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Approved Research

Cardiometabolic and lifestyle determinants of cardiovascular disease risk in breast cancer survivors

Principal Investigator: Ms Julia Rickard
Approved Research ID: 83076
Approval date: March 9th 2022

Lay summary

Breast cancer is the most commonly diagnosed cancer in women in the world. There have been tremendous improvements in early detection and treatment of breast cancer and early-stage breast cancer mortality rates have decreased by nearly 50% in the past 40 years as a result. However, now that more women are surviving their breast cancer diagnoses, there has been a rise in cardiovascular disease in this population. In fact, women with a breast cancer diagnosis are more at risk for cardiovascular disease at all time points following their diagnosis when compared to women without breast cancer. This elevated risk is credited to a variety of factors including cardiotoxic (causes damage to the heart) cancer treatment, poor lifestyle behaviours (e.g. physical inactivity and smoking), the overlap between the risk factors for breast cancer and cardiovascular disease, and ectopic (abnormal location) fat deposition. Our research group is interested in further understanding cardiometabolic dysfunction in breast cancer survivors and its role in elevated cardiovascular disease risk.

This 6-month project aims to evaluate the influence of a breast cancer diagnosis on cardiovascular and metabolic health. Established cardiometabolic risk factors such as blood pressure and lipid profile, cardiac structure and function, ectopic fat volumes, fitness, components of the metabolic syndrome, lifestyle behaviours (such as physical activity and alcohol consumption) and Framingham risk score will be compared between women with and without a history of breast cancer. We also aim to examine the association between lifestyle behaviours and cardiovascular disease risk in all women, and if this risk differs between those with and without a history of breast cancer. In addition, we aim to explore whether menopausal status and the female sex hormone, estrogen, play a role in these relationships.

By establishing the reasons behind the elevated cardiovascular disease risk, we are able to better understand the cardiometabolic dysfunction experienced by breast cancer survivors. This allows researchers to develop risk reduction interventions and strategies to mitigate this risk and improve the health of breast cancer survivors.

Scope extension:

Current scope:

Purpose: Evaluate the influence of breast cancer (BC) on the interrelationships between cardiometabolic health, lifestyle behaviour, and cardiovascular and metabolic ('cardiometabolic') morbidity and mortality among women.

Objective 1: Compare metrics of cardiometabolic health and cardiovascular disease (CVD) risk between women who have a history of BC and women without a history of cancer (controls).

Objective 2: Determine the relationship between lifestyle behaviours and CVD and metabolic disease risk in all women, and whether this differs between BC survivors and controls.

Objective 3: Evaluate whether the effects of lifestyle behaviours on the risk of CVD and metabolic disease are mediated by CVD risk factors, cardiac function, and ectopic fat volumes among women with a history of BC, and if this differs from controls.

Objective 4: Perform an exploratory evaluation of whether menopause status and estradiol levels modify the results of the first three objectives.

Hypotheses: 1:  BC survivors will have worse cardiometabolic health and greater CVD risk than controls. 2&3: Lifestyle behaviours and mediation by CVD risk factors and ectopic fat will play a stronger role in cardiometabolic risk in controls due to the effects of cancer treatment.

4: Women with post-menopausal diagnoses will have worse measures of cardiometabolic health.

 

New Scope:

Purpose: Evaluate the influence of breast cancer (BC) and prostate cancer (PC) on the interrelationships between cardiometabolic health, lifestyle behaviour, and cardiovascular and metabolic ('cardiometabolic') morbidity and mortality among women and men, respectively.

Objective 1: Compare metrics of cardiometabolic health and cardiovascular disease (CVD) risk between women who have a history of BC and women without a history of cancer (controls).

Objective 2: Determine the relationship between Framingham risk score or lifestyle behaviours with CVD and metabolic disease events in all women, and whether this differs between BC survivors and controls.

Objective 3: Evaluate whether the effects of lifestyle behaviours on the risk of CVD and metabolic disease are mediated by CVD risk factors, cardiac function, and ectopic fat volumes among women with a history of BC, and if this differs from controls.

Objective 4: Determine a correction factor that can be added to the Framingham risk score for a history of BC to increase the predictive accuracy of the Framingham risk score in BC survivors.

Objective 5: Perform an exploratory evaluation of whether menopause status and estradiol levels modify the results of the first three objectives among women.

Objective 6: Compare metrics of cardiometabolic health and cardiovascular disease (CVD) risk between men who have a history of PC and men without a history of cancer (controls).

Objective 7: Determine the relationship between Framingham risk score or lifestyle behaviours with CVD and metabolic disease events in all men, and whether this differs between PC survivors and controls.

Objective 8: Evaluate whether the effects of lifestyle behaviours on the risk of CVD and metabolic disease are mediated by CVD risk factors, cardiac function, and ectopic fat volumes among men with a history of PC, and if this differs from controls.

Objective 9: Determine a correction factor that can be added to the Framingham risk score for a history of PC to increase the predictive accuracy of the Framingham risk score in PC survivors.

Hypotheses: 1:  BC survivors will have worse cardiometabolic health and greater CVD risk than controls. 2&3: Lifestyle behaviours and mediation by CVD risk factors and ectopic fat will play a stronger role in cardiometabolic risk in controls due to the effects of cancer treatment. 4: Adding a positive correction factor to Framingham risk calculation for a history of BC will increase the predictive accuracy of the Framingham risk score for BC survivors. 5: Women with post-menopausal diagnoses will have worse measures of cardiometabolic health. 6: PC survivors will have worse cardiometabolic health and greater CVD risk than controls. 7&8: Lifestyle behaviours and mediation by CVD risk factors and ectopic fat will play a stronger role in cardiometabolic risk in controls due to the effects of cancer treatment. 9: Adding a positive correction factor to Framingham risk calculation for a history of PC will increase the predictive accuracy of the Framingham risk score for PC survivors