Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype
To investigate the association between metabolic syndrome (MetS) and risk of breast cancer mortality by menopausal status, obesity, and subtype.
Data from 94,555 women free of cancer at baseline in the National Institute of Health-American Association of Retired Persons Diet and Health Study cohort (NIH-AARP) were used to investigate the prospective associations of baseline MetS and components with risk of breast cancer mortality using Cox proportional hazard regression models adjusted for baseline behavioral and demographic covariates.
During a mean follow-up duration of 14 years, 607 women in the cohort died of breast cancer. Overall, MetS was associated with a 73% increased risk of breast cancer mortality (HR 1.73; 95% CI 1.09–2.75); the association remained significant among post-menopausal women overall (HR 2.07, 95% CI 1.32, 3.25), and among those with overweight/obesity (HR 1.15, 95% CI 0.81, 1.64). MetS was associated with increased risk of breast cancer mortality for ER+/PR+ (HR 1.28, 95% CI 0.52, 3.16) and lower risk for ER−/PR− (HR 0.44, 95% CI 0.11, 1.75) subtypes; however, the associations were not statistically significant. Of the individual MetS components, high waist circumference (HR 1.32, 95% CI 1.03, 1.70), high cholesterol (HR 1.24, 95% CI 1.05, 1.46), and hypertension (HR 1.24, 95% CI 1.05, 1.46) were independently associated with increased risk of breast cancer mortality.
MetS was associated with increased risk of breast cancer mortality, especially among post-menopausal women. Further studies with larger sample sizes are needed to definitively determine the extent to which these associations vary by breast cancer subtype.
KeywordsMetabolic syndrome Breast cancer mortality Menopause Obesity Hormone-receptor subtypes
We thank the participants in the NIH-AARP Diet and Health Study for their cooperation, and David Campbell and Jane Wang at Information management Services (Silver Spring, MD) for data support.
TA conceived and designed the study and oversaw statistical analysis and manuscript writing. DTD, KO, TA, and DB contributed to statistical analysis, drafting of the results, and critical review of the manuscript. All authors substantially contributed to the manuscript.
TA was funded by Grant K01TW010271 by the NIH. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
The Special Studies Institutional Review Board (IRB) of the U.S. National Cancer Institute approved the NIH-AARP Diet and Health Study (Protocol Number: OH95CN025).
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