Mammography Foundation Models for Opportunistic Prediction of Major Adverse Cardiovascular Events

2026-09-16

AI Summary

研究通过使用乳腺X线摄影基础模型预测心血管疾病风险，无需特定心血管监督或标注，仅基于影像信息即显著优于仅用年龄的模型。

Abstract

Cardiovascular disease (CVD) remains the leading cause of death among women, yet cardiovascular risk assessment often relies on clinical variables that may be missing, outdated, or unavailable in routine care. Screening mammography offers an opportunity for opportunistic cardiovascular risk stratification because it is routinely acquired and contains vascular features, including breast arterial calcifications (BAC), that are associated with cardiovascular risk and events. We evaluate whether mammography specific foundation models, originally pretrained for breast cancer-related tasks, can transfer to cardiovascular risk prediction without cardiovascular specific supervision or explicit BAC annotation. We constructed a 5-year major adverse cardiovascular event (MACE) cohort of 22,497 women linked to electronic health record outcomes, including 500 events (2.22% prevalence). The foundation models achieved AUROCs of 0.823 and 0.822 substantially exceeding an age-only model (AUROC 0.765), despite using only the screening mammogram as input, with no clinical variables. Both foundation models evaluated assigned substantially higher predicted risk to patients with radiologist-documented BAC, despite BAC never being used as a training label, and showed activation patterns consistent with vascular findings. Together, these findings suggest that mammography foundation models can recover clinically relevant cardiovascular risk information directly from mammographic pixels and suggest that screening mammography may provide an opportunistic source of cardiovascular risk information to complement conventional clinical assessment without additional imaging. Code is available in https://github.com/PauFeld/MammoCVD

Problem

• cardiovascular disease
• risk assessment
• mammography
• breast arterial calcifications
• opportunistic screening

Innovation

• mammography foundation models
• cardiovascular risk prediction
• breast arterial calcifications (BAC)
• transfer learning
• major adverse cardiovascular event (MACE)