Body composition associated with cardiovascular risk in patients with breast cancer survival
August 1, 2019 cancer, obesity, women's health 0 comments In a large study by Kaiser Permanente, visceral and intramuscular obesity increased cardiovascular risk, even in women of normal weight.
Body composition, especially excessive central adipose tissue or intraperitoneal fat, can lead to an increased risk of cardiovascular disease in patients who have survived breast cancer with normal body weight, according to a new new study by Kaiser Permanente.
Cardiovascular disease is a major source of morbidity and mortality from survivors of breast cancer, said lead author Elizabeth Cespedes Feliciano, ScD, a researcher at Kaiser's Permanente Northern California Department of Science. People of normal weight are not generally considered to be at risk for cardiovascular disease. However, many of them have an abnormal distribution of adipose tissue and we need to pay attention to them.
The study "Fat Distribution and the Risk of Cardiovascular Disease in Breast Cancer Survivors" was published today in the Journal of Clinical Oncology.
Most cardiovascular studies of cancer survivors have relied on body mass index (BMI) to measure adipose tissue or excess fat in the body, Feliciano said. This study is unique in that we were able to review computed tomography (CT) scans of nearly 3,000 breast cancer patients. Although these scans were performed to diagnose and monitor the patient, we used them to measure exactly where adipose tissue was kept in the body.
* Subcutaneous: adipose tissue in which adipose tissue cells are located under the skin but outside the abdominal wall. * Visceral: adipose tissue stored in adipose tissue cells around organs in the abdomen. * Intramuscular: fat droplets stored in muscle tissue cells.
When fat accumulates in muscles and organs, it promotes inflammation and insulin resistance, which in turn can contribute to cardiovascular disease, Feliciano said.
In this CT scan with breast cancer (cross-section of the third vertebra), blue shows subcutaneous fat, yellow visceral fat, red muscle, and green muscle fat.
Increased visceral and intramuscular obesity increased cardiovascular risk by 15% and 21% in all women studied, respectively. In women of normal weight, increased visceral obesity increased cardiovascular risk by 70%, regardless of cancer treatment and pre-existing cardiovascular risk factors such as diabetes, high blood pressure and dyslipidaemia (abnormal levels of lipids or fats in the blood).
When researchers studied categories of BMI that are more commonly used clinically, only severely obese women had an increased cardiovascular risk; the risk did not increase in the lower BMI categories.
Significantly increased cardiovascular risk in patients with normal weight in visceral obesity is not noticed by BMI alone, said Bette J. Caan, senior researcher at DrPH, drPH.
Caan is a co-author of a recent study in JAMA Oncology that found a similar increase in cardiac risk in patients with colorectal cancer with higher visceral and intramuscular obesity, as well as a JAMA Network Open study that found an increased risk of both cardiovascular and non-cardiovascular obesity. cancer mortality in women of normal weight with central obesity.
Feliciano said clinicians, including the cancer treatment team, should consider body composition in addition to BMI when assessing the risk of heart disease in breast cancer patients. The waist circumference can be a proxy for a simple central nervous system. CT scans, which are often used in cancer patients, can also be used to identify patients at risk for cardiovascular disease who are overweight.
Caan is a researcher in the ongoing FORCE study, which tests interventions to increase resistance training in cancer patients, to help optimize body composition during cancer treatment.
We know that resistance training is safe during active chemotherapy. Feliciano said it is effective in building muscle and reducing intramuscular and visceral adipose tissue, and it also has benefits in improving short-term measurement of cardiovascular risk. Endurance training has many benefits and few potential harms for cancer patients.
In addition to Feliciano and Caan, the co-authors were Wendy Y. Chen, MD, MPH, Dana Farber Cancer Institute; Patrick T. Bradshaw, PhD, University of California, Berkeley; Carla M. Prado, PhD, University of Alberta, Edmonton; and Stacey Alexeeff, PhD, Kathleen B. Albers, MPH, and Adrienne L. Castillo, MS, Kaiser Permanente Northern California Research Department.
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