Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors
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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.
KeywordsCardiovascular 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.
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.
- 4.Foraker RE, Abdel-Rasoul M, Kuller LH, Jackson RD, Van Horn L, Seguin RA, Safford MM, Wallace RB, Kucharska-Newton AM, Robinson JG, Martin LW, Agha G, Hou L, Allen NB, Tindle HA (2016) Cardiovascular health and incident cardiovascular disease and cancer: the women’s health initiative. Am J Prev Med 50(2):236–240. doi: 10.1016/j.amepre.2015.07.039 CrossRefPubMedGoogle Scholar
- 5.Poirier P, Giles TD, Bray GA, Hong Y, Stern JS, Pi-Sunyer FX, Eckel RH (2006) Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss an update of the 1997 American Heart Association Scientific statement on obesity and heart disease from the obesity committee of the council on nutrition, physical activity, and metabolism. Circulation 113(6):898–918CrossRefPubMedGoogle Scholar
- 7.Caan BJ, Kwan ML, Hartzell G, Castillo A, Slattery ML, Sternfeld B, Weltzien E (2008) Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control 19(10):1319–1328. doi: 10.1007/s10552-008-9203-0 CrossRefPubMedPubMedCentralGoogle Scholar
- 8.Caan BJ, Kwan ML, Shu XO, Pierce JP, Patterson RE, Nechuta SJ, Poole EM, Kroenke CH, Weltzien EK, Flatt SW, Quesenberry CP Jr, Holmes MD, Chen WY (2012) Weight change and survival after breast cancer in the after breast cancer pooling project. Cancer Epidemiol Biomark Prev 21(8):1260–1271. doi: 10.1158/1055-9965.epi-12-0306 CrossRefGoogle Scholar
- 11.Nichols HB, Trentham-Dietz A, Egan KM, Titus-Ernstoff L, Holmes MD, Bersch AJ, Holick CN, Hampton JM, Stampfer MJ, Willett WC, Newcomb PA (2009) Body mass index before and after breast cancer diagnosis: associations with all-cause, breast cancer, and cardiovascular disease mortality. Cancer Epidemiol Biomark Prev 18(5):1403–1409. doi: 10.1158/1055-9965.epi-08-1094 CrossRefGoogle Scholar
- 13.Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life after cancer epidemiology (LACE) study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16:545–556Google Scholar
- 14.Kwan ML, Ambrosone CB, Lee MM, et al (2008) The pathways study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control 19:1065–1076Google Scholar
- 17.Kohl M, Heinze G (2013) PSHREG: a SAS macro for proportional and nonproportional substribution hazards regression with competing risk data. Vienna, AustriaGoogle Scholar
- 18.Lin G, So Y, Johnston G (2012) Analyzing survival data with competing risks using SAS® software. In: SAS Global Forum. CiteseerGoogle Scholar
- 25.NCIC Clinical Trials Group (2015) Alliance for clinical trials in oncology. MAC20 (ALLIANCE A011401) randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early breast cancer. https://www.ctg.queensu.ca/public/all-disease-sites