Skip to main content

Advertisement

Log in

Cardiorespiratory fitness predicts cardiovascular health in breast cancer survivors, independent of body composition, age and time post-treatment completion

  • Original Article
  • Published:
Breast Cancer Aims and scope Submit manuscript

Abstract

Background

Breast cancer treatment may increase non-cancer related mortality risk due to unintended cardiovascular consequences. The aim of this study was to investigate the strongest correlate of cardiovascular health (CVH) in female breast cancer survivors, cardiorespiratory fitness or fatness.

Methods

Fifty-one women (59 ± 9 years, BMI 26.4 ± 4.8 kg/m2) previously diagnosed and treated for primary breast cancer were assessed using pulse wave analysis to determine central arterial wave reflection (augmentation index, AIx) and central systolic blood pressure (cSBP). A composite Z score calculated which incorporated central double product and AIx, as an indicator of CVH. Dual energy X-ray absorptiometry was used to obtain total body fat percentage (BF%). Cardiorespiratory fitness was determined using the single-stage walk test to predict maximal oxygen uptake (\(V{\text{O}}_{2\hbox{max} }\)).

Results

Linear regression analysis revealed that fitness was associated with AIx after adjusting for BF %, age and time post-treatment completion (β = − 0.271, p = 0.010). A significant association between BF% and AIx after adjusting for fitness and age was found (β = 0.166, p = 0.0005); however, this association was lost when time post-treatment was included in the model (β = 0.166, p = 0.167). Both fitness (β = − 0.347, p = 0.0005) and BF% (β = 0.333, p = 0.013) were independently associated with CVH in the fully adjusted model.

Conclusions

This study provides evidence for an association between cardiorespiratory fitness and cardiovascular health in female breast cancer survivors. While fatness may be associated with cardiovascular health, it appears to be more strongly associated with age.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Colzani E, Liljegren A, Johansson ALV, Adolfsson J, Hellborg H, Hall PFL, Czene K. Prognosis of patients with breast cancer: causes of death and effects of time since diagnosis, age, and tumor characteristics. J Clin Oncol. 2011;29:4014–21.

    Article  PubMed  Google Scholar 

  2. Patnaik J, Byers T, DiGuiseppi C, Dabelea D, Denberg T. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res. 2011;13:R64.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Hanrahan EO, Gonzalez-Angulo AM, Giordano SH, Rouzier R, Broglio KR, Hortobagyi GN, Valero V. Overall survival and cause-specific mortality of patients with stage T1a, bN0M0 breast carcinoma. J Clin Oncol. 2007;25:4952–60.

    Article  PubMed  Google Scholar 

  4. Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50:1435–41.

    Article  PubMed  Google Scholar 

  5. Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, Scott JM, Hornsby WE, Coan AD, Herndon JE, Douglas PS, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol. 2012;30:2530–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12:282–94.

    Article  CAS  PubMed  Google Scholar 

  7. Nissen MJ, Shapiro A, Swenson KK. Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer. 2011;11:52–60.

    Article  PubMed  Google Scholar 

  8. Schmid D, Leitzmann MF. Cardiorespiratory fitness as predictor of cancer mortality: a systematic review and meta-analysis. Ann Oncol. 2015;26(2):272–8.

    Article  CAS  PubMed  Google Scholar 

  9. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97:1746–57.

    Article  PubMed  Google Scholar 

  10. Jones LW, Haykowsky M, Pituskin EN, Jendzjowsky NG, Tomczak CR, Haennel RG, Mackey JR. Cardiovascular reserve and risk profile of postmenopausal women after chemoendocrine therapy for hormone receptor-positive operable breast cancer. Oncologist. 2007;12:1156–64.

    Article  PubMed  Google Scholar 

  11. Chan DSM, Vieira AR, Aune D, Bandera EV, Greenwood DC, McTiernan A, Navarro Rosenblatt D, Thune I, Vieira R, Norat T. Body mass index and survival in women with breast cancer-systematic literature review and meta-analysis of 82 follow-up studies. Ann Oncol. 2014;25:1901–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.

    Article  Google Scholar 

  13. Stoner L, Lambrick DM, Faulkner J, Young J. Guidelines for the use of pulse wave analysis in adults and children. J Atheroscler Thromb. 2013;20:404–6.

    Article  PubMed  Google Scholar 

  14. Lowe A, Harrison W, El-Aklouk E, Ruygrok P, Al-Jumaily AM. Non-invasive model-based estimation of aortic pulse pressure using suprasystolic brachial pressure waveforms. J Biomech. 2009;42:2111–5.

    Article  CAS  PubMed  Google Scholar 

  15. Kelly RP, Millasseau SC, Ritter JM, Chowienczyk PJ. Vasoactive drugs influence aortic augmentation index independently of pulse-wave velocity in healthy men. Hypertension. 2001;37:1429–33.

    Article  CAS  PubMed  Google Scholar 

  16. Soga J, Nakamura S, Nishioka K, Umemura T, Jitsuiki D, Hidaka T, Teragawa H, Takemoto H, Goto C, Yoshizumi M, et al. Relationship between augmentation index and flow-mediated vasodilation in the brachial artery. Hypertens Res. 2008;31:1293–8.

    Article  PubMed  Google Scholar 

  17. Vlachopoulos C, Aznaouridis K, Stefanadis C. Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol. 2010;55:1318–27.

    Article  PubMed  Google Scholar 

  18. Stoner L, Credeur D, Fryer S, Faulkner J, Lambrick D, Gibbs BB. Reliability of pulse waveform separation analysis: effects of posture and fasting. J Hypertens. 2017;35(3):501–5.

    Article  CAS  PubMed  Google Scholar 

  19. Young Y, Abdolhosseini P, Brown F, Faulkner J, Lambrick D, Williams MA, Stoner L. Reliability of oscillometric central blood pressure and wave reflection readings: effects of posture and fasting. J Hypertens. 2015;33(8):1588–93.

    Article  CAS  PubMed  Google Scholar 

  20. Ebbeling CB, Ward A, Puleo EM, Wildrick J, Rippe JM. Development of a single-stage submaximal treadmill walking test. Med Sci Sports Exerc. 1991;23:966–73.

    Article  CAS  PubMed  Google Scholar 

  21. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012;59(7):665–72.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Barry VW, Baruth M, Beets MW, Durstine JL, Liu J, Blair SN. Fitness vs. fatness on all-cause mortality: a meta-analysis. Prog Cardiovasc Dis. 2014;56(4):382–90.

    Article  PubMed  Google Scholar 

  23. Ross R, Blair SN, Arena R, Church TS, Despres JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, et al. Importance of assessing cardiorespiratory fitness in clinical practice: a case for fitness as a clinical vital sign: a scientific statement from the American Heart Association. Circulation. 2016;134(24):e653–99.

    Article  PubMed  Google Scholar 

  24. Lakoski SG, Barlow CE, Koelwyn GJ, Hornsby WE, Hernandez J, DeFina LF, Radford NB, Thomas SM, Herndon JE II, Peppercorn J, et al. The influence of adjuvant therapy on cardiorespiratory fitness in early-stage breast cancer seven years after diagnosis: the Cooper Center Longitudinal Study. Breast Cancer Res Treat. 2013;138:909–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Wonders KY, Reigle BS. Trastuzumab and doxorubicin-related cardiotoxicity and the cardioprotective role of exercise. Integr Cancer Ther. 2009;8:17–21.

    Article  CAS  PubMed  Google Scholar 

  26. Fitzgerald MD, Tanaka H, Tran ZV, Seals DR. Age-related declines in maximal aerobic capacity in regularly exercising vs. sedentary women: a meta-analysis. J Appl Physiol. 1997;83:160–5.

    Article  CAS  PubMed  Google Scholar 

  27. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, et al. American College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors. Med Sci Sports Exerc. 2010;42:1409–26.

    Article  PubMed  Google Scholar 

  28. Demark-Wahnefried W, Rimer BK, Winer EP. Weight gain in women diagnosed with breast cancer. J Am Diet Assoc. 1997;97:519–29.

    Article  CAS  PubMed  Google Scholar 

  29. George S, Bernstein L, Smith A, Neuhouser M, Baumgartner K, Baumgartner R, Ballard-Barbash R. Central adiposity after breast cancer diagnosis is related to mortality in the Health, Eating, Activity, and Lifestyle study. Breast Cancer Res Treat. 2014;146:647–55.

    Article  PubMed  PubMed Central  Google Scholar 

  30. van Bussel BC, Schouten F, Henry RM, Schalkwijk CG, de Boer MR, Ferreira I, Smulders YM, Twisk JW, Stehouwer CD. Endothelial dysfunction and low-grade inflammation are associated with greater arterial stiffness over a 6-year period. Hypertension. 2011;58:588–95.

    Article  PubMed  Google Scholar 

  31. Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, et al. Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev. 2009;18:1403–9.

    Article  Google Scholar 

  32. Bulten B, Mavinkurve-Groothuis AC, de Geus-Oei L-F, de Haan AJ, de Korte C, Bellersen L, van Laarhoven HM, Kapusta L. Early myocardial deformation abnormalities in breast cancer survivors. Breast Cancer Res Treat. 2014;146(1):127–35.

    Article  CAS  PubMed  Google Scholar 

  33. Avolio AP, Butlin M, Walsh A. Arterial blood pressure measurement and pulse wave analysis—their role in enhancing cardiovascular assessment. Physiol Meas. 2010;31:R1–47.

    Article  PubMed  Google Scholar 

  34. Drafts BC, Twomley KM, D’Agostino R Jr, Lawrence J, Avis N, Ellis LR, Thohan V, Jordan J, Melin SA, Torti FM, et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. JACC Cardiovasc Imaging. 2013;6:877–85.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Schmitz KH, Prosnitz RG, Schwartz AL, Carver JR. Prospective surveillance and management of cardiac toxicity and health in breast cancer survivors. Cancer. 2012;118:2270–6.

    Article  PubMed  Google Scholar 

  36. Ades F, Zardavas D, Pinto AC, Criscitiello C, Aftimos P, de Azambuja E. Cardiotoxicity of systemic agents used in breast cancer. Breast. 2014;23:317–28.

    Article  PubMed  Google Scholar 

  37. Rafie AHS, Sungar GW, Dewey FE, Hadley D, Myers J, Froelicher VF. Prognostic value of double product reserve. Eur J Cardiovas Prev Rehabil. 2008;15:541–7.

    Article  Google Scholar 

  38. Jones LM, Stoner L, Brown C, Baldi C, McLaren B. Cardiovascular disease among breast cancer survivors: the call for a clinical vascular health toolbox. Breast Cancer Res Treat. 2013;142(3):645–53.

    Article  PubMed  Google Scholar 

  39. Bouchard C, Rankinen T, Timmons JA. Genomics and genetics in the biology of adaptation to exercise. Compr Physiol. 2011;1(3):1603–48.

    PubMed  PubMed Central  Google Scholar 

  40. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors would like to thank the participants for their time.

Funding

University of Otago Research Grant.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Lynnette M. Jones.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest to declare.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, L.M., Stoner, L., Brown, C. et al. Cardiorespiratory fitness predicts cardiovascular health in breast cancer survivors, independent of body composition, age and time post-treatment completion. Breast Cancer 26, 729–737 (2019). https://doi.org/10.1007/s12282-019-00975-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12282-019-00975-2

Keywords

Navigation