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Rillamas-Sun E, Kwan ML, Iribarren C, Cheng R, Neugebauer R, Rana JS, Nguyen-Huynh M, Shi Z, Laurent CA, Lee VS, Roh JM, Huang Y, Shen H, Hershman DL, Kushi LH, Greenlee H. Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer. Breast Cancer Res Treat 2023; 201:117-126. [PMID: 37326764 PMCID: PMC10498727 DOI: 10.1007/s10549-023-06997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/26/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Studies comparing the effect of aromatase inhibitor (AI) and tamoxifen use on cardiovascular disease (CVD) risk factors in hormone receptor-positive breast cancer (BC) survivors report conflicting results. We examined associations of endocrine therapy use with incident diabetes, dyslipidemia, and hypertension. METHODS The Pathways Heart Study examines cancer treatment exposures with CVD-related outcomes in Kaiser Permanente Northern California members with BC. Electronic health records provided sociodemographic and health characteristics, BC treatment, and CVD risk factor data. Hazard ratios (HR) and 95% confidence intervals (CI) of incident diabetes, dyslipidemia, and hypertension in hormone receptor-positive BC survivors using AIs or tamoxifen compared with survivors not using endocrine therapy were estimated using Cox proportional hazards regression models adjusted for known confounders. RESULTS In 8985 BC survivors, mean baseline age and follow-up time was 63.3 and 7.8 years, respectively; 83.6% were postmenopausal. By treatment, 77.0% used AIs, 19.6% used tamoxifen, and 16.0% used neither. Postmenopausal women who used tamoxifen had an increased rate (HR 1.43, 95% CI 1.06-1.92) of developing hypertension relative to those who did not use endocrine therapy. Tamoxifen use was not associated with incident diabetes, dyslipidemia, or hypertension in premenopausal BC survivors. Postmenopausal AI users had higher hazard rates of developing diabetes (HR 1.37, 95% CI 1.05-1.80), dyslipidemia (HR 1.58, 95% CI 1.29-1.92), and hypertension (HR 1.50, 95% CI 1.24-1.82) compared with non-endocrine therapy users. CONCLUSION Hormone receptor-positive BC survivors treated with AIs may have higher rates of developing diabetes, dyslipidemia, and hypertension over an average 7.8 years post-diagnosis.
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Affiliation(s)
- Eileen Rillamas-Sun
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N. M4-B402, Seattle, WA, 98109, USA
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Carlos Iribarren
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Richard Cheng
- University of Washington School of Medicine, Seattle, WA, USA
- Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Romain Neugebauer
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Jamal S Rana
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Northern California, Oakland Medical Center, Oakland, CA, USA
| | - Mai Nguyen-Huynh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Kaiser Permanente Northern California, Walnut Creek Medical Center, Oakland, CA, USA
| | - Zaixing Shi
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N. M4-B402, Seattle, WA, 98109, USA
- School of Public Health, Xiamen University, Xiamen, China
| | - Cecile A Laurent
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Valerie S Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Janise M Roh
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Yuhan Huang
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N. M4-B402, Seattle, WA, 98109, USA
| | - Hanjie Shen
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N. M4-B402, Seattle, WA, 98109, USA
| | - Dawn L Hershman
- Columbia University Irving Medical Center, Herbert Irving Comprehensive Cancer Center, New York, NY, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Heather Greenlee
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Ave N. M4-B402, Seattle, WA, 98109, USA.
- University of Washington School of Medicine, Seattle, WA, USA.
- Seattle Cancer Care Alliance, Seattle, WA, USA.
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Rillamas-Sun E, Kwan ML, Iribarren C, Cheng R, Neugebauer R, Rana JS, Nguyen-Huynh M, Shi Z, Laurent CA, Lee VS, Roh JM, Huang Y, Shen H, Hershman DL, Kushi LH, Greenlee H. Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer. RESEARCH SQUARE 2023:rs.3.rs-2675372. [PMID: 36993531 PMCID: PMC10055634 DOI: 10.21203/rs.3.rs-2675372/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
PURPOSE Studies comparing the effect of aromatase inhibitor (AI) and tamoxifen use on cardiovascular disease (CVD) risk factors in hormone-receptor positive breast cancer (BC) survivors report conflicting results. We examined associations of endocrine therapy use with incident diabetes, dyslipidemia, and hypertension. METHODS The Pathways Heart Study examines cancer treatment exposures with CVD-related outcomes in Kaiser Permanente Northern California members with BC. Electronic health records provided sociodemographic and health characteristics, BC treatment, and CVD risk factor data. Hazard ratios (HR) and 95% confidence intervals (CI) of incident diabetes, dyslipidemia, and hypertension in hormone-receptor positive BC survivors using AIs or tamoxifen compared with survivors not using endocrine therapy were estimated using Cox proportional hazards regression models adjusted for known confounders. RESULTS In 8,985 BC survivors, mean baseline age and follow-up time was 63.3 and 7.8 years, respectively; 83.6% were postmenopausal. By treatment, 77.0% used AIs, 19.6% used tamoxifen, and 16.0% used neither. Postmenopausal women who used tamoxifen had an increased rate (HR: 1.43, 95% CI: 1.06-1.92) of developing hypertension relative to those who did not use endocrine therapy. Tamoxifen use was not associated with incident diabetes, dyslipidemia, or hypertension in premenopausal BC survivors. Postmenopausal AI users had higher hazard rates of developing diabetes (HR: 1.37, 95% CI: 1.05-1.80), dyslipidemia (HR: 1.58, 95% CI: 1.29-1.92) and hypertension (HR: 1.50, 95% CI: 1.24-1.82) compared with non-endocrine therapy users. CONCLUSION Hormone-receptor positive BC survivors treated with AIs may have higher rates of developing diabetes, dyslipidemia, and hypertension over an average 7.8 years post-diagnosis.
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Jones DH, Nestore M, Henophy S, Cousin J, Comtois AS. Increased cardiovascular risk factors in breast cancer survivors identified by routine measurements of body composition, resting heart rate and arterial blood pressure. SPRINGERPLUS 2014; 3:150. [PMID: 24790808 PMCID: PMC4002997 DOI: 10.1186/2193-1801-3-150] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 03/11/2014] [Indexed: 12/05/2022]
Abstract
Purpose The main objective of this prospective study was to obtain a better understanding of the body composition and vital sign measures of cancers survivors (CS) when compared to regular (R) patients. Methods A total of 9,315 female patients were evaluated: 476 CS and 8,839 R patients. Kinesiologists worked side by side with the medical/oncology team to collect a number of base-line measurements on body composition, resting heart rate, and blood pressure as part of the standard intake evaluation during the female patients’ annual checkup. Results CS were more likely to have a higher BMI (P = 0.001) and a larger waist circumference (P = 0.001) than R patients. CS were also shown to have higher blood pressure values: diastolic pressure of 76.9 mmHg ± 10.5 VS 75.5 mmHg ± 9.9, (P = 0.01) and systolic pressure of 129.8 mmHg ± 17.2 VS 126.7 mmHg ±17.4 (P = 0.001) compared to R patients, respectively. Regression analysis looking at the relationship between mean arterial pressure and waist circumference did not show any difference between the two groups (CS vs R). Conclusion CS who had a higher BMI, a larger waist circumference and higher blood pressure levels, are probably at greater risk for developing cardiovascular disease, diabetes, various musculoskeletal problems as well as an increased risk for various forms of cancers including reoccurrence of previously treated cancer when compared to R patients. Changes in body composition should be considered by the medical team when looking at preventative healthcare strategies for their CS patients.
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Affiliation(s)
- David H Jones
- Department of Biological Sciences, University of Quebec in Montreal, Montreal, QC H3C 3P8 Canada ; Department of Exercise Science, The Richard J. Renaud Science Complex, Concordia University, Montreal, QC H4B 1R6 Canada ; Integrative Health & Wellness, VM Medical Centre, Montreal, QC H3G 1L5 Canada
| | - Melisa Nestore
- Integrative Health & Wellness, VM Medical Centre, Montreal, QC H3G 1L5 Canada
| | - Sara Henophy
- Integrative Health & Wellness, VM Medical Centre, Montreal, QC H3G 1L5 Canada
| | - Julia Cousin
- Integrative Health & Wellness, VM Medical Centre, Montreal, QC H3G 1L5 Canada
| | - Alain Steve Comtois
- Department of Kinanthropology, University of Quebec in Montreal, Montreal, QC H3C 3P8 Canada
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Raison D, Coquard C, Hochane M, Steger J, Massfelder T, Moulin B, Karaplis AC, Metzger D, Chambon P, Helwig JJ, Barthelmebs M. Knockdown of parathyroid hormone related protein in smooth muscle cells alters renal hemodynamics but not blood pressure. Am J Physiol Renal Physiol 2013; 305:F333-42. [PMID: 23720345 DOI: 10.1152/ajprenal.00503.2012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parathyroid hormone-related protein (PTHrP) belongs to vasoactive factors that regulate blood pressure and renal hemodynamics both by reducing vascular tone and raising renin release. PTHrP is expressed in systemic and renal vasculature. Here, we wanted to assess the contribution of vascular smooth muscle cell endogenous PTHrP to the regulation of cardiovascular and renal functions. We generated a mouse strain (SMA-CreERT2/PTHrPL2/L2 or premutant PTHrPSM-/-), which allows temporally controlled, smooth muscle-targeted PTHrP knockdown in adult mice. Tamoxifen treatment induced efficient recombination of PTHrP-floxed alleles and decreased PTHrP expression in vascular and visceral smooth muscle cells of PTHrPSM-/- mice. Blood pressure remained unchanged in PTHrPSM-/- mice, but plasma renin concentration and creatinine clearance were reduced. Renal hemodynamics were further analyzed during clearance measurements in anesthetized mice. Conditional knockdown of PTHrP decreased renal plasma flow and glomerular filtration rate with concomitant reduction in filtration fraction. Similar measurements were repeated during acute saline volume expansion. Saline volume expansion induced a rise in renal plasma flow and reduced filtration fraction; both were blunted in PTHrPSM-/- mice leading to impaired diuresis. These findings show that endogenous vascular smooth muscle PTHrP controls renal hemodynamics under basal conditions, and it is an essential factor in renal vasodilation elicited by saline volume expansion.
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Affiliation(s)
- Denis Raison
- Institut National de la Santé et de la Recherche Médicale (INSERM), U682, Equipe Cancer du rein et Physiopathologie rénale, Faculté de Médecine, Strasbourg, France
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