Prospective study of risk factors for cardiovascular disease in breast cancer survivors using aromatase inhibitors

Background: The increased risk for the occurrence of cardiovascular diseases in breast cancer (BC) survivors has been widely discussed in the literature and occurs due to the cardiotoxicity of antineoplastic treatments and also to the common risk factors between these diseases. Objectives: To evaluate the risk factors for cardiovascular diseases (anthracycline chemotherapy, radiotherapy, diabetes mellitus, hypertension, inadequate diet, excess body weight, abdominal adiposity, alcoholism, smoking, physical inactivity and altered lipid profile) in BC women surviving in use of endocrine therapy with Aromatase Inhibitors (AI). Material and methods: A prospective study was conducted with a follow-up time of 24 months and evaluations in three stages, called T0, the initial follow-up period; T1, intermediate period, corresponding to 12 months after T0; and T2, the final follow-up period, corresponding to 24 months after T0. Treatments and BC clinical data were obtained through the analysis of medical records. Questionnaires containing information on sociodemographic data, comorbidities, smoking, alcoholism, physical inactivity, food consumption and anthropometric variables were collected in the three periods. Food consumption was assessed using three 24-hour food records at each time, and its qualitative analysis was performed by calculating the Revised Diet Quality Index (IQDR). For the evaluation of biomarkers related to cardiovascular risk (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), non-HDL cholesterol and triglycerides), samples of venous blood were collected. Results: Most women underwent cardiotoxic treatments such as anthracycline chemotherapy (60.9%) and radiotherapy (84.3%). We verify a predominance of inadequacy of the IQD-R food groups, except for oils, in addition to inadequate consumption of total, saturated, monounsaturated fats and fibers in the three periods. We found that the Body Mass Index did not change over the three times, but there was a predominance of inadequacy (T0 = 60.7%; T1 = 64.6%; T2 = 65.8%). There was an increase in waist circumference and waist-height ratio (p = 0.027 and p = 0.029) between T0 and T1, with inadequacy at all times. As for biochemical data, there was a reduction in total cholesterol (p = 0.013), LDL (p = 0.010) and non-HDL cholesterol (p = 0.004) from T1 to T2. There was a high percentage of systemic arterial hypertension (T0 = 56.2%; T1 = 58.5%; T2 = 55.3%) and physical inactivity (T0 = 59.6; T1 = 47.7%; T2 = 57.9%) throughout the study. There were no alcoholic women in the three periods of the study. As for the number of risk factors, most women had between 6 and 10 risk factors for CVDs. Conclusion: Despite showing improvement in the lipid profile and not being alcoholics, most BC survivors using AI had a worrying amount of CVD risk factors at all times in the study. Thus, we suggest the necessity to carry out interventions in this population aiming at food reeducation and encouraging regular physical activity.FAPEMIG - Fundação de Amparo a Pesquisa do Estado de Minas GeraisDissertação (Mestrado)Introdução: O risco aumentado para a ocorrência de doenças cardiovasculares (DCVs) em sobreviventes ao câncer de mama (CM) tem sido bastante discutido na literatura e ocorre devido à cardiotoxicidade dos tratamentos antineoplásicos e, também, aos fatores de risco comuns entre essas doenças. Objetivos: Avaliar fatores de risco para DCVs (quimioterapia com antraciclina, radioterapia, diabetes mellitus, hipertensão arterial, dieta inadequada, excesso de peso corporal, adiposidade abdominal, alcoolismo, tabagismo, sedentarismo e perfil lipídico alterado) em mulheres sobreviventes ao CM em uso de terapia endócrina com Inibidores de Aromatase (IA). Material e métodos: Trata-se de um estudo prospectivo, com tempo de seguimento de 24 meses e avaliações em três tempos, denominados T0, período inicial do seguimento; T1, período intermediário, correspondendo a 12 meses após T0; e T2, período final do seguimento, correspondendo a 24 meses após T0. Os tratamentos e dados clínicos do CM foram obtidos por meio da análise dos prontuários. Questionários contendo informações sobre dados sociodemográficos, comorbidades, tabagismo, etilismo, sedentarismo, consumo alimentar e variáveis antropométricas foram coletados nos três tempos. O consumo alimentar foi avaliado por meio de três recordatórios alimentares de 24 horas em cada tempo, e sua análise qualitativa foi realizada pelo cálculo do Índice de Qualidade da Dieta Revisado (IQD-R). Para a realização da avaliação de biomarcadores relacionados ao risco cardiovascular (colesterol total, lipoproteína de baixa densidade (LDL), lipoproteína de alta densidade (HDL), colesterol não-HDL e triglicérides), amostras de sangue venoso foram coletados. Resultados: A maioria das mulheres foram submetidas a tratamentos cardiotóxicos como quimioterapia com antraciclina (60,9%) e radioterapia (84,3%). Observou-se predomínio de inadequação dos grupos alimentares do IQD-R, exceto grupo de óleos, além de consumo inadequado de gorduras totais, saturadas, monoinsaturadas e fibras nos três tempos. Verificamos que o Índice de Massa Corporal não alterou ao longo dos três tempos, mas houve predomínio de inadequação (T0 = 60,7%; T1 = 64,6%; T2 = 65,8%). Observou-se aumento da circunferência da cintura e relação cintura-estatura (p=0,027 e p=0,029) entre T0 e T1, com inadequação em todos os tempos. Quanto aos dados bioquímicos, houve redução do colesterol total (p=0,013), LDL (p=0,010) e colesterol não-HDL (p=0,004) de T1 para T2. Observou-se alta porcentagem de hipertensão arterial sistêmica (HAS) (T0 = 56,2%; T1 = 58,5%; T2 = 55,3%) e sedentarismo (T0 = 59,6; T1 = 47,7%; T2 = 57,9%) ao longo do estudo. Não houve mulheres etilistas nos três tempos do estudo. Quanto à quantidade de fatores de risco, foi visto que a maioria das mulheres apresentou entre 6 a 10 fatores de risco para DCVs. Conclusão: Apesar de apresentarem melhora do perfil lipídico e não serem etilistas, a maioria das mulheres apresentou uma quantidade preocupante de fatores de risco para DCVs em todos os tempos do estudo. Assim, sugerimos a necessidade da realização de intervenções nesta população objetivando a reeducação alimentar e incentivo à prática regular de atividade física

Temporal influence of endocrine therapy with tamoxifen and chemotherapy on nutritional risk and obesity in breast cancer patients

Abstract Background The effect of endocrine therapy with tamoxifen (TMX) on weight gain has been reported in the literature, but the outcomes are still controversial. Moreover, previous treatment options, such as chemotherapy (CT), also include body changes. The focus of this study was to verify the temporal influence of endocrine therapy with TMX on nutritional risk and obesity and its association with CT in breast cancer patients. Methods In this cross-sectional study, 84 breast cancer surviving women were evaluated during endocrine therapy with TMX. Anthropometric, biochemical and body composition parameters were measured. A generalized estimating equation (GEE) was used to examine the association between CT and groups of women using TMX categorized by the duration of the treatment (group 1, women using TMX for the first 3 years; group 2, women using TMX between 3 and 4 years and group 3, women using TMX for more than 4 years). Results The interaction of CT with duration of TMX use showed a significant effect on Body Mass Index (BMI), waist circumference (WC) and body fat percentage (BFP) (GEE p-value = 0.002, 0.000, 0.000, respectively). Women from group 1 who underwent CT presented higher values of body variables compared to those women from group 2 who also underwent CT (BMI = 29.14 ± 0.93, 26.76 ± 0.85 kg/m2; WC = 94.45 ± 1.96, 91.07 ± 2.44 cm; BFP = 36.36 ± 1.50, 33.43 ± 1.66%, respectively). On the other hand, women from group 1 who did not undergo CT presented lower values of body variables compared to those women from group 2 who also did not undergo CT (BMI = 25.29 ± 0.46, 28.40 ± 0.95 kg/m2; WC = 85.84 ± 0.90, 97.75 ± 0.88 cm; BFP = 30.32 ± 0.43; 42.95 ± 1.03%, respectively). Conclusions Women on endocrine therapy with TMX are mostly overweighed and obese, most evidently in women who received CT, and who were at the beginning of treatment. Women that did not undergo CT, despite presenting lower values of body variables in the first 3 years, still deserve special attention because significantly higher values were observed in women between 3 and 4 years of therapy