Abstract P1-12-06: Endothelial dysfunction in breast cancer survivors on aromatase inhibitors (AIs) over time

Endothelial dysfunction in breast cancer survivors on aromatase inhibitors (AIs) over time

Background: AIs reduce breast cancer-related mortality however they may increase cardiovascular (CV) risk. Our previously published cross-sectional study suggested women on AIs were more likely to have endothelial dysfunction when measured by EndoPAT ratio as compared to healthy postmenopausal women. Reductions in EndoPAT ratio (<1.67) and small artery elasticity (SAE) and increases in highly sensitive C-reactive protein (CRP) are associated with worsening endothelial dysfunction and increased cardiovascular events. We present data from a longitudinal pilot study looking at endothelial dysfunction over time in women on AIs.

Methods: Fourteen women with locally advanced breast cancer prescribed an AI underwent vascular testing at baseline (pre-AI) and at 6 months. Subjects with tobacco use, hypertension or hyperlipidemia were excluded. Consented subjects underwent biomarker analysis and radial artery pulse wave analysis using the HDI/Pulse Wave CR-2000 CV Profiling System and pulse contour analysis using the Endo-PAT2000 system. Biomarkers were obtained using a fasting blood draw to evaluate the following lipids and inflammatory markers: serum ultrasensitive estradiol, serum glucose, total cholesterol (TC), low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglycerides (TG), CRP, plasminogen-activator 1 (PA1), and tissue-type plasminogen activator (tPA). Changes between baseline and follow-up using Wilcoxon signed-rank tests were analyzed.

Results: Mean baseline age was 59 years and median body mass index was 26.5 kg/m2. Median systolic blood pressure and total cholesterol were 120/70 mm/Hg and 228 mg/dL, respectively. Baseline ultrasensitive estradiol levels were 7 pg/mL and hsCRP was 2.45 mg/dL. Prior to AI therapy, endoPAT ratio was 2.18 (1.19, 2.43). After six months, EndoPAT ratio declined to a median 1.12 (0.85, 1.86) (p=0.045). There were no statistically significant changes in serum glucose, TC, LDL, HDL, hsCRP, PA1 and tPA. HsCRP remained elevatedat median 2.98 mg/L. At six months, estradiol levels decreased to a median of 2 pg/mL (p=0.052), however, there appeared to be no linear association between changes in EndoPAT and estradiol (p=0.91).

Conclusion: Breast cancer survivors on AIs have endothelial dysfunction, a predictor of adverse CV disease. These changes develop while on AIs. Underlying pathophysiology requires further evaluation.

Cardiovascular markersMeasuresBaselineFollow-Up at 6 MonthsChangeP-valueBMI (kg/m2)26.5 (24.4, 31.6)27.1 (23.9, 32.9)0.5 (0.0, 1.3)0.056SBP (mmHg)120 (115, 124)123 (114, 127)-0.8 (-7.4, 3.6)0.91DBP (mmHg)70 (61, 73)69 (62, 71)0.0 (-3.0, 2.6)0.88Total Cholesterol (mg/dL)228 (202, 244)213 (210, 229)-1 (-18, 27)0.70HDL (mg/dL)64 (58, 69)73 (61, 77)2 (-3, 14)0.44LDL (mg/dL)143 (121, 159)129 (120, 142)6 (-11, 14)0.65Estradiol (pg/mL)7 (4, 15)2 (2, 3)-8 (-12, -3)0.05hsCRP (mg/dL)2.45 (1.14, 6.07)2.98 (0.90, 4.81)-8 (-12, -3)0.85EndoPAT Ratio2.18 (1.19, 2.43)1.12 (0.85, 1.86)-0.16 (-1.45, -0.02)0.0451.Summaries shown are median (1st quartile, 3rd quartile).

Citation Format: Blaes AH, Petersen A, Beckwith H, Potter D, Florea N, Yee D, Vogel R, Duprez D. Endothelial dysfunction in breast cancer survivors on aromatase inhibitors (AIs) over time [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-06.

Unexpected redox behaviour of large surface alumina containing highly dispersed ceria nanoclusters

Cerium-containing oxide materials have several very interesting applications due to their capacity to store and release oxygen under oxidizing and reducing conditions respectively. In the case of pure ceria this property is highly size dependent inasmuch as the phenomenon is limited to the surface and subsurface oxygen atoms. As a consequence, the design of nanocrystals of ceria has been attracting much attention. In this paper, the evaporation-induced self-assembly method was used to prepare a series of mixed oxide materials composed of nanoclusters of ceria very well dispersed over large surface mesoporous alumina. We observed a total and reversible reduction of Ce4+ into Ce3+ at 400 °C for the materials with a Ce loading between 20 and 35 wt%. A combination of analyses including in situ X-ray diffraction, temperature-programmed reduction, oxygen storage capacity, isotopic exchange, 27-Al and 17-O solid state NMR, and X-ray absorption spectroscopy at the Ce L3-edge was employed to investigate this unexpected redox behavior. The results reveal that the strong structural disorder observed in both CeO2 and Al2O3 nanoclusters favors the formation of non-crystallized CeAlO3 pseudo phase at the interface between the two oxides.

Circulating oleic acid levels are related to greater risks of cardiovascular events and all-cause mortality: The Multi-Ethnic Study of Atherosclerosis

BACKGROUND

Limited evidence has suggested that circulating levels of the omega-9 fatty acid, oleic acid, may be related to greater risks of adverse cardiovascular outcomes.

OBJECTIVE

We aimed to determine whether plasma oleic acid may be independently associated with clinical and subclinical cardiovascular disease (CVD) and all-cause mortality in a large multiethnic cohort.

METHODS

Plasma fatty acids were measured by gas chromatography-flame ionization in 6568 participants of the Multi-Ethnic Study of Atherosclerosis. The presence of coronary artery calcium (CAC) and aortic valve calcification (AVC) was determined by computed tomography, and carotid plaque was assessed by ultrasound. Incident CVD was defined as myocardial infarction, fatal coronary heart disease, resuscitated cardiac arrest, stroke, or stroke death. Heart failure (HF) was adjudicated from clinical records. Relative risk regression estimated plasma oleic acid-related rate ratios for prevalent CAC, AVC, and carotid plaque. Cox regression estimated hazard ratios (HRs) for CVD, HF, and all-cause mortality over a median 13-year follow-up.

RESULTS

Individuals in top quartiles of oleic acid showed greater rate ratios of CAC, AVC, and carotid plaque (all P < .001), but associations were rendered nonsignificant after adjustment for other risk factors. By contrast, those in top quartiles of plasma oleic acid showed significantly greater risks of incident HF (HR: 2.03; P < .001), CVD (HR: 1.41; P = .008), and all-cause mortality (HR: 1.55; P < .001) than those in referent quartiles independent of typical risk factors as well as plasma omega-3 fatty acid levels.

CONCLUSIONS

Plasma oleic acid appears to be a risk factor for CVD events and all-cause mortality independent of typical risk factors and plasma omega-3 fatty acids. Additional studies are warranted for confirmation and to further examine whether plasma oleic acid directly contributes to, or serves as a marker of, disease pathogenesis. These findings should not be extrapolated to dietary oleic acid intake.

Lp(a) [Lipoprotein(a)]-Related Risk of Heart Failure Is Evident in Whites but Not in Other Racial/Ethnic Groups

Objective- Lp(a) [lipoprotein(a)] levels vary by race/ethnicity and were recently found to be associated with risk of heart failure (HF). We aimed to determine whether Lp(a)-related risk of HF is similar across different races and whether Lp(a) may further be related to HF with reduced ejection fraction or HF with preserved ejection fraction (HFpEF). Approach and Results- In 6809 participants of the MESA (Multi-Ethnic Study of Atherosclerosis), aged 45 to 84 years and free of cardiovascular disease, 308 incident HF events occurred during a median 13-year follow-up. Baseline Lp(a) concentrations were determined by immunoassay. Incident HF was adjudicated, distinguishing HF with reduced ejection fraction (ejection fraction, <45%) from HFpEF (ejection fraction, ≥45%). Cox regression assessed relations between Lp(a) and HF risk among 4 races/ethnicities. Lp(a) was examined as a continuous variable (per log unit) and using clinical cutoff values, 30 and 50 mg/dL. Lp(a) was related to greater risk of HF in whites alone: per log unit Lp(a) (hazard ratio [HR], 1.20; P=0.02); Lp(a) ≥30 mg/dL (HR, 1.69; P=0.01), Lp(a) ≥50 mg/dL (HR, 1.87; P=0.006). No significant relations were found in black, Hispanic, or Chinese participants, and significant race interactions were observed. Lp(a) was additionally related to greater risk of HFpEF in white participants: per log unit Lp(a) (HR, 1.48; P=0.001), Lp(a) ≥30 mg/dL (HR, 2.15; P=0.01), Lp(a) ≥50 mg/dL (HR, 2.60; P=0.004). Lp(a)-related risk of HF and HFpEF in whites was independent of aortic valve disease. Conclusions- In a multiethnic sample, Lp(a)-related risks of HF and HFpEF were only evident in white participants. If confirmed, these findings have implications in further Lp(a) research and clinical practice.

Sleep-disordered breathing and electrocardiographic QRS-T angle: The MESA study

INTRODUCTION

Sleep-disordered breathing (SDB) has been linked to sudden cardiac death (SCD) but the mechanism is unclear. Abnormal QRS-T angle, a novel electrocardiographic (ECG) marker of ventricular repolarization, has been linked to adverse cardiovascular outcomes including SCD. We hypothesized that individuals with SDB have more pronounced abnormality in QRS-T angle.

METHODS

We performed a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA) Exam Sleep ancillary study. We calculated the odds ratio (OR) of abnormal frontal and spatial QRS-T angle (defined as >sex-specific 95th percentile thresholds) related to the apnea-hypopnea index (AHI) using logistic regression, adjusting for demographics, body habitus, cardiovascular risks, and prevalent cardiovascular disease. Linear associations between AHI and frontal and spatial QRS-T angle, separately, were also examined using multiple regression models.

RESULTS

A total of 1,804 participants (mean age 67.9 (±9.0) years, 55.3% women and 64.1% non-whites) were included in the study. Sleep-disordered breathing was common among participants (median AHI 8.6 events/hr IQR [3.2-19.5/hr]). Higher AHI was associated with the odds of abnormal frontal (≥81° in men and ≥79° in women) and spatial QRS-T angle (≥129.7° in men and ≥115.9° in women; OR [95%CI]: 1.25 [1.02-1.51], p = 0.03; 1.23 [1.01-1.50], p = 0.04 respectively per 1 SD [16.8 events/hr] increase in AHI). Similarly, linear associations were observed (frontal QRS-T angle: beta coefficient: 2.30° [0.92, 3.66], p = 0.001; spatial QRS-T angle: beta coefficient: 2.16° [0.67, 3.64], p = 0.005).

CONCLUSION

In a racially/ethnically diverse community cohort, severity of SDB is associated with abnormal ventricular repolarization as measured by QRS-T angle.

Association between sleep disordered breathing and electrocardiographic markers of atrial abnormalities: the MESA study

Aims

Electrocardiographic (ECG) markers of left atrial (LA) abnormalities have been linked to increased risk of atrial fibrillation (AF). Sleep disordered breathing (SDB) has been associated with increased risk of AF. We aimed to examine the association of ECG markers of LA abnormalities with SDB.

Methods and results

1546 participants (mean age 67.2 years, 53.4% women, and 63.3% non-whites) from the Multi-Ethnic Study of Atherosclerosis Exam 5 Sleep ancillary study were included in this analysis. ECG markers of LA abnormalities (P wave terminal force in V1 (PTFV1), maximum P wave duration, PR interval and heart rate corrected PR interval) were measured from resting standard digital ECG tracings using standardized processing. Linear and logistic regression analyses were utilized to examine the cross-sectional associations of measures of SDB (apnea hypopnea index [AHI] and % time spent with oxygen saturation <90% [%SpO290]) with each ECG marker. In a multivariable analysis adjusting for demographics, cardiovascular risk factors, and comorbidities, AHI was associated with greater PTFV1 but not with other ECG markers of LA abnormalities. A 1-SD increase of AHI (16.6/hr) was associated with higher levels of PTFV1 (175.1 µV.ms, 95% confidence interval [95%CI] 75.4, 274.7) and higher odds of abnormally elevated PTFV1 (≥4000 µV.ms) (Odds Ratio: 1.21 [95%CI 1.05, 1.39]). No association was found between %SpO290 and ECG markers of LA abnormalities.

Conclusion

Severity of SDB, as measured by AHI, is associated with subclinical LA disease, as indicated by PTFV1. PTFV1 may be an important ECG marker linking SDB and AF.

Inflammation Associates With Impaired Small Arterial Elasticity Early in HIV Disease

We estimated small arterial elasticity and used linear regression to evaluate its association with inflammatory biomarkers among antiretroviral therapy–naïve, HIV-positive patients with high CD4+ counts. After adjustment, high-sensitivity C-reactive protein and interleukin-6 were inversely associated with small arterial elasticity. These data suggest that systemic inflammation may contribute to vascular dysfunction even in very early HIV disease.

Clinical importance of non-participation in a maximal graded exercise test on risk of non-fatal and fatal cardiovascular events and all-cause mortality: CARDIA study

While poor performance during a maximal graded exercise test (GXT) predicts cardiovascular events and premature mortality, the potential clinical importance of non-participation in a GXT, either for medical or non-medical reasons, is currently unknown. Data are from 4086 and 3547 Coronary Artery Risk Development in Young Adults (CARDIA) participants who attended the Year 7 (ages 25-37years) and/or 20 exams (ages 38-50years), respectively, which included a GXT. Cox proportional hazard models were used to examine the effect of GXT disposition (at Year 7 and 20, separately) on risk of non-fatal and fatal cardiovascular events and all-cause mortality obtained through 28years of follow-up. A GXT was not conducted or completed according to protocol in 12.9% and 19.1% of participants attending the Year 7 and 20 exams, respectively. After adjustment, participants who missed the Year 20 GXT for medical reasons had a higher risk of cardiovascular events [HR: 4.06 (95% CI: 1.43, 11.5)] and all-cause mortality [HR: 3.07 (95% CI: 1.11, 12.3)] compared to GXT completers; participants who missed at Year 20 for non-medical reasons also had higher risk of all-cause mortality [HR: 2.53 (95% CI: 1.61, 3.99)]. Findings suggest that non-participation in a GXT, regardless of medical or non-medical reason, to be an important predictor of excess risk of adverse health outcomes and premature mortality. Additional patient follow-up, including identification of potential targets for intervention (e.g., weight management and smoking cessation programs), should be conducted at the point of a missed GXT.

Towards new recommendations to reduce the burden of alcohol-induced hypertension in the European Union

BACKGROUND

Hazardous and harmful alcohol use and high blood pressure are central risk factors related to premature non-communicable disease (NCD) mortality worldwide. A reduction in the prevalence of both risk factors has been suggested as a route to reach the global NCD targets. This study aims to highlight that screening and interventions for hypertension and hazardous and harmful alcohol use in primary healthcare can contribute substantially to achieving the NCD targets.

METHODS

A consensus conference based on systematic reviews, meta-analyses, clinical guidelines, experimental studies, and statistical modelling which had been presented and discussed in five preparatory meetings, was undertaken. Specifically, we modelled changes in blood pressure distributions and potential lives saved for the five largest European countries if screening and appropriate intervention rates in primary healthcare settings were increased. Recommendations to handle alcohol-induced hypertension in primary healthcare settings were derived at the conference, and their degree of evidence was graded.

RESULTS

Screening and appropriate interventions for hazardous alcohol use and use disorders could lower blood pressure levels, but there is a lack in implementing these measures in European primary healthcare. Recommendations included (1) an increase in screening for hypertension (evidence grade: high), (2) an increase in screening and brief advice on hazardous and harmful drinking for people with newly detected hypertension by physicians, nurses, and other healthcare professionals (evidence grade: high), (3) the conduct of clinical management of less severe alcohol use disorders for incident people with hypertension in primary healthcare (evidence grade: moderate), and (4) screening for alcohol use in hypertension that is not well controlled (evidence grade: moderate). The first three measures were estimated to result in a decreased hypertension prevalence and hundreds of saved lives annually in the examined countries.

CONCLUSIONS

The implementation of the outlined recommendations could contribute to reducing the burden associated with hypertension and hazardous and harmful alcohol use and thus to achievement of the NCD targets. Implementation should be conducted in controlled settings with evaluation, including, but not limited to, economic evaluation.

Vascular function in breast cancer survivors on aromatase inhibitors: a pilot study

PURPOSE

Aromatase inhibitors (AI) have been shown to reduce breast cancer-related mortality in women with estrogen positive (ER+) breast cancer. The use of AIs, however, has been associated with higher rates of hypertension, hyperlipidemia, and cardiovascular (CV) events.

METHODS

A cross-sectional study of 25 healthy postmenopausal women and 36 women with curative intent breast cancer on an AI was performed to assess endothelial dysfunction, an indicator of risk for CV events. Consented subjects underwent vascular testing using the HDI/Pulse Wave CR-2000 Cardiovascular Profiling System and the EndoPAT2000 system.

RESULTS

Mean age was 61.7 and 59.6 years (cases, controls). Most subjects were Caucasian and overweight. Controls had a lower mean systolic blood pressure (128.6 mmHg vs. 116.2 mmHg, p = 0.004). Median estradiol levels were reduced in cases (2 vs. 15 pg/ml, p < 0.0001). EndoPAT ratio (0.8 vs. 2.7, p < 0.0001) was significantly reduced in cases as compared to controls. Median large artery elasticity (12.9 vs. 14.6 ml/mmHg × 10, p = 0.12) and small artery elasticity (5.2 vs. 7.0 ml/mmHg × 100, p = 0.07) were also reduced though not statistically significant. There was no correlation between use of chemotherapy, radiation therapy, type of AI, or duration of AI use and endothelial function. When adjusting for differences in blood pressure, results remained significant.

CONCLUSION

Breast cancer cases on AIs have reductions in endothelial function, a predictor of adverse CV disease.

IMPACT

Vascular function changes in breast cancer cases on AIs compared to postmenopausal women. Further work is needed to evaluate vascular changes over time.

Rapid decline in lung function in healthy adults predicts incident excess urinary albumin excretion later in life

Introduction

Chronic lung disease, often characterised by rapid decline in lung function, is associated with vascular endothelial dysfunction (characterised by moderate to severe excess urinary albumin excretion (eUAE) but their longitudinal relationship is inadequately studied. In a bidirectional longitudinal examination of healthy adults, we analysed the following two hypotheses: (1) rapid decline (ie, highest tertile of lung function decline) predicts eUAE and (2) eUAE predicts rapid decline.

Methods

We performed a secondary data analysis from 3052 eligible participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study. For analysis 1, the predictor was rapid decline in lung function between the peak value (attained at or before CARDIA visit year 10 or Y10 at a mean age of 35 years) and Y20; and the outcome was incident eUAE at Y20 and/or Y25. For analysis 2, the predictor was eUAE at Y10 and the outcome was rapid decline between Y10 and Y20.

Results

After adjustment for covariates in analysis 1, rapid decline in FEV₁ or FVC between peak and Y20 predicted incident eUAE at Y20 and/or Y25 (OR 1.51 and 1.44, respectively; p≤0.05 for both analyses). In analysis 2, eUAE at Y10 did not predict subsequent rapid decline.

Conclusions

Healthy adults with rapid decline in lung function are at risk for developing vascular endothelial dysfunction, as assessed by incident eUAE, later in life.