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Breast cancer diagnosis tied to higher cardiometabolic risk in postmenopausal women
A cohort of postmenopausal women who received a breast cancer diagnosis were four times more likely to develop diabetes and metabolic syndrome and twice as likely to develop hypertriglyceridemia when compared with women without breast cancer, according to findings from a cross-sectional study published in Menopause.
“In a recent publication, the American Heart Association demonstrated growing concern with cardiovascular health in women with breast cancer,” Daniel de Araujo Brito Buttros, MD, PhD, of the department of gynecology and obstetrics at Botucatu Medical School at Sao Paulo State University in Brazil, and colleagues wrote. “In addition to an unhealthy lifestyle adopted by the majority of women after breast cancer diagnosis, the document correlated cancer treatment with high cardiotoxicity risk and subsequent cardiovascular repercussions. Some regimens based on anthracyclines, trastuzumab and left hemithorax irradiation, used alone or in combination, at specific dosages, are known to be cardiotoxic.”
Buttros and colleagues analyzed data from postmenopausal women with breast cancer (n = 96) and without a breast cancer diagnosis (n = 192), all without CVD at baseline, managed from 2015 to 2016 in a university hospital in Brazil (mean age, 59 years; mean age at menopause, 48 years). Researchers matched the groups by age, time since menopause and BMI in a ratio of one case to two controls. Women were diagnosed with metabolic syndrome if they met three of the following criteria: waist circumference of at least 88 cm; triglyceride level of at least 150 mg/dL; HLD cholesterol of 50 mg/dL or less; blood pressure of at least 130/85 mm Hg; and fasting glucose of at least 100 mg/dL. Immunoassays were used to measure plasma heat shock proteins HSP60 and HSP70 concentrations. Atherosclerotic disease was determined by intima-media thickness (> 1 mm) of the carotid arteries and/or the presence of atheromatous plaque assessed by carotid artery ultrasound.
The researchers found that diabetes was more frequently observed among breast cancer survivors vs. controls (19.8% vs. 6.8%), as was metabolic syndrome (54.2% vs. 30.7%; P < .05 for both). There was no between-group differences for subclinical atherosclerosis (P = .062); however, the presence of carotid artery plaque was twice as likely among breast cancer survivors vs. controls (19.8% vs. 9.4%; P = .013). Additionally, researchers found that women with a breast cancer diagnosis had higher HSP60 levels and lower HSP70 levels when compared with controls (P < .05).
“HSPs exert protective functions and act as molecular guardians during cell injury in response to diverse stimuli, helping cells defend the organism against potential aggressors,” the researchers wrote. “HSP expression is regulated by various factors, including infection, hypoxia, oxidative stress and inflammation.”
In logistic regression analysis, women with breast cancer were four times more likely to develop metabolic syndrome (OR = 4.21; 95% CI, 2.28-7.76) and diabetes (OR = 4.42; 95% CI, 1.86-8.49), more than twice as likely to develop hypertriglyceridemia (OR = 2.32; 95% CI, 1.33-4) and 11 times more likely to develop increased waist circumference (OR = 11.22; 95% CI, 4-21.65) when compared with women without breast cancer.
“Elevated cardiovascular risk in these patients may be more concerning than cancer risk in the medium to long term,” the researchers wrote. “Therefore, women diagnosed with breast cancer might receive multidisciplinary care, including cardiology consultation at the time of breast cancer diagnosis and also during oncologic follow-up visits.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.