Summary: Mammograms revealing fat-enlarged axillary nodes could aid in predicting cardiovascular risk, diabetes, and hypertension in women, potentially enhancing risk assessment without added cost, suggests a study presented at the ARRS Annual Meeting.

Key Takeaways:

  1. Fat-enlarged axillary nodes on mammograms could serve as predictors for high cardiovascular disease (CVD) risk, Type 2 diabetes (T2DM), and hypertension (HTN) in women, as highlighted in a study presented at the 124th ARRS Annual Meeting.
  2. Incorporating fat-enlarged nodes into CVD risk models could enhance risk stratification without additional cost, potentially aiding in identifying women who may benefit from CVD risk reduction strategies and intensive risk assessment.
  3. A study conducted on women aged 40 to 75 revealed that those with enlarged axillary nodes visible on mammograms had significantly higher risks of cardiovascular disease, diabetes, hypertension, and major cardiovascular events, suggesting the potential of mammograms as indicators of heart disease risk.

According to the Summa Cum Laude Award-Winning Online Poster presented during the 124th ARRS Annual Meeting, fat-enlarged axillary nodes on screening mammograms can predict high cardiovascular disease (CVD) risk, Type 2 diabetes (T2DM), and hypertension (HTN).

“Incorporating fat-enlarged nodes into CVD risk models has the potential to improve CVD risk stratification without additional cost or additional testing,” says Jessica Rubino, MD, a radiology resident at Dartmouth Hitchcock Medical Center in Lebanon, N.H. “Fat-enlarged axillary lymph nodes visualized on screening mammography may increase the ability to identify women who would benefit from CVD risk reduction strategies and more intensive risk assessment with coronary artery CT.”

Mammograms as Cardiovascular Prognosticators

Rubino and her colleagues studied women aged 40 to 75 with no known heart disease who had a mammogram and cardiovascular risk factors documented in their medical records within a year of the mammogram between January 1, 2011, and December 31, 2012. They looked at major cardiovascular events over the following decade, using clinical data from the time of the mammogram to identify those at high risk, defined by the American Heart Association as having over a 7.5% chance of such events within 10 years.

Breast imagers assessed the size of the largest axillary lymph node visible on the mammograms. They then analyzed the association between lymph node size, cardiovascular risk, diabetes, hypertension, cholesterol levels, age, and body mass index using logistic regression.

Mammograms Indicate Heart Disease Risk for Women

Among the 1,216 women in the American Roentgen Ray Society (ARRS) Annual Meeting Summa Cum Laude Scientific Poster, 907 (74.6%) had a visible axillary lymph node on their mammogram, and 232 (19.1%) had enlarged nodes, defined as larger than 20 mm due to fat accumulation. Those with enlarged nodes were at higher risk of cardiovascular disease (OR = 2.6, 95% CI 1.5–4.2), and had higher rates of diabetes (OR = 4, 95% CI 2.1–7.7) and hypertension (OR = 2.5, 95% CI 1.6–4.0). Enlarged nodes also showed a trend towards increased risk of major cardiovascular events (OR = 1.7, 95% CI 0.9–3.1) and high LDL cholesterol (OR = 1.4, 95% CI 0.9–2.1).

“These results support further investigation of fat-enlarged lymph nodes,” Rubino adds, “particularly with studies leveraging AI evaluation of mammographic fat-enlarged LNs and cardiometabolic disease.” 

Featured image: A, Normal axillary lymph nodes measuring < 1.5 cm in 63-year-old woman with BM = 43.2. B, Fat-enlarged axillary node with large fatty hilum measuring 4.2 cm in 52-year-old woman with BMI = 45.8.