In a Republic of Korea nationwide cohort study reported as a research letter in JAMA Oncology, Jung et al found that weight increase following diagnosis of breast cancer was associated with increased risk of heart failure.
Study Details
The study used the National Health Insurance Service database of the Republic of Korea to identify women diagnosed with invasive breast cancer between January 2010 and December 2016 without diagnosis of heart failure before or within 1 year after cancer diagnosis. Weight change was determined from biennial health screenings before (0–2 years) and after (0.5–2.5 years) diagnosis of cancer.
Key Findings
The cohort included 43,717 women (mean age = 53.7), with mean prediagnosis body mass index (BMI) of 23.5 kg/m2 and mean postdiagnosis BMI of 23.3 kg/m2.
Of these, 6.1% of patients had > 10% weight loss, 15.7% had 5% to 10% weight loss, 63.9% maintained weight, 10.7% had 5% to 10% weight gain, and 3.5% had > 10% weight gain. Among patients with prediagnosis obesity, 77% maintained obesity. By weight change category, anthracycline use was highest (58.5%) among patients with > 10% weight loss.
In analysis adjusting for cardiovascular risk factors, cancer treatment, and sociodemographic factors, during mean follow-up of 4.67 ± 1.83 years, patients with 5% to 10% weight gain (adjusted HR = 1.59, 95% confidence interval [CI] = 1.16–2.17) and those with > 10% weight gain (adjusted HR = 1.85, 95% CI = 1.15–2.98) had significantly increased risk for heart failure compared with patients with maintained weight.
No significant associations of heart failure risk were observed among patients with 5% to 10% weight loss (adjusted HR = 0.97, 95% CI = 0.72–1.32) or > 10% weight loss (adjusted HR = 1.00, 95% CI = 0.64–1.56) compared with patients with maintained weight.
Patients with postdiagnosis sustained obesity had a numeric but not statistically significant increased risk of heart failure compared with those with sustained nonobesity (adjusted HR = 1.37, 95% = 0.91–2.07).
The investigators concluded: “In this nationwide cohort study in the Republic of Korea, postdiagnosis weight gain was associated with an increased risk of [heart failure] after [breast cancer] development, with risk escalating alongside greater weight gain. The findings underscore the importance of effective weight intervention in the oncological care of patients with [breast cancer], particularly within the first few years after diagnosis, to protect cardiovascular health.”
Dong Wook Shin, MD, DrPH, MBA, Samsung Medical Center, Samsung Advanced Institute for Health Science and Technology, Seoul, is the corresponding author for the JAMA Oncology article.
Disclosure: The study was supported by the Institution of Quality of Life in Cancer of Samsung Medical Center from the Samsung Fire and Marine Insurance and others. For full disclosures of the study authors, visit jamanetwork.com.
