Michael S Simon1,2, Theresa A Hastert1,2, Ana Barac3, Hailey R Banack4, Bette J Caan5, Rowan T Chlebowski6, Randi Foraker7, Gayane Hovsepyan8, Simin Liu9, Juhua Luo10, JoAnn E Manson11, Marian L Neuhouser12, Tochukwu M Okwuosa13, Kathy Pan6, Lihong Qi14, Julie J Ruterbusch1,2, Aladdin H Shadyab15, Cynthia A Thomson16, Jean Wactawski-Wende4, Nida Waheed17, Jennifer L Beebe-Dimmer1,2. 1. Department of Oncology, Barbara Ann Karmanos Cancer Institute at Wayne State University, Detroit, Michigan. 2. Population Studies and Disparities Research Program, Barbara Ann Karmanos Cancer Institute at Wayne State University, Detroit, Michigan. 3. MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Georgetown University, Washington, DC. 4. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, New York. 5. Division of Research, Kaiser Permanente Medical Program of Northern California, Oakland, California. 6. Lundquist Institute for Biomedical Innovation, Harbor-UCLA Medical Center, Torrance, California. 7. Institute for Informatics, School of Medicine, Washington University in St. Louis, St. Louis, Missouri. 8. Wayne State University School of Medicine, Detroit, Michigan. 9. Department of Epidemiology, Brown University, Providence, Rhode Island. 10. Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, Indiana. 11. Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 12. Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington. 13. Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois. 14. Department of Public Health Sciences, University of California Davis School of Medicine, Davis, California. 15. Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, California. 16. Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health and Arizona Cancer Center, University of Arizona, Tucson, Arizona. 17. Department of Medicine, University of Florida, Gainesville, Florida.
Abstract
BACKGROUND: Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer. METHODS: This study examined the association between prediagnosis cardiovascular health and total and cause-specific mortality among 12,076 postmenopausal women who developed local- or regional-stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity-related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non-Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival. RESULTS: After a median follow-up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all-cause mortality (HR, 1.99; 95% CI, 1.73-2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88-5.57), cancer-specific mortality (HR, 1.37; 95% CI, 1.1-1.72), and other-cause mortality (HR, 2.14; 95% CI, 1.70-2.69). A higher waist circumference was associated with greater all-cause mortality (HR, 1.17; 95% CI, 1.06-1.30) and cancer-specific mortality (HR, 1.22; 95% CI, 1.04-1.42). CONCLUSIONS: Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all-cause, CVD, cancer-specific, and other-cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation. LAY SUMMARY: This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country. The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors. It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.
BACKGROUND: Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer. METHODS: This study examined the association between prediagnosis cardiovascular health and total and cause-specific mortality among 12,076 postmenopausal women who developed local- or regional-stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity-related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non-Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival. RESULTS: After a median follow-up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all-cause mortality (HR, 1.99; 95% CI, 1.73-2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88-5.57), cancer-specific mortality (HR, 1.37; 95% CI, 1.1-1.72), and other-cause mortality (HR, 2.14; 95% CI, 1.70-2.69). A higher waist circumference was associated with greater all-cause mortality (HR, 1.17; 95% CI, 1.06-1.30) and cancer-specific mortality (HR, 1.22; 95% CI, 1.04-1.42). CONCLUSIONS: Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all-cause, CVD, cancer-specific, and other-cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation. LAY SUMMARY: This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country. The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors. It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer.
Authors: G Sofia Martinez; Kellee White; Dahai Yue; Luisa Franzini; Craig S Fryer; Ninet Sinaii; Dylan H Roby Journal: BMC Health Serv Res Date: 2022-03-14 Impact factor: 2.655
Authors: Lauren McVicker; Christopher R Cardwell; Lauren Edge; W Glenn McCluggage; Declan Quinn; James Wylie; Úna C McMenamin Journal: BMC Cancer Date: 2022-04-20 Impact factor: 4.638
Authors: Giorgio Bogani; Isabelle Ray-Coquard; Nicole Concin; Natalie Y L Ngoi; Philippe Morice; Takayuki Enomoto; Kazuhiro Takehara; Hannelore Denys; Remi A Nout; Domenica Lorusso; Michelle M Vaughan; Marta Bini; Masashi Takano; Diane Provencher; Alice Indini; Satoru Sagae; Pauline Wimberger; Robert Póka; Yakir Segev; Se Ik Kim; Francisco J Candido Dos Reis; Salvatore Lopez; Andrea Mariani; Mario M Leitao; Francesco Raspagliesi; Pieluigi Benedetti Panici; Violante Di Donato; Ludovico Muzii; Nicoletta Colombo; Giovanni Scambia; Sandro Pignata; Bradley J Monk Journal: Gynecol Oncol Date: 2021-04-30 Impact factor: 5.304