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Breast cancer patients must be aware of increased risk for cardiovascular disease

Sunday, March 31, 2019

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KINGSTON, Jamaica — Student Researcher, Dr Charisse Best, is calling on breast cancer patients and their medical practitioners to be aware of the increased risk for cardiovascular disease and has made some recommendations.

Best, who was winner of the best student entry at the Ninth Annual National Health Research Conference 2018, shared the findings of her award winning study at a recent JIS 'Think Tank'.

The research progamme was done in partial fulfilment of her Doctor of Medicine (DM) degree, and was titled the Prevalence of risk factors for Cardiovascular Disease in Breast Cancer patients treated with Anthracycline Based Therapy at the University Hospital of the West Indies.

“The research looked at the baseline risk factors for cardiovascular disease, the patient related risk factors, some of which we can do nothing about (age, ethnicity and sex) as well as modifiable risk factors, such as hypertension, diabetes and obesity,” she explained.

“We also looked at therapy-related risk factors, where, though beneficial, some of the treatments can affect the heart,” she added.

According to Dr Best, who is a resident at the University Hospital of the West Indies and a part of the post-graduate Programme of Haematology and Oncology, the study also looked at measures that were implemented to modify the risk factors.

The study showed that 78 per cent of patients who had non-metastatic breast cancer, who were treated with anthracycline based therapy, which is one of the standard treatments for breast cancer, actually had at least one risk factor for cardiovascular disease, which she said is quite an alarming percentage.

Non-metastatic cancer does not spread from the primary or original site to other parts of the body.

Of the 78 per cent, the highest percentage was obesity at 42 per cent, followed by hypertension at 36 per cent.

“We also noted that 10 per cent of the patients had a history of smoking and 10 per cent had a history of diabetes,” she informed.

Best pointed out that breast cancer is the most common cancer diagnosed in females in Jamaica and worldwide, and that survivors have been increasing over the years.

She added that conversely, cardiovascular disease is the most common cause for mortality both worldwide and in Jamaica.

It was also noted that all patients in the study had a history of being treated with anthracyclines, 53 per cent of whom were also treated with chest wall radiation and another five per cent with Trastuzemab, an antibody used in treating cancer.

“These treatments, though beneficial, can increase the risk of cardiovascular disease, so we want to look at the risk factor profile before starting these treatments, to see if we can modify the risk factors for these treatments,” Dr Best said.

She said although the study was not designed to determine how many of the patients developed cardiovascular disease after being treated, the team had some interesting findings.

“What we noted was that those who had more than three risk factors for heart failure tended to have heart failure, so we looked at some of the implementations that were made for the study,” she explained.

“For the hypertensive patients, who came to the oncology clinic, just 29 per cent of them were on hypertension therapy and we also noted that although most of them got echocardiograms before starting treatment, just four per cent got the echocardiograms after. Though we were not able to tell why this is so, it was implied that for most of them it was a financial issue,” she said.

Best said what is recommended from the results of this study is that patients and general practitioners should know that these patients are at high cardiovascular risk, therefore more needs to be done to modify their cardiovascular risk factors, such as hypertension and diabetes, and they also need to increase exercise and decrease obesity.

According to Dr Best, it would also be good to put the patients on cardio-protective agents, such as ace inhibitors for hypertension and encourage echocardiograms at least six to 12 months after their therapy.

Angiotensin Converting Enzyme inhibitors or ACE inhibitors are medications that slow or inhibit the activity of the enzyme.

The research was a retrospective study of 284 patients with non-metastatic breast cancer diagnosed during 2006 to 2015. It was carried out by Dr Best under the supervision of Dr Sheray Chin and Dr Gillian Wharfe in the Department of Pathology at the University of the West Indies.


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