Cardiovascular Characteristics Of Patients With First Diagnosis Of Breast Cancer And A Comparative Study Before And After Chemotherapy

Objective: Since its high incidence and increasing year by year,breast cancer has become a common disease.Follow-up treatment level improved,subsistence rate of breast cancer increased obviously.Some investigations found that breast cancer patients have a high risk of cardiovascular disease,and their mortality is comparable to the recurrence of the tumor itself.Meanwhile,both of them have many same risk factors.So the cardiovascular protection of breast cancer patients is particularly important.Currently,the understanding of the baseline cardiovascular conditions of the first confirmed breast cancer patients in southwest China is not comprehensive.Moreover,breast cancer patients with chemotherapy drugs are more likely to have cardiovascular problems,but there are limited studies on cardiovascular health before and after chemotherapy.This research aims to:(1)The clinical characteristics of the first breast cancer patients were analyzed to understand the comorbidity of cardiovascular disease and its risk factors and the possible correlation between them.(2)To understand the effects of anthracycline-based chemotherapy protocols on cardiovascular health and its hazardous elements and on Electrocardiograph(ECG)activity in breast cancer patients.Method: From Jan 2014 to Jan 2020,600 breast cancer patients who were first confirmed in Chongqing Medical University and Chongqing Breast Cancer Center for retrospective analysis.Of these,243 patients received adjuvant chemotherapy with EC-T or TEC regimen.Data included:(1)Basic characteristics: Age,Place of life(urban / rural),Number of children,BMI,Menstrual status,Previous medical history,etc.(2)Oncology features: Axillary lymph node metastasis.(3)Routine examination(at the first confirmed and at the last admission of chemotherapy): including Blood pressure,Blood lipids,Fasting blood glucose(FBG),Renal function,etc.(4)ECG(at the first confirmed and at the last admission of chemotherapy).The risk prediction model of atherosclerotic cardiovascular disease(ASCVD)was used to assess risk of ASCVD in patients.Continuous variables: normal distribution data using independent sample T test;non-normal distribution data using U test.According to P<0.05,there was considered statistically criteria.After that,regression analysis(binary logical regression)was applied to search the influencing elements to independence of axillary lymph node metastasis(ALNM)and influencing elements to independence of resting heart rate increase after chemical therapy.P<0.1 was considered statistically criteria.Result: Part 1: Of the 600 patients diagnosed for the first time,248(41.3%)cases were found with overweight and obesity,227(37.83%)cases of hypertension,combination of hyperlipidemia in 116(19.33%),51 cases(8.5%)of T2 DM.68 cases(11.33%)were found with hyperuricemia.The number and prevalence of overweight/obesity,hypertension and T2 DM in post-menopausal group were apparently greater than those in the premenopausal group(P < 0.05).Subgroup analysis by the place(Rural/Urban)of residence,age and menopause were obviously different(P<0.05).ASCVD risk assessment stratification showed that there were markedly differences between post-menopausal group and pre-menopausal group: among them,low-risk(56.4% vs 90.8%,P<0.05),medium-risk(20.6% vs 0.3%,P<0.05)and high-risk population(19.3% vs 6.6%,P<0.05),respectively.Residence(OR = 0.735;95% CI = 0.516-1.046;P=0.087),the number of children born(OR=1.250;95% CI = 0.990-1.578;P=0.061),LP(A)≥500mg/L(OR=0.603;95% CI = 0.342-1.063;P=0.080)maybe were independent affecting element for ALNM.Part2: Among the first diagnosed breast cancer patients,94 cases(47.0%)were overweight or obese,61 cases(25.1%)were hypertensive,7cases(2.9%)were T2 DM,76 cases(31.3%)were hyperlipidemia,and 6cases(2.5%)were hyperuricemia.Grouped by menopausal status,the prevalence of hypertension,hyperlipidemia and T2 DM in post-menopausal breast cancer patients markedly exceed the pre-menopausal’s group(P<0.05).Compared the initially diagnosis,the incidence of hyperlipidemia increased obviously after chemotherapy(48.2% vs 31.3%,P < 0.05),the FBG level was dramatically improved(5.54mmol/L vs 5.20 mmol/L,P<0.05),and the morbidity of hyperuricemia was remarkably rose(7.4% vs2.5%,P < 0.05),the changes of blood pressure and morbidity of hypertension weren’t obvious,and there was no remarkable difference.The resting heart rate was appreciable acceleration(80.32 vs 76.20,P < 0.05),and the QTc interval was noticeable prolonged(427.00 vs 421.00,P< 0.05).Grouped analysis according to menopausal status showed the same trend regardless of menopausal status.Atherosclerotic cardiovascular disease(ASCVD)risk stratification showed a decrease in low-risk patients after chemotherapy(75.3% vs 83.5%),the accounted for medium-risk people(9.1% vs 5.8%)and high-risk people(13.6% vs 8.6%)increased.Grouped by menopausal status,two groups displayed that the number of patients with low-risk reduced,the number of middle-risk and high-risk added.The independent affecting element of elevated heart rate after chemotherapy were postmenopausal state(OR=0.465,95%CI=0.272-0.794,P < 0.05).Conclusion: 1.Postmenopausal breast cancer patients with the first diagnosis have more cardiovascular risk factors and higher risk of ASCVD than premenopausal patients.2.Lp(a)≥500 mg/L,living in rural areas and having more children may be independent influencing elements for ALNM in breast cancer patients.3.After the use of chemotherapeutic protocols,the levels of cardiovascular risk factors in the two groups changed in the direction of disease.chemotherapeutic agents raised the risk of ASCVD in these patients,especially in the medium-risk population.4.Postmenopausal breast cancer patients are more likely to have a faster resting heart rate after chemotherapy.5.It is suggested to strengthen multidisciplinary cooperation in the dynamic cardiovascular fitness evaluation during the diagnosis and cure of breast cancer patients.