scholarly journals Adipose Tissue Distribution and Cardiovascular Disease Risk Among Breast Cancer Survivors

2019 ◽  
Vol 37 (28) ◽  
pp. 2528-2536 ◽  
Author(s):  
Elizabeth M. Cespedes Feliciano ◽  
Wendy Y. Chen ◽  
Patrick T. Bradshaw ◽  
Carla M. Prado ◽  
Stacey Alexeeff ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Adipose Tissue ◽  
Tissue Distribution ◽  
Breast Cancer Survivors ◽  
Normal Weight ◽  
Visceral Adiposity ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Adipose Tissue Distribution

PURPOSE Cardiovascular disease (CVD) is a major source of morbidity and mortality among breast cancer survivors. Although body mass index (BMI) is associated with CVD risk, adipose tissue distribution may better identify patients with a high risk of CVD after breast cancer. METHODS Among 2,943 patients with nonmetastatic breast cancer without prior CVD, we used International Classification of Diseases (9th and 10th revisions) codes to identify incidence of nonfatal stroke, myocardial infarction, heart failure, or CVD death. From clinically acquired computed tomography scans obtained near diagnosis, we measured visceral adiposity (centimeters squared), subcutaneous adiposity (centimeters squared), and intramuscular adiposity (fatty infiltration into muscle [Hounsfield Units, scored inversely]). We estimated hazard ratios (HRs) and 95% CIs per SD increase in adiposity accounting for competing risks and adjusting for demographics, smoking, cancer treatment, and pre-existing CVD risk factors. RESULTS Mean (SD) age was 56 (12) years. Over a median follow-up of 6 years, 328 CVD events occurred. Each SD increase in visceral or intramuscular adiposity was associated with an increase in CVD risk (HR, 1.15 [95% CI, 1.03 to 1.29] and HR, 1.21 [95% CI, 1.06 to 1.37]), respectively). Excess visceral and intramuscular adiposity occurred across all BMI categories. Among normal-weight patients, each SD greater visceral adiposity increased CVD risk by 70% (HR, 1.70 [95% CI, 1.10 to 2.62]). CONCLUSION Visceral and intramuscular adiposity were associated with increased CVD incidence after breast cancer diagnosis, independent of pre-existing CVD risk factors and cancer treatments. The increased CVD incidence among normal-weight patients with greater visceral adiposity would go undetected with BMI alone. Measures of adipose tissue distribution may help identify high-risk patients and tailor CVD prevention strategies.

scholarly journals A Cardiac Rehabilitation Program for Breast Cancer Survivors: A Feasibility Study

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Filadelfiya Zvinovski ◽  
Julie A. Stephens ◽  
Bhuvaneswari Ramaswamy ◽  
Raquel E. Reinbolt ◽  
Anne M. Noonan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiac Rehabilitation ◽  
Cancer Survivors ◽  
Feasibility Study ◽  
Study Protocol ◽  
Breast Cancer Survivors ◽  
Cvd Risk Factors ◽  
Vo2 Max ◽  
Cvd Risk

Purpose. The purpose of this study was to determine the feasibility and preliminary efficacy of a cardiac rehabilitation (CR) intervention in the breast cancer population. Methods. This single-arm feasibility study evaluated a 14-week CR intervention program in breast cancer survivors. Feasibility was defined as completion of at least 30/36 sessions of the program without serious adverse events (SAE) in 80% of patients. Secondary endpoints included the change in VO2 max, cardiovascular disease (CVD) risk factors, Duke Activity Secondary Index (DASI), Brief Fatigue Inventory (BFI), and QLQ-C30. All outcomes were reported as mean change and compared using paired t-tests. Results. A total of 25 patients were enrolled in the study. 18 patients of the 25 enrolled (72%) completed the 14 weeks program without SAE. The overall adherence to the study protocol was 60%. Of the 18 participants who did not withdraw from the program, 15 (83%) adhered to the study protocol and completed 30 or more sessions. There was a nonsignificant improvement in VO2 max (mean Δ0.5, p = 0.6 ). The scores for DASI, BFI, and QLQ-C30 improved from baseline to posttreatment. Conclusion. A CR intervention in breast cancer survivors had high adherence in those who were able to complete the 14-week program. The program significantly improved patient reported physical activity, fatigue, and quality of life (QoL), without significant improvement in CVD risk factors. Implications for cancer patients are that early implementation of a CR program should be considered by practitioners as it improves QoL and exercise tolerance in breast cancer survivors.

Abstract 14833: The Association Between Cardiovascular Disease Knowledge and Risk Factors Among African American Breast Cancer Survivors in the Deep South

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michelle S Williams ◽  
Chizoba Anyimukwu
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
African American ◽  
Heart Disease ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Deep South ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Disease Knowledge

Introduction: African American breast cancer survivors in the Deep South have a disproportionately high burden of cardiovascular disease (CVD) mortality. This is due, in large part, to multiple potentially modifiable CVD risk factors that are disproportionately high in this group, such as high blood pressure, obesity, and poor dietary habits. The purpose of this study was to assess the association between CVD risk factors and heart disease knowledge among African American breast cancer survivors in the Deep South. Hypothesis: We hypothesize that the key CVD risk factors (smoking, BMI, physical activity, healthy diet, total cholesterol, blood pressure, and blood sugar) will be positively associated with heart disease knowledge score. Methods: The Heart Disease Knowledge Questionnaire was used to assess the participants’ knowledge of heart disease and heart disease risk factors. Questions from My Life Check were used to assess the participants CVD risk factors. Multivariate regression analyses were performed to determine which CVD risk factors and demographic characteristics can predict the participants’ heart disease knowledge score. Results: Seventy African American breast cancer survivors living in the Deep South enrolled in the study. A research team member administered the questionnaires over the phone. The mean age of the participants was 56.76 years (± 10.36) and 42.9% had a college degree or higher level of education. Results of a multivariate regression analysis showed that the number of healthy diet score components was the only cardiovascular health metric that was statistically significantly associated with heart disease knowledge score (p = .01). Education level was the only demographic characteristic that was statistically significantly associated with heart disease knowledge score (p = .004). Conclusions: Our results indicate that women with more knowledge of heart disease and higher levels of education are more likely to have better cardiovascular health metrics. Our findings underscore the need to disseminate and implement health education interventions aimed at increasing knowledge of modifiable CVD risk factors that are targeted towards African American breast cancer survivors in the Deep South.

Abstract P174: Increased Cardiovascular Disease Risk Factors in Young Hispanic Women at the High-end of Normal-weight Body Mass Index

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Chantal A Vella ◽  
Ximena Burgos-Monzon ◽  
Carla J Ellis
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Adipose Tissue ◽  
Waist Circumference ◽  
Glucose Tolerance ◽  
Hispanic Women ◽  
Normal Weight ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Abdominal Adipose Tissue

BMI is often used to assess risk of cardiovascular disease (CVD); however, current BMI cutpoints may not be accurate for all ethnicities. Given the high prevalence of obesity and type 2 diabetes in Hispanics, it is important to examine whether current BMI cutpoints accurately identify those at healthy weight and those at risk. We examined whether there was a difference in CVD risk factors within the normal-weight BMI category in young, Hispanic women. We hypothesized that women in the highest tertile of normal-weight would have significantly more CVD risk factors than those in the lowest tertile of normal-weight. Sixty nine normal-weight Hispanic women (20-39 y) were divided into tertiles of normal-weight BMI: 18.5-20.9 kg/m2 (NW low, n=17), 21.0-22.9 kg/m2 (NW mid, n=31) and 23.0-24.9 kg/m2 (NW high, n=21). CVD risk factors measured included waist circumference, blood pressure and fasting glucose, triglycerides and high-density and low-density lipoprotein. Glucose tolerance was measured by a 2h oral glucose tolerance test. Body composition was measured by dual-energy x-ray absorptiometry. Intra-abdominal adipose tissue, an estimate of visceral adiposity, was calculated. Data were analyzed using multivariate ANOVA, with Levine’s test indicating homogeneity of variances among groups, and Kruskal-Wallace test. Post hoc tests included Bonferroni and Mann Whitney. Results indicated the prevalence of women who were risk factor free was 65%, 39% and 24% for NW low, mid and high, respectively. The prevalence of women with one or more CVD risk factors was 35%, 61%, and 76% for NW low, mid and high, respectively. The prevalence of women with two or more CVD risk factors was 0%, 3%, and 29% for NW low, mid and high, respectively. The prevalence of women with three or more CVD risk factors was 0%, 0% and 10% for NW low, mid and high, respectively. Overall the prevalence of CVD risk factors was significantly higher in NW high than NW low (p=0.006) and NW mod (p=0.04) and approached significance between NW mid and NW low (p=0.08). There was a significant increase in percentage body fat (27.6±5.1%, 30.7±4.6%, 36.9±4.6%, respectively), intra-abdominal adipose tissue (24.2±7.9 cm2, 45.6±12.2 cm2, 66.5±19.7 cm2, respectively), and waist circumference (71.2±3.1 cm, 76.6±4.8 cm, 81.0±5.8 cm, respectively) from NW low to NW high (p<0,001). NW high had significantly higher triglyceride levels than NW low (86.4±40.0 mg/dL vs. 58.9±20.6 mg/dL, p=0.04) and significantly higher 2h glucose levels than NW mid (120.0±27.9 mg/dL vs. 99.1±17.3 mg/dL, p=0.003). In conclusion, young, Hispanic women at the upper-end of the normal-weight BMI range had a significantly higher prevalence of CVD risk factors, body fat and central obesity than women in the mid and lower end of normal-weight BMI range. These findings suggest that the normal-weight BMI cutpoint may need to be adjusted for Hispanic women.

Abstract P292: Severe Obesity is Associated with Dramatic Increase in Cardiovascular Disease Risk Factor Prevalence: Hispanic Community Health Study/Study of Latinos (HCHS/SOL)

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Robert Kaplan ◽  
Larissa M Avilés-Santa ◽  
Christina M Parrinello ◽  
Sheila Castañeda ◽  
Arlene L Hankinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Class Ii ◽  
Normal Weight ◽  
Class Iii ◽  
C Reactive Protein ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Total N ◽  
Reactive Protein ◽  
Class Iii Obesity

Introduction: Prevalence of severe obesity is increasing, especially among the young Hispanic population. Methods: In the HCHS/SOL cohort of 18-74 year old US Hispanics, we examined gradients across BMI and age in CVD risk factors. Results: Approximately one in five males (total N = 6,547) and one in ten females (total N=9,797) met criteria for class II obesity (BMI 35 - 40 kg/m 2 ) or class III obesity (BMI ≥ 40 kg/m 2 ). The prevalence of hypertension, diabetes, and elevated C-reactive protein rose with each successive class of overweight/obesity. In contrast, the prevalence of elevated levels of total cholesterol, LDL-c and triglycerides increased across normal weight, overweight (BMI 25 - 30 kg/m 2 ), and class I obese (BMI 30 - 35 kg/m 2 ) groups, but did not increase in frequency across class I, class II, and class III obesity groups. The Figure depicts isolines that identify age- specific subgroups of the normal-weight and class II - III obese groups that had the same estimated prevalence of CVD risk factors, with 95 percent confidence intervals. Among young adults with class II or III obesity, the prevalence of hypertension, diabetes, and the combination of three or more CVD risk factors was similar to that among normal-weight individuals (BMI 18.5 - 25 kg/m 2 ) who were 15 to 30 years older. Among young obese individuals, the prevalence of low HDL-c levels and high C-reactive protein levels exceeded that among the oldest adults in the cohort. CVD risk factors had stronger, more consistent gradients across the BMI categories among men than among women. Conclusion: Class II and III obesity, defined as BMI ≥ 35 kg/m 2 , are common in the Hispanic/Latino population. Young adults with these severe forms of obesity have dramatically increased frequency of cardiometabolic risk factors. The age-related accumulation of multiple CVD risk factors, such as is typically seen in normal-weight individuals, is accelerated by 1-2 decades in severly overweight women and by 2-3 decades in severely overweight men.

scholarly journals Effects of visceral adipose tissue reduction on CVD risk factors independent of weight loss: The Look AHEAD study

2016 ◽  
Vol 42 (2) ◽  
pp. 86-95 ◽  
Author(s):  
Anawin Sanguankeo ◽  
Mariana Lazo ◽  
Sikarin Upala ◽  
Frederick L. Brancati ◽  
Susanne Bonekamp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Weight Loss ◽  
Adipose Tissue ◽  
Visceral Adipose Tissue ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Look Ahead ◽  
The Look ◽  
Visceral Adipose ◽  
Tissue Reduction

scholarly journals Adipose Tissue Distribution and Survival Among Women with Nonmetastatic Breast Cancer

Obesity ◽  
2019 ◽  
Vol 27 (6) ◽  
pp. 997-1004 ◽  
Author(s):  
Patrick T. Bradshaw ◽  
Elizabeth M. Cespedes Feliciano ◽  
Carla M. Prado ◽  
Stacey Alexeeff ◽  
Kathleen B. Albers ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Adipose Tissue ◽  
Tissue Distribution ◽  
Adipose Tissue Distribution

Cardiovascular risk profile of breast cancer patients treated with anthracycline-taxane containing adjuvant chemotherapy and/or trastuzumab

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 666-666 ◽  
Author(s):  
L. W. Jones ◽  
M. Haykowsky ◽  
C. J. Peddle ◽  
A. A. Joy ◽  
E. N. Pituskin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Adjuvant Chemotherapy ◽  
Cancer Patients ◽  
Sinus Tachycardia ◽  
Early Stage ◽  
Early Stage Breast Cancer ◽  
Breast Cancer Patients ◽  
Cvd Risk Factors ◽  
Cvd Risk

666 Background: With improving longevity, post-treatment cardiovascular disorders will become an increasingly important indicator of competing mortality in early-stage breast cancer. As such, we conducted a pilot study to comprehensively evaluate the CVD profile of a subset of early-stage breast cancer patients treated with adjuvant taxane-anthracycline containing chemotherapy and/or trastuzumab. Methods: Twenty-six breast cancer patients (mean 20 months post chemotherapy) who participated in Breast Cancer International Research Group 006 clinical trial and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established CVD risk factors, BMI, VO2peak and left ventricular systolic function. All assessments were performed within a 14-day period. Results: Cardiac abnormalities were suggested by LVEF <50% in 10% of patients, LVEF remained >10% below pre-treatment values in 38% while 50% presented with resting sinus tachycardia. BNP was significantly elevated in 40% and was correlated with LVEF (r = -0.72, p=<.001). For the majority of CVD risk factors, similar proportions of patients and controls (35% to 60%) were classified as ‘undesirable.’ A significantly higher proportion of patients were classified with low VO2peak (46% vs. 0%, p<0.01), being overweight/obese (72% vs. 50%, p<0.05), and having resting sinus tachycardia (50% vs. 0%, p<0.01) compared with controls. VO2peak and BMI were correlated with CV risk factors (r = -0.64 to 0.63, p<0.05; r = -0.63 to 0.67, p<0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen. Conclusions: Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age matched controls due to direct and indirect treatment-related toxicity. No significant financial relationships to disclose.

scholarly journals Bragatston study protocol: a multicentre cohort study on automated quantification of cardiovascular calcifications on radiotherapy planning CT scans for cardiovascular risk prediction in patients with breast cancer

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e028752 ◽  
Author(s):  
Marleen J Emaus ◽  
Ivana Išgum ◽  
Sanne G M van Velzen ◽  
H J G Desirée van den Bongard ◽  
Sofie A M Gernaat ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Radiotherapy Planning ◽  
Ct Scans ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Multicentre Cohort Study ◽  
Automated Quantification ◽  
Cardiovascular Calcifications ◽  
Planning Ct

IntroductionCardiovascular disease (CVD) is an important cause of death in breast cancer survivors. Some breast cancer treatments including anthracyclines, trastuzumab and radiotherapy can increase the risk of CVD, especially for patients with pre-existing CVD risk factors. Early identification of patients at increased CVD risk may allow switching to less cardiotoxic treatments, active surveillance or treatment of CVD risk factors. One of the strongest independent CVD risk factors is the presence and extent of coronary artery calcifications (CAC). In clinical practice, CAC are generally quantified on ECG-triggered cardiac CT scans. Patients with breast cancer treated with radiotherapy routinely undergo radiotherapy planning CT scans of the chest, and those scans could provide the opportunity to routinely assess CAC before a potentially cardiotoxic treatment. The Bragatston study aims to investigate the association between calcifications in the coronary arteries, aorta and heart valves (hereinafter called ‘cardiovascular calcifications’) measured automatically on planning CT scans of patients with breast cancer and CVD risk.Methods and analysisIn a first step, we will optimise and validate a deep learning algorithm for automated quantification of cardiovascular calcifications on planning CT scans of patients with breast cancer. Then, in a multicentre cohort study (University Medical Center Utrecht, Utrecht, Erasmus MC Cancer Institute, Rotterdam and Radboudumc, Nijmegen, The Netherlands), the association between cardiovascular calcifications measured on planning CT scans of patients with breast cancer (n≈16 000) and incident (non-)fatal CVD events will be evaluated. To assess the added predictive value of these calcifications over traditional CVD risk factors and treatment characteristics, a case-cohort analysis will be performed among all cohort members diagnosed with a CVD event during follow-up (n≈200) and a random sample of the baseline cohort (n≈600).Ethics and disseminationThe Institutional Review Boards of the participating hospitals decided that the Medical Research Involving Human Subjects Act does not apply. Findings will be published in peer-reviewed journals and presented at conferences.Trial registration numberNCT03206333.

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