Breast Cancer Research and Treatment

, Volume 162, Issue 3, pp 549–557 | Cite as

Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors

  • Elizabeth M. Cespedes FelicianoEmail author
  • Marilyn L. Kwan
  • Lawrence H. Kushi
  • Erin K. Weltzien
  • Adrienne L. Castillo
  • Bette J. Caan



Little research examines whether adiposity or post-diagnosis weight changes influence Cardiovascular disease (CVD) among breast cancer patients for whom effects may differ due to treatment and recovery.


We studied Stage I–III breast cancer survivors 18 to  <80 years, without pre-existing CVD, diagnosed from 1997 to 2013 at Kaiser Permanente. Women reported weight at diagnosis and weight and waist circumference (WC) around 24 months post diagnosis. Using Cox models for time to incident coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, we examined at-diagnosis body mass index (BMI, n = 3109) and post-diagnosis WC (n = 1898) and weight change (n = 1903, stable, ±5 to  <10-lbs or ±≥10-lbs).


Mean (SD) age was 57 (11) years, and BMI was 28 (6) kg-m2. Post diagnosis, 25% of women gained and 14% lost ≥10-lbs; mean (SD) WC was 90 (15) cm. Over a median of 8.28 years, 915 women developed CVD. BMI 25–30-kg/m2 (vs. BMI < 25-kg/m2) was not associated with CVD, while BMI ≥ 35-kg/m2 increased risk by 33% (HR: 1.33; 95%CI 1.08–1.65), independent of lifestyle and tumor/treatment factors. The increased risk at BMI ≥ 35-kg/m2 attenuated with adjustment for pre-existing CVD risk factors to HR: 1.20; 95%CI 0.97–1.50. By contrast, even moderate elevations in WC increased risk of CVD, independent of pre-existing risk factors (HR: 1.93; 95%CI 1.31–2.84 comparing ≥100-cm vs. ≤80-cm). Post-diagnosis weight change had no association with CVD.


Extreme adiposity and any elevation in WC increased risk of CVD among breast cancer survivors; however, changes in weight in the early post-diagnosis period were not associated with CVD. Survivors with high WC and existing CVD risk factors should be monitored.


Cardiovascular diseases Breast cancer Survivors Body mass index Waist circumference Body weight changes Breast neoplasms 



This study was funded by the National Cancer Institute, grant numbers R01 CA105274 (PI: Kushi LH), U01 CA195565 (PI: Kushi LH), and R01 CA129059 (B.J. Caan, PI).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Participants provided informed consent under human subjects’ protocols approved by the institutional review boards at KPNC.

Supplementary material

10549_2017_4133_MOESM1_ESM.pdf (134 kb)
Supplementary material 1 (PDF 133 kb)


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Elizabeth M. Cespedes Feliciano
    • 1
    Email author
  • Marilyn L. Kwan
    • 1
  • Lawrence H. Kushi
    • 1
  • Erin K. Weltzien
    • 1
  • Adrienne L. Castillo
    • 1
  • Bette J. Caan
    • 1
  1. 1.Division of ResearchKaiser Permanente Northern CaliforniaOaklandUSA

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