TY - JOUR
T1 - Cardiometabolic risk factors and survival after breast cancer in the Women's Health Initiative
AU - Simon, Michael S.
AU - Beebe-Dimmer, Jennifer L.
AU - Hastert, Theresa A.
AU - Manson, Jo Ann E.
AU - Cespedes Feliciano, Elizabeth M.
AU - Neuhouser, Marian L.
AU - Ho, Gloria Y.F.
AU - Freudenheim, Jo L.
AU - Strickler, Howard
AU - Ruterbusch, Julie
AU - Barac, Ana
AU - Chlebowski, Rowan
AU - Caan, Bette
N1 - Funding Information:
We acknowledge the dedicated efforts of investigators and staff at the Women’s Health Initiative (WHI) clinical centers, the WHI Clinical Coordinating Center, the WHI Life and Longevity After Cancer Study (LILAC) funded by National Cancer Institute grant 1UM1CA173642, and the National Heart, Lung and Blood program office (http://www.whi.org). We also recognize the WHI participants for their extraordinary commitment to the WHI program. For a list of all the investigators who have contributed to WHI science, please visit: http://www.whiscience.org/publications/WHI_investigators_longlist.pdf
Funding Information:
The WHI program is funded by the National Heart, Lung, and Blood Institute (contracts N01WH22110, 24152, 32100-2, 32105-6, 32108-9, 32111-13, 32115, 32118-32119, 32122, 42107-26, 42129-32, and 44221); Cancer Center Support Grant NIH:NCI P30CA022453; and the Blue Cross Blue Shield Foundation of Michigan.
PY - 2018/4/15
Y1 - 2018/4/15
N2 - BACKGROUND: Few studies have examined the relationship between cardiometabolic risk factors linked to metabolic syndrome and mortality among women with breast cancer. METHODS: We used the Women's Health Initiative to evaluate the relationship between cardiometabolic risk factors, including waist circumference (WC), blood pressure, cholesterol level, and presence of type 2 diabetes, and their relation with death from breast cancer, cardiovascular disease (CVD), and other causes among 8641 women with local or regional stage invasive breast cancer. Cox proportional hazards models were used to estimate hazard ratios, and 95% confidence intervals, adjusted for important predictors of survival. RESULTS: After a median of 11.3 years, there were 2181 total deaths, 619 (28.4%) of which were due to breast cancer. Most participants (55.7%) had at least 2 cardiometabolic risk factors, and 4.9% had 3 or 4. Having a larger number of risk factors was associated with higher risk of CVD and other-cause mortality (P trend <.001 for both), but not with breast cancer mortality (P trend =.86). Increased WC was associated with a higher risk of CVD (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.05-1.57) and other-cause mortality (HR, 1.32; 95% CI, 1.16-1.49) and only with a small and nonsignificant higher risk of breast cancer mortality (HR, 1.19; 95% CI, 0.93-1.52). The results did not differ in analyses stratified by race, hormone receptor status, or after an analysis of cases diagnosed within 5 years after baseline. CONCLUSIONS: Among women with early stage breast cancer, cardiometabolic risk factors are significantly associated with cardiovascular and other-cause mortality, but not breast cancer mortality. Cancer 2018;124:1798-807.
AB - BACKGROUND: Few studies have examined the relationship between cardiometabolic risk factors linked to metabolic syndrome and mortality among women with breast cancer. METHODS: We used the Women's Health Initiative to evaluate the relationship between cardiometabolic risk factors, including waist circumference (WC), blood pressure, cholesterol level, and presence of type 2 diabetes, and their relation with death from breast cancer, cardiovascular disease (CVD), and other causes among 8641 women with local or regional stage invasive breast cancer. Cox proportional hazards models were used to estimate hazard ratios, and 95% confidence intervals, adjusted for important predictors of survival. RESULTS: After a median of 11.3 years, there were 2181 total deaths, 619 (28.4%) of which were due to breast cancer. Most participants (55.7%) had at least 2 cardiometabolic risk factors, and 4.9% had 3 or 4. Having a larger number of risk factors was associated with higher risk of CVD and other-cause mortality (P trend <.001 for both), but not with breast cancer mortality (P trend =.86). Increased WC was associated with a higher risk of CVD (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.05-1.57) and other-cause mortality (HR, 1.32; 95% CI, 1.16-1.49) and only with a small and nonsignificant higher risk of breast cancer mortality (HR, 1.19; 95% CI, 0.93-1.52). The results did not differ in analyses stratified by race, hormone receptor status, or after an analysis of cases diagnosed within 5 years after baseline. CONCLUSIONS: Among women with early stage breast cancer, cardiometabolic risk factors are significantly associated with cardiovascular and other-cause mortality, but not breast cancer mortality. Cancer 2018;124:1798-807.
KW - Women's Health Initiative
KW - breast cancer
KW - cardiometabolic risk factors
KW - survival
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U2 - 10.1002/cncr.31230
DO - 10.1002/cncr.31230
M3 - Article
C2 - 29338086
AN - SCOPUS:85045137122
VL - 124
SP - 1798
EP - 1807
JO - Cancer
JF - Cancer
SN - 0008-543X
IS - 8
ER -