Cardiovascular risk in middle-aged breast cancer survivors: a comparison between two risk models

Abstract

PURPOSE: It was to assess the risk of cardiovascular disease (CVD) in breast cancer survivors (BCS). METHODS:This cross-sectional study analyzed 67 BCS, aged 45-65 years, who underwent complete oncological treatment, but had not received hormone therapy, tamoxifen or aromatase inhibitors during the previous 6 months. Lipid profile and CVD risk were evaluated, the latter using the Framingham and Systematic COronary Risk Evaluation (SCORE) models. The agreement between cardiovascular risk models was analyzed by calculating a kappa coefficient and its 95% confidence interval (CI). RESULTS: Mean subject age was 53.2±6.0 years, with rates of obesity, hypertension, and dyslipidemia of 25, 34 and 90%, respectively. The most frequent lipid abnormalities were high total cholesterol (70%), high LDL-C (51%) and high non-HDL-C (48%) concentrations. Based on the Framingham score, 22% of the participants had a high risk for coronary artery disease. According to the SCORE model, 100 and 93% of the participants were at low risk for fatal CVD in populations at low and high risk, respectively, for CVD. The agreement between the Framingham and SCORE risk models was poor (kappa: 0.1; 95%CI 0.01-0.2) for populations at high risk for CVD. CONCLUSIONS: These findings indicate the need to include lipid profile and CVD risk assessment in the follow-up of BCS, focusing on adequate control of serum lipid concentrations. ResumoOBJETIVO: Avaliar o risco de doença cardiovascular (DCV) em mulheres com câncer de mama. MÉTODOS: Foi conduzido estudo de corte transversal, com 67 mulheres com câncer de mama, entre 45 e 65 anos, tratamento oncológico completo, não usuárias de terapia hormonal, tamoxifeno ou inibidores da aromatase nos últimos 6 meses. Foram avaliados o perfil lipídico e o risco de DCV. Para avaliar o risco de DCV, foram utilizados os modelos Framingham e Systematic COronary Risk Evaluation (SCORE). Para investigar a concordância entre os modelos de risco cardiovascular, foi calculado o coeficiente kappa com seu respectivo intervalo de confiança (IC) de 95%. RESULTADOS: A média de idade das participantes foi de 53,2±6,0 anos. A prevalência de obesidade, hipertensão e dislipidemia foi 25, 34 e 90%, respectivamente. A prevalência de dislipidemia foi 90%. As anormalidades mais comuns do perfil lipídico foram: alto colesterol total (70%), alto LDL-C (51%) e alto não HDL-C (48%). Baseado no escore de Framingham, 22% das mulheres com câncer de mama apresentaram alto risco de doença arterial coronariana. De acordo com o modelo SCORE, 100 e 93% das participantes apresentaram baixo risco de DCV fatal, considerando populações de baixo e alto risco de DCV, respectivamente. A concordância entre os modelos de Framingham e SCORE foi ruim (kappa: 0,1; IC95% 0,01-0,2), considerando populações de alto risco de DCV. CONCLUSÕES: Esses dados indicam a necessidade de incluir a avaliação do perfil lipídico e do risco de DCV na rotina de seguimento de mulheres com câncer de mama, sendo observadoo adequado controle dos níveis séricos de lipídios.

Reliability between Cardiovascular Risk Assessment Tools: A Pilot Study

“…However, no studies comparing the 2008 FRS with the SCORE model was found. 19,20 Given the findings from this series, in accordance with previous studies, 7,9,10 it can be inferred that we may use both the FRS 2008 and the SCORE-High to stratify cardiovascular risk, without this meaning the need to adopt different therapeutic measures.…”

“…The literature indicates poor to high degree of agreement between FRS and SCORE, and this variation is observed depending on where the comparison was performed and/or on the methodology used. 7,9,10,19,20 In a Spanish study, there was poor agreement between the FRS version recommended by the Adult Treatment Panel III (ATP III) and the SCORE-Low, 10,21 while a research in Germany showed moderate agreement between an older version of the FRS (1991) and both SCORE models (High and Low). 7 In an Iranian study using a different methodology for assessing the degree of agreement, the result was similar (high agreement between FRS vs. SCORE-High) when compared to the present series.…”

<p>The Association of Serum Lipid Levels with Breast Cancer Risks Among Women with Breast Cancer at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia</p>

“…1,2 The precise cause of breast cancer is unknown; but, the female sex hormone, estrogen, is a potential carcinogenic promoter for cellular growth in breast tissues and reproductive organs. 3 In addition, environmental and lifestyle factors, 4,5 lack or short duration of breastfeeding, low parity, irregular menstrual period, family history of breast cancer, and inherited mutated genes associated with the onset of breast cancer. 6 According to the global burden of cancer report of 2018, globally there are about 2.1 million breast cancer cases and responsible for 11.6% of deaths from cancer causes.…”

Bee pollen and honey for the alleviation of hot flushes and other menopausal symptoms in breast cancer patients

“…We also assessed demographic data and collected blood samples for measuring triglycerides, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and oestradiol. The background for the analyses of blood lipids is the fact that hormonal treatments may modify blood lipid levels, affecting cardiovascular disease risks, which appear to be higher in breast cancer patients (27,28).…”