Body composition measures linked to cardiovascular events among patients with colorectal cancer

Visceral fat and muscle radiodensity appeared significantly associated with risk for major adverse cardiovascular events among patients with colorectal cancer, according to study results published in JAMA Oncology.

BMI, however, may be less useful in assessing cardiovascular risk among these patients.

“Colorectal cancer is the fourth most common malignant neoplasm in the United States. Five-year survival for patients with [colorectal cancer] increased by 33% over the past 4 decades,” Justin C. Brown, PhD, director of the cancer metabolism program at Pennington Biomedical Research Institute, and colleagues wrote. “Patients with [colorectal cancer] are now more susceptible to competing causes of morbidity and mortality, such as those from cardiovascular disease.”

In the population-based, retrospective cohort study, Brown and colleagues evaluated 2,839 patients (mean age, 61;9 years; range, 19-80; 51% women) with stage I to stage III colorectal cancer diagnosed between January 2006 and December 2011 who underwent surgical resection with curative intent. The population included former (n = 1,127; 40%) and current smokers (n = 340; 12%) and patients with hypertension (n = 1,150; 55%), hyperlipidemia (n = 1,389; 49%) and type 2 diabetes (n = 573; 20%).

At a median follow-up of 6.8 years (interquartile range, 5.2-8.3), 366 patients (12.9%) had experienced a major adverse cardiovascular event. Cumulative incidence of major adverse cardiovascular events was 3.4% at 1 year, 5.9% at 3 years and 19.1% at 10 years.

Researchers observed positive correlations between BMI and visceral adipose tissue area (r = 0.61; 95% CI, 0.59-0.63), subcutaneous adipose tissue area (r = 0.83; 95% CI, 0.82-0.85) and muscle mass (r = 0.41; 95% CI, 0.38-0.44), and a negative association between BMI and muscle radiodensity (r = -0.33; 95% CI, –0.37 to –0.3).

However, BMI did not appear significantly associated with major adverse cardiovascular events; in comparing BMI categories of greater than or equal to 25 kg/m² with 18 25 kg/m² to 24.9 25 kg/m², the HR was 1.23 (95% CI, 0.85-1.77).

In comparing the highest vs. lowest quintile of visceral adipose tissue area, the HR was 0.96 (95% CI, 0.57-1.61), indicating a significant association with major adverse cardiovascular events (P = .04 for trend).

Muscle radiodensity also appeared associated with major adverse cardiovascular events; in an analysis contrasting the highest vs. lowest quintiles, the HR was 0.67 (95% CI, 0.44-1.03; P = .02 for trend).

Results showed no such associations in contrasting the highest vs. lowest quintiles of subcutaneous adipose tissue (HR = 1.15; 95% CI, 0.78-1.69) and muscle mass (HR = 0.96; 95% CI, 0.57-1.61).

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Future studies that consider different components of major adverse cardiovascular events should provide further insight into the relationship between colorectal cancer and these outcomes, according to a related editorial by Michael N. Passarelli, PhD, assistant professor of epidemiology at Dartmouth Geisel School of Medicine.
cardiovascular events are commonly used in cardiovascular disease research, but potentially different condition-specific associations might be masked,” Passarelli wrote. “Future epidemiological studies of body composition and cardiovascular disease risk after cancer should be large enough to consider myocardial infarction and stroke separately and broadly evaluate other heart and vascular conditions.” – by Jennifer Byrne

Disclosures: Brown reports grants to his institution from the NCI. Please see the study for all other authors’ relevant financial disclosures. Passarelli reports no relevant financial disclosures.

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Source:

Brown JC, et al. JAMA Oncol. 2019;doi:10.1001/jamaoncol.2019.0695.
Passarelli MN. JAMA Oncol, 2019;doi:10.1001/jamaoncol.2019.0676.