Cardiometabolic risk factors and survival after cancer in the Women's Health Initiative.Citation: Cancer. 127(4):598-608, 2021 02 15.PMID: 33151547Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Cardiometabolic Risk Factors | *Cardiovascular Diseases/ep [Epidemiology] | *Diabetes Mellitus, Type 2/ep [Epidemiology] | *Ovarian Neoplasms/ep [Epidemiology] | Aged | Breast Neoplasms/co [Complications] | Breast Neoplasms/mo [Mortality] | Breast Neoplasms/pa [Pathology] | Cardiovascular Diseases/co [Complications] | Cardiovascular Diseases/pa [Pathology] | Cause of Death | Diabetes Mellitus, Type 2/co [Complications] | Diabetes Mellitus, Type 2/pa [Pathology] | Endometrial Neoplasms/co [Complications] | Endometrial Neoplasms/ep [Epidemiology] | Endometrial Neoplasms/mo [Mortality] | Endometrial Neoplasms/pa [Pathology] | Female | Follow-Up Studies | Humans | Kidney Neoplasms/co [Complications] | Kidney Neoplasms/ep [Epidemiology] | Kidney Neoplasms/mo [Mortality] | Kidney Neoplasms/pa [Pathology] | Middle Aged | Obesity/co [Complications] | Obesity/ep [Epidemiology] | Obesity/mo [Mortality] | Obesity/pa [Pathology] | Ovarian Neoplasms/co [Complications] | Ovarian Neoplasms/pa [Pathology] | Pancreatic Neoplasms/co [Complications] | Pancreatic Neoplasms/ep [Epidemiology] | Pancreatic Neoplasms/mo [Mortality] | Pancreatic Neoplasms/pa [Pathology] | Postmenopause | Proportional Hazards Models | Risk Factors | Waist Circumference | Women's HealthYear: 2021Local holdings: Available online from the MWHC library: 1948 - present, Available in print through MWHC library: 1999 - 2006ISSN:
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Available online from the MWHC library: 1948 - present, Available in print through MWHC library: 1999 - 2006
BACKGROUND: Cardiometabolic abnormalities are a leading cause of death among women, including women with cancer.
CONCLUSIONS: Among postmenopausal women diagnosed with cancer in the WHI, cardiometabolic risk factors before the cancer diagnosis were associated with greater all-cause, CVD, cancer-specific, and other-cause mortality. These results raise hypotheses regarding potential clinical intervention strategies targeting cardiometabolic abnormalities that require future prospective studies for confirmation.
LAY SUMMARY: This study uses information from the Women's Health Initiative (WHI) to find out whether cardiac risk factors are related to a greater risk of dying among older women with cancer. The WHI is the largest study of medical problems faced by older women in this country. The results show that women who have 3 or 4 risk factors are more likely to die of any cause, heart disease, or cancer in comparison with women with no risk factors. It is concluded that interventions to help to lower the burden of cardiac risk factors can have an important impact on survivorship among women with cancer. Copyright (c) 2020 American Cancer Society.
METHODS: This study examined the association between prediagnosis cardiovascular health and total and cause-specific mortality among 12,076 postmenopausal women who developed local- or regional-stage invasive cancer in the Women's Health Initiative (WHI). Cardiovascular risk factors included waist circumference, hypertension, high cholesterol, and type 2 diabetes. Obesity-related cancers included breast cancer, colorectal cancer, endometrial cancer, kidney cancer, pancreatic cancer, ovarian cancer, stomach cancer, liver cancer, and non-Hodgkin lymphoma. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for important predictors of survival.
RESULTS: After a median follow-up of 10.0 years from the date of the cancer diagnosis, there were 3607 total deaths, with 1546 (43%) due to cancer. Most participants (62.9%) had 1 or 2 cardiometabolic risk factors, and 8.1% had 3 or 4. In adjusted models, women with 3 to 4 risk factors (vs none) had a higher risk of all-cause mortality (HR, 1.99; 95% CI, 1.73-2.30), death due to cardiovascular disease (CVD) (HR, 4.01; 95% CI, 2.88-5.57), cancer-specific mortality (HR, 1.37; 95% CI, 1.1-1.72), and other-cause mortality (HR, 2.14; 95% CI, 1.70-2.69). A higher waist circumference was associated with greater all-cause mortality (HR, 1.17; 95% CI, 1.06-1.30) and cancer-specific mortality (HR, 1.22; 95% CI, 1.04-1.42).