Dataset Information

The risk of cardiovascular disease following breast cancer by Framingham risk score.

ABSTRACT:

Objectives

This study evaluates the risk of cardiovascular disease (CVD) following breast cancer, accounting for baseline CVD risk.

Methods

Within the EPIC-NL (Dutch part of the European Prospective Investigation into Nutrition and Cancer) cohort, 1103 women were diagnosed with breast cancer. For every breast cancer patient, 3-4 women without breast cancer (n = 4328) were selected matched for age, year, and time since cohort enrollment. Based on CVD risk factors at cohort enrollment, 10-year risk of CVD was calculated and categorized: low (< 10%), intermediate (10-20%), high (> 20%). Cox proportional hazard models assessed the risk of CVD events (hospitalization or mortality) and CVD mortality of women with versus without breast cancer, adjusted for baseline CVD risk.

Results

After median follow-up of 5 and 6 years, 92 (8.3%) and 325 (7.5%) CVD events occurred in women with and without breast cancer, respectively. In the low CVD risk group, women with breast cancer had 1.44 (95% CI 1.00-2.06) times higher risk of CVD events than women without breast cancer. In the intermediate and high CVD risk categories, risk of CVD events was similar in women with and without breast cancer. Overall, women with breast cancer had 1.77 (95% CI 1.10-2.86) times higher risk of CVD mortality than women without breast cancer.

Conclusions

Among women with low CVD risk, women with breast cancer have a higher risk of CVD event than women without breast cancer. Overall, women with breast cancer have a higher risk of CVD mortality than women without breast cancer.

SUBMITTER: Gernaat SAM

PROVIDER: S-EPMC5993849 | biostudies-literature | 2018 Jul

REPOSITORIES: biostudies-literature

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Publications

The risk of cardiovascular disease following breast cancer by Framingham risk score.

Gernaat Sofie A M SAM Boer Jolanda M A JMA van den Bongard Desiree H J DHJ Maas Angela H E M AHEM van der Pol Carmen C CC Bijlsma Rhodé M RM Grobbee Diederick E DE Verkooijen Helena M HM Peeters Petra H PH

Breast cancer research and treatment 20180228 1

<h4>Objectives</h4>This study evaluates the risk of cardiovascular disease (CVD) following breast cancer, accounting for baseline CVD risk.<h4>Methods</h4>Within the EPIC-NL (Dutch part of the European Prospective Investigation into Nutrition and Cancer) cohort, 1103 women were diagnosed with breast cancer. For every breast cancer patient, 3-4 women without breast cancer (n = 4328) were selected matched for age, year, and time since cohort enrollment. Based on CVD risk factors at cohort enrollme ...[more]

PMID: 29492735

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Project description:BackgroundFramingham risk score (FRS) is an important cardiovascular risk assessment tool, based on objective measurements of blood pressure and lipid profile, among other factors. However, in large population surveys, these measures are not always available, which limits their use.ObjectivesEvaluate the performance of the FRS predictive results using subjective measures.MethodologyCross-sectional study of 1,414 male rotating shift workers in an iron ore extraction company. The original FRS was calculated using objective systolic and diastolic blood pressure measurements, total cholesterol (TC), and HDL cholesterol. The modified FRS was calculated using subjective measurements of blood pressure and lipid profile, based on self-reported medical diagnosis and use of medications for these conditions. Three adaptations were proposed: (1) FRS-SAH, which considers only self-reported hypertension; (2) FRS-DLP, based solely on self-reported dyslipidemia; and (3) FRS-SAH and DLP, which integrates both self-reported factors. Agreement between the two scores was assessed using the kappa coefficient and the Bland-Altman analysis. The accuracy of the scores in predicting cardiovascular risk was compared using the ROC curve and the area under the curve (AUC).ResultsThe scatter plot showed a strong correlation (r = 0.9036, p < 0.001) between adapted FRS-SAH and original FRS. The ROC curve showed an AUC with results above 0.85 for all models, confirming the effectiveness of the adapted scale. Bland-Altman indicated good precision between the measurements. Binary logistic regression analysis showed that all the factors associated with CVD-risk by the original FRS were similar to those associated with the adapted FRS. Among the adaptations, the FRS-SAH demonstrated the highest correlation and predictive accuracy.ConclusionThe adapted FRS proved to be effective in estimating CVD-risk, showing high correlation, sensitivity, specificity, and accuracy compared to the original FRS. Adaptive FRS based on self-reported hypertension, showed the best performance, making it a reliable alternative for contexts where direct measurements are not feasible.

Project description:ObjectivesLevel of education and genetic risk are key predictors of cardiovascular disease (CVD). While several studies have explored the causal mechanisms of education effects, it remains uncertain to what extent genetic risk is mediated by established CVD risk factors. This study sought to investigate this and explored the mediation of education and genetic effects on CVD by established cardiovascular risk factors in the Framingham Heart Study (FHS).DesignProspective observational cohort study.Participants7017 participants from the FHS.SettingCommunity-based cohort of adults in Framingham, Massachusetts, USA.Primary outcome measureIncident CVD. The total effects of education and genetic predisposition using a 63-variant genetic risk score (GRS) on CVD, as well as those mediated by established CVD risk factors, were assessed via mediation analysis based on the counterfactual framework using Cox proportional hazards regression models.ResultsOver a median follow-up time of 12.0 years, 1091 participants experienced a CVD event. Education and GRS displayed significant associations with CVD after adjustment for age and sex and the established risk factors smoking, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), body mass index, systolic blood pressure (SBP) and diabetes. For education effects, smoking, HDL-C and SBP were estimated to mediate 18.8% (95% CI 9.5% to 43%), 11.5% (95% CI 5.7% to 29.0%) and 4.5% (95% CI 1.6% to 13.3%) of the total effect of graduate degree, respectively, with the collective of all risk factors combined mediating 38.5% (95% 24.1% to 64.9%). A much smaller proportion of the effects of GRS were mediated by established risk factors combined (17.6%, 95% CI 2.4% to 35.7%), with HDL-C and TC mediating 11.5% (95% CI 6.2% to 21.5%) and 3.1% (95% CI 0.2% to 8.3%), respectively.ConclusionsUnlike education inequalities, established risk factors mediated only a fraction of GRS effects on CVD. Further research is required to elucidate the underlying causal mechanisms of genetic contributions to CVD.

Dataset Information

The risk of cardiovascular disease following breast cancer by Framingham risk score.

Objectives

Methods

Results

Conclusions

Publications

The risk of cardiovascular disease following breast cancer by Framingham risk score.

Similar Datasets

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