Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer

Abstract

Purpose Cardiovascular disease (CVD) is a leading cause of death among women with nonmetastatic breast cancer. Whether exercise is associated with reductions in CVD risk in patients with breast cancer with an elevated CVD risk phenotype is not known. MethodsUsing a prospective design, women (n = 2,973; mean age, 57 years) diagnosed with nonmetastatic breast cancer participating in two registry-based, regional cohort studies, completed a questionnaire that assessed leisure-time recreational physical activity (metabolic equivalent task [MET]-h/wk). The primary end point was the first occurrence of any of the following: new diagnosis of coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, occurring after study enrollment. ResultsMedian follow-up was 8.6 years (range, 0.2 to 14.8 years). In multivariable analysis, the incidence of cardiovascular events decreased across increasing total MET-h/wk categories (P trend , .001). Compared with , 2 MET-h/wk, the adjusted hazard ratio was 0.91 (95% CI, 0.76 to 1.09) for 2 to 10.9 MET-h/wk, 0.79 (95% CI, 0.66 to 0.96) for 11 to 24.5 MET-h/wk, and 0.65 (95% CI, 0.53 to 0.80) for $ 24.5 MET-h/wk. Similar trends were observed for the incidence of coronary artery disease and heart failure (P values , .05). Adherence to national exercise guidelines for adult patients with cancer (ie, $ 9 MET-h/wk) was associated with an adjusted 23% reduction in the risk of cardiovascular events in comparison with not meeting the guidelines (, 9 MET-h/wk; P , .001). The association with exercise did not differ according to age, CVD risk factors, menopausal status, or anticancer treatment. ConclusionExercise is associated with substantial, graded reductions in the incidence of cardiovascular events in women with nonmetastatic breast cancer.

Effectiveness of Oncologist-Referred Exercise and Healthy Eating Programming as a Part of Supportive Adjuvant Care for Early Breast Cancer

“…Among breast cancer survivors, a reduction in physical activity levels following diagnosis and treatment is common . Importantly, physical activity following a cancer diagnosis is associated with a 38% reduction in breast cancer‐specific mortality and an incremental reduction of cardiovascular events in breast cancer survivors . Therefore, the success of NExT in increasing physical activity levels and maintaining this increase for a period of 2 years after initiating adjuvant treatment has the potential to influence important clinical outcomes.…”

Physical Activity, Exercise and Breast Cancer - What Is the Evidence for Rehabilitation, Aftercare, and Survival A Review

“…A prospective cohort study with non-metastatic breast cancer patients showed that exercise is associated with a reduction in the incidence of cardiovascular events [43]. Runowicz et al [10] recommend among other things early cardiovascular monitoring and education of breast cancer survivors about lifestyle adaptations including exercise.…”

Adiposity, post-diagnosis weight change, and risk of cardiovascular events among early-stage breast cancer survivors

“…[18] A prior study in our cohorts found greater physical activity was associated with lower CVD risk in a dose-response fashion, independent of BMI at diagnosis. [19] Physical activity interventions among breast cancer survivors could be a promising area for CVD prevention: to date no controlled study has had sufficient follow-up or sample size to demonstrate effects on CVD morbidity/mortality, though many have demonstrated safety/efficacy for treatment-related side effects, quality of life, resting heart rate and blood pressure. [20–22]…”

“…Participants were drawn from a well-characterized population of Kaiser Permanente Northern California (KPNC) health plan members enrolled in two prospective cohorts with similar characteristics: LACE [19]) and Pathways [20]. The 2,135 LACE participants were diagnosed with breast cancer (AJCC stage I-IIIA) from 1997–2000 and were 18–79 years old.…”