Pre-Diagnosis Exercise and Cardiovascular Events in Primary Breast Cancer: Women's Health Initiative

Tochi M Okwuosa; Roberta M Ray; Andres Palomo; Randi E Foraker; Lisa Johnson; Electra D Paskett; Bette Caan; Lee W Jones

doi:10.1016/j.jaccao.2019.08.014

Pre-Diagnosis Exercise and Cardiovascular Events in Primary Breast Cancer: Women's Health Initiative

JACC CardioOncol. 2019 Sep 24;1(1):41-50. doi: 10.1016/j.jaccao.2019.08.014. eCollection 2019 Sep.

Authors

Tochi M Okwuosa¹, Roberta M Ray², Andres Palomo³, Randi E Foraker⁴, Lisa Johnson², Electra D Paskett⁵, Bette Caan⁶, Lee W Jones⁷

Affiliations

¹ Rush University Medical Center, Division of Cardiology, Department of Internal Medicine; Chicago, Illinois, USA.
² Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
³ Rush University Medical Center, Department of Internal Medicine, Chicago, Illinois, USA.
⁴ Institute for Informatics (I2), Washington University in St. Louis, School of Medicine, St. Louis, Missouri, USA.
⁵ Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, USA.
⁶ Division of Research, Kaiser Permanente of Northern California, Oakland, California, USA.
⁷ Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Abstract

Objectives: The purpose of this study was to investigate whether pre-diagnosis exercise reduces the risk of subsequent cardiovascular events (CVEs) in women with primary breast cancer.

Background: Cardiovascular disease (CVD) is the leading nonmalignant cause of death in patients with cancer, and it is the leading cause of death in women with primary breast cancer who are older than 65 years of age.

Methods: Using a prospective design, 4,015 patients with confirmed diagnosis of primary breast cancer enrolled in the Women's Health Initiative (WHI) completed a self-report questionnaire assessing leisure-time physical activity (i.e., exercise) in metabolic equivalent task (MET) hours per week. Age- and multivariable-adjusted Cox proportional hazards models were used to estimate associations between pre-diagnosis exercise and new-onset CVEs (i.e., heart failure [HF], myocardial infarction [MI], angina, coronary revascularization, peripheral arterial disease [PAD], carotid artery disease, transient ischemic attack [TIA], stroke, and cardiovascular death).

Results: Median follow-up was 12.7 years and 8.2 years for cardiovascular disease (CVD) mortality and CVEs, respectively, with 324 CVEs, including 89 MIs, 49 new diagnoses of HF, and 215 CVD deaths. In multivariable analysis, the incidence of composite CVEs decreased across increasing total MET h/week categories (p = 0.016). Compared with <2.5 MET-hours per week, the adjusted hazard ratio (HR) was 0.80 (95% confidence interval [CI]: 0.59 to 1.09) for 2.5 to <8.6 MET h/week; 0.9 (95% CI: 0.64 to 1.17) for 8.6 to <18 MET h/week; and 0.63 (95% CI: 0.45 to 0.88) for ≥18 MET h/week.

Conclusion: Pre-diagnosis exercise exposure is associated with a significant graded reduction in subsequent CVEs in long-term survivors of primary breast cancer.

Keywords: BMI, body mass index; CRF, cardiorespiratory fitness; CT, clinical trial; CVE, cardiovascular event; HF, heart failure; HT, hormone therapy; IQR, interquartile range; MET, metabolic equivalent task; MI, myocardial infarction; OS, observational study; PAD, peripheral arterial disease; TIA, transient ischemic attack; WHI, Women’s Health Initiative; Women’s Health Initiative; breast cancer; cardiovascular disease; cardiovascular events; exercise; physical activity; survivors.

Abstract

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