Adiposity Distribution and Risk for Cardiovascular Disease Among Breast Cancer Survivors
In a study reported in the Journal of Clinical Oncology, Cespedes Feliciano et al found that increased visceral and intramuscular adiposity were associated with increased risk of cardiovascular disease among breast cancer survivors, independent of baseline risk factors and cancer treatment.
Study Details
The study involved data from 2,943 patients diagnosed from 2005 to 2013 with nonmetastatic stage I–III invasive breast cancer who had an abdominal computed tomography (CT) scan at diagnosis and no history of cardiovascular disease. Visceral, subcutaneous, and intramuscular adiposity was quantified from CT images and associations with incident cardiovascular disease was assessed; analysis was adjusted for demographics, smoking, preexisting cardiovascular disease risk factors (including diabetes, dyslipidemia, and hypertension), and receipt of chemotherapy or radiation. Patients had a mean age of 56 years at diagnosis.
Cardiovascular Disease Risk
Over median follow-up of 6 years, 328 cardiovascular disease events occurred. The cumulative incidence of cardiovascular disease reached 15% by year 10 of follow-up. Women in the highest tertiles of adiposity had the highest cumulative incidence of cardiovascular disease.
Each standard deviation (SD) increase in visceral adiposity (hazard ratio [HR] = 1.15, 95% confidence interval [CI] = 1.03–1.29) and in intramuscular adiposity (HR = 1.21, 95% CI = 1.06–1.37) was associated with increased risk of cardiovascular disease. The increase in risk for each SD increase in subcutaneous adiposity was not statistically significant (HR = 1.11, 95% CI = 0.99–1.25). Excess visceral and intramuscular adiposity was observed across all body mass index categories; for example, 2% of normal-weight and 11% of overweight patients were in the highest tertile of visceral adiposity and 10% of normal-weight and 15% of overweight patients were in the highest tertile of intramuscular adiposity. The HR for cardiovascular disease for each SD increase in visceral adiposity among normal-weight patients was 1.70 (95% CI = 1.10-2.62).
The investigators concluded: “Visceral and intramuscular adiposity were associated with increased cardiovascular disease incidence after breast cancer diagnosis, independent of preexisting cardiovascular disease risk factors and cancer treatments. The increased cardiovascular disease incidence among normal-weight patients with greater visceral adiposity would go undetected with body mass index alone. Measures of adipose tissue distribution may help identify high-risk patients and tailor cardiovascular disease prevention strategies.”
Elizabeth M. Cespedes Feliciano, ScM, ScD, of Kaiser Permanente Northern California, Oakland, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit jco.ascopubs.org.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
