European Journal of Obstetrics & Gynecology and Reproductive Biology 183 (2014) 10–11
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
LETTER TO THE EDITOR—BRIEF COMMUNICATION Cardiovascular risk in postmenopausal women with and without breast cancer Dear Editors, Postmenopausal breast cancer survivors (BCS) may present with traditional cardiovascular risk factors such as hypertension, dyslipidemia and obesity [1,2]. In addition, treatment-related factors including chemotherapy and endocrine therapy may increase the risk of cardiovascular disease (CVD). The risk of the metabolic syndrome is higher in postmenopausal BCS compared to non-BCS [2]. High body mass index (BMI 30 kg/ m2), high total cholesterol (TC) [3] and diabetes mellitus [4] are associated with an increased risk of mortality in BCS. High BMI is associated with harmful alterations in the cardiovascular system [5]. The aim of the present study was to compare the prevalence of cardiovascular risk factors and the risk of cardiovascular disease between postmenopausal BCS and non-BCS. This cross-sectional study included participants of the Brazilian Breast Cancer and Menopause Study, conducted at the Women’s
Hospital, University of Campinas (UNICAMP), Brazil [1]. Women of 45–65 years of age who had not used hormone therapy, tamoxifen or aromatase inhibitors in the previous 6 months and had no history of any other malignancies were invited to join the study. Overall, 100 BCS and 87 non-BCS were invited to participate. Three BCS refused to participate due to lack of time, 22 were still undergoing treatment, 11 were premenopausal and 8 had no record of their lipid profile. Two non-BCS declined due to lack of time and four were premenopausal. Therefore, 56 BCS and 81 nonBCS constituted the present sample. The institution’s internal review board approved the study and all women signed an informed consent form. A 12-h-fasting blood sample was collected for analysis of TC, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Plasma TC, HDL-C and TG were measured by an enzymatic colorimetric method. Low-density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula. CVD risk was assessed using the Framingham risk score (FRS). The 10-year CVD risk was classified as low (20%).
Table 1 Sociodemographic characteristics, lipid profile and cardiovascular risk in women with and without breast cancer. Variables Sociodemographic characteristics Age (years), mean (SD) Age at menarche (years), mean (SD) Age at menopause (years),a mean (SD) Body mass index (kg/m2), mean (SD) Skin color, white, n (%) Smokers, n (%) Hypertension, n (%) Diabetes mellitus, n (%) Lipid profile Total cholesterol, mean (SD) LDL-C, mean (SD) HDL-C, mean (SD) Non-HDL-C, mean (SD) Triglycerides, mean (SD) Total cholesterol/HDL-C ratio, mean (SD) LDL-C/HDL-C ratio, mean (SD) Triglycerides/HDL-C ratio, mean (SD)
With cancer (n = 56) 54.5 (5.7) 13.1 (1.7) 47.1 (5.2) 27.7 (5.2) 41 (73.2) 4 (7.1) 21 (37.5) 7 (12.5)
219.2 137.3 53.3 166.0 146.3 4.3 2.7 3.1
(35.1) (31.6) (13.8) (33.9) (65.4) (1.0) (0.8) (1.8)
Without cancer (n = 81) 58.2 (4.7) 13.1 (1.8) 47.4 (4.9) 29.8 (5.6) 54 (66.7) 4 (4.9) 49 (60.5) 18 (22.2)
218.4 137.6 52.5 165.9 149.4 4.4 2.8 3.2
(39.1) (36.7) (13.4) (37.8) (72.5) (1.2) (1.0) (2.2)
Framingham risk score Low, n (%) Moderate, n (%)
21 (37.5) 21 (37.5)
15 (18.5) 26 (32.1)
High, n (%)
14 (25.0)
40 (49.4)
a b c d e f
Exclusion of 7 women with cancer and 10 women without cancer for whom the date of their last menstruation was unknown. Student’s t test. Fisher’s exact test. Adjusted for age and body mass index, using logistic regression model. Adjusted for age and body mass index, using linear regression model. Adjusted for age, using logistic regression model.
http://dx.doi.org/10.1016/j.ejogrb.2014.10.004 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.
p-Value, and/or OR (95% CI)
Contents lists available at ScienceDirect
European Journal of Obstetrics & Gynecology and Reproductive Biology journal homepage: www.elsevier.com/locate/ejogrb
LETTER TO THE EDITOR—BRIEF COMMUNICATION Cardiovascular risk in postmenopausal women with and without breast cancer Dear Editors, Postmenopausal breast cancer survivors (BCS) may present with traditional cardiovascular risk factors such as hypertension, dyslipidemia and obesity [1,2]. In addition, treatment-related factors including chemotherapy and endocrine therapy may increase the risk of cardiovascular disease (CVD). The risk of the metabolic syndrome is higher in postmenopausal BCS compared to non-BCS [2]. High body mass index (BMI 30 kg/ m2), high total cholesterol (TC) [3] and diabetes mellitus [4] are associated with an increased risk of mortality in BCS. High BMI is associated with harmful alterations in the cardiovascular system [5]. The aim of the present study was to compare the prevalence of cardiovascular risk factors and the risk of cardiovascular disease between postmenopausal BCS and non-BCS. This cross-sectional study included participants of the Brazilian Breast Cancer and Menopause Study, conducted at the Women’s
Hospital, University of Campinas (UNICAMP), Brazil [1]. Women of 45–65 years of age who had not used hormone therapy, tamoxifen or aromatase inhibitors in the previous 6 months and had no history of any other malignancies were invited to join the study. Overall, 100 BCS and 87 non-BCS were invited to participate. Three BCS refused to participate due to lack of time, 22 were still undergoing treatment, 11 were premenopausal and 8 had no record of their lipid profile. Two non-BCS declined due to lack of time and four were premenopausal. Therefore, 56 BCS and 81 nonBCS constituted the present sample. The institution’s internal review board approved the study and all women signed an informed consent form. A 12-h-fasting blood sample was collected for analysis of TC, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG). Plasma TC, HDL-C and TG were measured by an enzymatic colorimetric method. Low-density lipoprotein cholesterol (LDL-C) was calculated using the Friedewald formula. CVD risk was assessed using the Framingham risk score (FRS). The 10-year CVD risk was classified as low (20%).
Table 1 Sociodemographic characteristics, lipid profile and cardiovascular risk in women with and without breast cancer. Variables Sociodemographic characteristics Age (years), mean (SD) Age at menarche (years), mean (SD) Age at menopause (years),a mean (SD) Body mass index (kg/m2), mean (SD) Skin color, white, n (%) Smokers, n (%) Hypertension, n (%) Diabetes mellitus, n (%) Lipid profile Total cholesterol, mean (SD) LDL-C, mean (SD) HDL-C, mean (SD) Non-HDL-C, mean (SD) Triglycerides, mean (SD) Total cholesterol/HDL-C ratio, mean (SD) LDL-C/HDL-C ratio, mean (SD) Triglycerides/HDL-C ratio, mean (SD)
With cancer (n = 56) 54.5 (5.7) 13.1 (1.7) 47.1 (5.2) 27.7 (5.2) 41 (73.2) 4 (7.1) 21 (37.5) 7 (12.5)
219.2 137.3 53.3 166.0 146.3 4.3 2.7 3.1
(35.1) (31.6) (13.8) (33.9) (65.4) (1.0) (0.8) (1.8)
Without cancer (n = 81) 58.2 (4.7) 13.1 (1.8) 47.4 (4.9) 29.8 (5.6) 54 (66.7) 4 (4.9) 49 (60.5) 18 (22.2)
218.4 137.6 52.5 165.9 149.4 4.4 2.8 3.2
(39.1) (36.7) (13.4) (37.8) (72.5) (1.2) (1.0) (2.2)
Framingham risk score Low, n (%) Moderate, n (%)
21 (37.5) 21 (37.5)
15 (18.5) 26 (32.1)
High, n (%)
14 (25.0)
40 (49.4)
a b c d e f
Exclusion of 7 women with cancer and 10 women without cancer for whom the date of their last menstruation was unknown. Student’s t test. Fisher’s exact test. Adjusted for age and body mass index, using logistic regression model. Adjusted for age and body mass index, using linear regression model. Adjusted for age, using logistic regression model.
http://dx.doi.org/10.1016/j.ejogrb.2014.10.004 0301-2115/ß 2014 Elsevier Ireland Ltd. All rights reserved.
p-Value, and/or OR (95% CI)
