiologist and cardiac imaging specialist at Piedmont Heart.

A mammogram not only detects breast cancer, but it can also detect breast arterial calcification (BAC), which is plaque buildup in the breast’s arteries.

“Breast arterial calcification can be considered a red flag for coronary artery disease,” says Dr. Rinehart. “The blood vessels in the breasts are smaller than those in the heart, so sometimes women can develop early disease in the breast arteries.”

The connection between breast arterial calcification and heart disease

“Traditionally, in literature, the presence of BAC was seen in 10 to 12 percent of patients,” she says. “Even with this conservative measure, approximately 4 million women nationwide undergoing screening mammography would exhibit BAC, with 2 to 3 million likely to have signs of premature coronary atherosclerotic disease.”

This means that breast arterial calcification can be an equivalent or stronger risk factor for coronary artery disease when compared to risk factors like high cholesterol, high blood pressure and diabetes.

“Seventy percent of women who had breast arterial calcification on their mammogram were found to have coronary artery calcification as well,” explains Dr. Rinehart. “This could be an important finding for the early detection of heart disease, especially in women under age 60.”

Taking this into account, a physician reviewing a woman’s mammogram can look for breast arterial calcification. The physician can then refer the woman to a preventive cardiologist for further evaluation.

“As breast arterial calcification becomes more intense, so does coronary arterial calcification,” she says. “Even though they don’t understand the reason behind the correlation, it’s definitely there. It gives us the opportunity to use screening exams, such as coronary artery calcium scans, to further risk stratify women for premature coronary artery disease. Then, if the calcium score is high, such as greater than 400, further screening for significant blockages with stress testing can be completed.”

Screening for heart disease

“Unlike cancer screenings, the current recommendations for heart screenings are much less recognized,” says Dr. Rinehart. “Women start getting mammograms at age 40 and colonoscopies at age 50. With heart disease, women are typically only referred for screening if they have a strong family history of early heart disease or are at increased risk themselves.  Even though patients may fall into this category, many don’t seek out a heart screening.”

Many women in their 30s and 40s may not have a primary care provider and may only see an OB/GYN.

“This means they may not be monitored for high blood pressure or high cholesterol,” she says.

Raising awareness of the No. 1 killer of women

She says women tend to be aggressive in getting mammograms and Pap smears, but many don’t think about the “silent killer,” heart disease.

“Women generally are more concerned over developing cancer compared to heart disease,” says Dr. Rinehart. “However, while breast cancer affects one in seven women, heart disease affects one in three women. Unfortunately, heart disease is more prevalent, but there is a lack of awareness.”

Talk to your doctor about breast arterial calcification

“I encourage women to have a discussion with whoever ordered their mammogram and ask if they have breast arterial calcification on the scan,” she says. “Getting a mammogram can trigger a discussion about your heart health and if you need to have further testing with a preventive cardiologist.”

It’s important to seek the right kind of cardiologist, she says. Ideally, you’ll see someone active in cardiac prevention or women’s health.

“At Piedmont, we have a dedicated group of women’s health physicians who have a special interest in cardiovascular health in women,” she says.

A preventive cardiologist can review your heart disease risk factors, such as high blood pressure, high cholesterol or risk factors more prevalent in females like depression, lupus, gestational diabetes or preeclampsia during pregnancy. He or she can also order heart disease screening tests, such as a coronary calcium scan.

Know your heart disease risk factors

“Knowing the risk factors of heart disease in women is very important, and breast arterial calcification should be considered as a risk factor,” says Dr. Rinehart. “The key is to modify your heart disease risk factors before you have symptoms.”

The future of early heart disease detection

Dr. Rinehart is optimistic about the future in using mammogram screenings to identify a certain subset of women who otherwise may not know they are at risk for coronary artery disease.

“Multiple articles support the concept, but we don’t know the exact reason for the correlation between breast arterial calcification and heart disease because the pathophysiology is different,” she explains. “This information is just now being highlighted in the cardiovascular imaging community and more research needs to be done, but this is great progress.”

Learn more about how to decrease your heart disease risk factors.

Book an appointment with a Piedmont cardiologist today. 

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