Pre-Menopausal Breast Fat Density Might Predict MACE During 10 Years of Follow-Up: The BRECARD Study.

Celestino Sardu, Gianluca Gatta, Gorizio Pieretti, Luigi Viola, Cosimo Sacra, Graziella Di Grezia, Lanfranco Musto, Salvatore Minelli, Daniele La Forgia, Mariangela Capodieci, Alessandro Galiano, Angela Vestito, Angela De Lisio, Pia Clara Pafundi, Ferdinando Carlo Sasso, Salvatore Cappabianca, Gianfranco Nicoletti, Giuseppe Paolisso, Raffaele Marfella

Research output: Contribution to journalArticlepeer-review


Objectives: This study sought to determine whether the breast gland adipose tissue is associated with different rates of major adverse cardiac events (MACEs) in pre-menopausal women. Background: To our knowledge, no study investigated the impact of breast adipose tissue infiltration on MACEs in pre-menopausal women. Methods: Prospective multicenter cohort study conducted on pre-menopausal women >40 years of age without cardiovascular disease and breast cancer at enrollment. The study started in January 2000 and ended in January 2009, and the end of the follow-up for the evaluation of MACEs was in January 2019. Participants underwent mammography to evaluate breast density and were divided into 4 groups according to their breast density. The primary endpoint was the probability of a MACE at 10 years of follow-up in patients staged for different breast deposition/adipose tissue deposition. Results: The propensity score matching divided the baseline population of 16,763 pre-menopausal women, leaving 3,272 women according to the category of breast density from A to D. These women were assigned to 4 groups of the study according to baseline breast density. At 10 years of follow-up, we had 160 MACEs in group 1, 62 MACEs in group 2, 27 MACEs in group 3, and 16 MACEs in group 4. MACEs were predicted by the initial diagnosis of lowest breast density (hazard ratio: 3.483; 95% confidence interval: 1.476 to 8.257). Further randomized clinical trials are needed to translate the results of the present study into clinical practice. The loss of ex vivo breast density models to study the cellular/molecular pathways implied in MACE is another study limitation. Conclusions: Among pre-menopausal women, a higher evidence of adipose tissue at the level of breast gland (lowest breast density, category A) versus higher breast density shows higher rates of MACEs. Therefore, the screening mammography could be proposed in overweight women to stage breast density and to predict MACEs. (Breast Density in Pre-menopausal Women Is Predictive of Cardiovascular Outcomes at 10 Years of Follow-Up [BRECARD]; NCT03779217)

Original languageEnglish
Pages (from-to)426-438
Number of pages13
JournalJACC: Cardiovascular Imaging
Issue number2
Publication statusPublished - Feb 2021


  • breast density
  • major adverse cardiac events
  • pre-menopausal status

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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