Risk factors for cardiovascular complications in patients with left breast cancer in daily clinical practice

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Abstract

Purpose. Detection of adherence to a healthy lifestyle (HLS) and evaluation of behavioral risk factors for cardiovascular complications (CVC), including psychosocial, in patients with left breast cancer at the stage of chemoradiotherapy in daily clinical practice.

Materials and methods. The patients were hospitalized for 3D conformal radiation therapy on the bed of the left breast with a total radiation dose (TRD) of 39 Gy (equivalent to 48 Gy of conventional fractionation). All the patients had a Madden mastectomy at the previous stages followed by doxorubicin therapy at a cumulative dose not exceeding 360 mg/m2. Determination of all components of a healthy lifestyle was carried out according to the data of interviewing the participants. The risk category of cardiovascular complications was assessed according to the SCORE scale. Additional characteristics including psychosocial factors were assessed. The examination included ECG and echocardiography.

Results. At the initial examination, 58% of middle-aged patients and 74% of elderly patients showed comorbidity, while 18% of middle-aged patients and 29% of elderly patients had multiple comorbidities. Low adherence to healthy lifestyle in the patients was primarily associated with low physical activity due to the existing pain syndrome caused by both the tumor process itself and the surgical intervention. Physical activity in both groups was significantly lower than in the general population. High risk of CVC was significantly more common in the elderly patients. Systolic and diastolic dysfunction as a manifestation of cardiotoxicity after the previous stage of doxorubicin therapy were detected in middle-aged patients in 35.7% of the cases, in the elderly patients in 56.5% of the cases (HR 0.643, 95% CI 0.470-0.880). Psychosocial factors such as acute chronic stress and family problems were the most common. All the examined patients showed moderate reactive anxiety. The elderly patients showed a high level of personal anxiety.

Conclusions. The obtained data suggest that in breast cancer patients, low adherence to HLS is primarily associated with low physical activity and ‘unhealthy diet’ and to a much lesser extent smoking, which is of great importance in the formation of a healthy lifestyle in these patients in the future. In elderly patients, the study significantly more often identified risk factors such as obesity, high blood pressure, hypercholesterolemia and hyperglycemia. These patients revealed increased level of personal anxiety. This highlights the need for an expanded study of not only the main but also additional risk factors.

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About the authors

Elena G. Poroshina

North-West State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: elporoshina@mail.ru

docent

Russian Federation, KSaint Petersburg

Irina V. Vologdina

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: Vologdina@yandex.ru

doctor of Medicine Sciences

Russian Federation, Saint Petersburg

Razifa M. Zhabina

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: RAZIFA@list.ru

Doctor of Medical Sciences, Honored Doctor of the Russian Federation, Head of the Radiotherapy Department No. 1

Russian Federation, Saint Petersburg

Andrey A. Stanzhevsky

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: stanzhevsky@gmail.com

Doctor of Medcine Sciences.Deputy Director for Research

Russian Federation, Saint Petersburg

Larisa A. Krasilnikova

A.M. Granov Russian Research Center for Radiology and Surgical Technologies

Email: krasilka@gmail.com

MD, doctor of functional diagnostics

Russian Federation, Saint Petersburg

References

  1. Концевая А.В., Муканеева Д.К., Мырзаматова А.О., и др. Экономический ущерб факторов риска, обусловленный их вкладом в заболеваемость и смертность от основных хронических неинфекционных заболеваний в Российской Федерации в 2016 году // Кардиоваскулярная терапия и профилактика. – 2020. – Т. 19. – № 1. – С. 48–55. [Kontsevaya AV, Mukaneeva DK, Myrzamatova AO, et al. Economic damage of risk factors associated with morbidity and mortality from major chronic non-communicable diseases in Russia in 2016. Cardiovascular therapy and prevention. 2020;19(1):48-55. (In Russ.)]. https://doi.org/10.15829/1728-8800-2020-1-2396.
  2. Вологдина И.В., Жабина Р.М., Корытова Л.И., и др. Кардиоваскулярные осложнения у онкологических больных на этапе проведения химиолучевой терапии: современное состояние проблемы // Вопросы онкологии. – 2018. – T. 64. – № 4. – С. 470–478. [Vologdina IV, Zhabina RM, Korytova LI, et al. Cardiovascular complications in oncological patients at stage of chemoradiotherapy: actual position of the problem. Vopr Onkol. 2018;64(4):470-478. (In Russ.)]
  3. Каприн А.Д., Мацкеплишвили С.Т., Потиевская В.И., и др. Сердечно-сосудистые заболевания у онкологических больных // Онкология. Журнал им. П.А. Герцена. – 2019. – Т. 8. – № 2. – С. 139–147. [Kaprin AD, Matskeplishvili ST, Potievskaya VI, et al. Cardiovascular diseases in cancer patients. Onkologiia. 2019;8(2):139-147. (In Russ.)]. https://doi.org/10.17116/onkolog20198021139.
  4. Adão R, de Keulenaer G, Leite-Moreira A, Brás-Silva C. Cardiotoxicity associated with cancer therapy: Pathophysiology and prevention. Revista Portuguesa de Cardiologia (English Edition). 2013;32(5):395-409. https://doi.org/10.1016/j.repce.2012.11.019.
  5. Chang HM, Okwuosa TM, Scarabelli T, et al. Cardiovascular complications of cancer therapy: best practices in diagnosis, prevention, and management: Part 2. J Am Coll Cardiol. 2017;70(20):2552-2565. https://doi.org/10.1016/j.jacc.2017.09.1095.
  6. Curigliano G, Lenihan D, Fradley M, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020;31(2):171-190. https://doi.org/10.1016/ j.annonc.2019.10.023.
  7. Каприн А.Д., Рудской А.И., Смирнов А.В., и др. Выступления участников общего собрания членов РАН // Вестник Российской академии наук. – 2019. – Т. 89. – № 9. – С. 948–956. [Kaprin AD, Rudskoy AI, Smirnov AV, et al. Speeches by the participants of the general meeting of the RAS members. Vestnik Rossiiskoi akademii nauk. 2019;89(9):948-956. (In Russ.)]. https://doi.org/10.31857/S0869-5873899948-956.
  8. Zamorano JL, Lancellotti P, Rodriguez Munoz D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(36):2768-2801. https://doi.org/10.1093/eurheartj/ehw211.
  9. Шальнова С.А., Баланова Ю.А., Деев Л.Д., и др. Интегральная оценка приверженности здоровому образу жизни как способ мониторинга эффективности профилактических мер // Профилактическая медицина. – 2018. – Т. 21. – № 4. – С. 65–72. [Shal’nova SA, Balanova YA, Deev LD, et al. Integrated assessment of adherence to a healthy lifestyle as a way of monitoring the effectiveness of preventive measures. Profilakticheskaya meditsina. 2018;21(4):65-72. (In Russ.)]. https://doi.org/10.17116/profmed201821465.
  10. Шальнова С.А., Максимов С.А., Баланова Ю.А., и др. Приверженность к здоровому образу жизни в российской популяции в зависимости от социально-демографических характеристик населения // Кардиоваскулярная терапия и профилактика. – 2020. – Т. 19. – № 2. – С. 33–41. [Shal’nova SA, Maksimov SA, Balanova YA, et al. Adherence to a healthy lifestyle of the russian population depending on the socio-demographics. Cardiovascular therapy and prevention. 2020;19(2):33-41. (In Russ.)]. https://doi.org/10.15829/1728-8800-2020-2452.
  11. Вологдина И.В., Порошина Е.Г., Жабина Р.М., Станжевский А.А. Распространенность факторов риска кардиоваскулярных осложнений у женщин пожилого возраста с раком левой молочной железы // Вестник Северо-Западного государственного медицинского университета. – 2019. – Т. 11. – № 3. – С. 85–92. [Vologdina IV, Poroshina EG, Zhabina RM, Stanzhevskiy AA. Prevalence of risk factors of cardiovascular complications in elderly women with left breast cancer. Vestnik Severo-Zapadnogo gosudarstvennogo meditsinskogo universiteta. 2019;11(3):85-92. (In Russ.)]. https://doi.org/ 10.17816/mechnikov201911385-92.
  12. Порошина Е.Г., Вологдина И.В., Пестерева Е.В. Психологические особенности и качество жизни у онкологических больных с сочетанной сердечно-сосудистой патологией // Вестник СЗГМУ им. Мечникова. – 2017. – Т. 9. – № 1. – С. 83–89. [Poroshina EG, Vologdina IV, Pestereva EV. Psychological characteristics and quality of life of cancer patients with concomitant cardiovascular pathology. Vestnik SZGMU im. Mechnikova. 2017;9(1):83-89. (In Russ.)]. https://doi.org/10.17816/mechnikov20179183-88.
  13. Оганов Р.Г., Симаненков В.И., Бакулин И.Г., и др. Коморбидная патология в клинической практике. алгоритмы диагностики и лечения // Кардиоваскулярная терапия и профилактика. – 2019. – Т. 18. – № 1. – С. 5–66. [Oganov RG, Simanenkov VI, Bakulin IG, et al. Comorbidities in clinical practice. algorithms for diagnostics and treatment. Cardiovascular therapy and prevention. 2019;18(1):5-66. (In Russ.)]. https://doi.org 10.15829/1728-8800-2019-1-5-66.
  14. Заридзе Д.Г., Каприн А.Д., Стилиди И.С. Динамика заболеваемости и смертности от злокачественных новообразований в России // Вопросы онкологии. – 2018. – Т. 64. – № 5. – С. 578–591. [Zaridze DG, Kaprin AD, Stilidi IS. Dynamics of morbidity and mortality from malignant tumors in Russia. Vopr Onkol. 2018;64(5):578-591. (In Russ.)]
  15. Бойцов С.А., Погосова Г.В., Бубнова М.Г., и др. Кардиоваскулярная профилактика 2017. Российские национальные рекомендации // Российский кардиологический журнал. – 2018. – Т. 23. – № 6. – С. 7–122. [Boitsov SA, Pogosova GV, Bubnova MG, et al. Cardiovascular prevention 2017. National guidelines. Russian journal of cardiology. 2018;23(6):7-122. (In Russ.)]. https://doi.org/10.15829/1560-4071-2018-6-7-122.
  16. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-2381. https://doi.org/10.1093/eurheartj/ehw106.
  17. Оганов Р.Г., Денисов И.Н., Симаненков В.И., и др. Коморбидная патология в клинической практике. Клинические рекомендации // Кардиоваскулярная терапия и профилактика. – 2017. – Т. 16. – № 6. – С. 5–56. [Oganov RG, Denisov IN, Simanenkov VI, et al. Comorbidities in practice. Clinical guidelines. Cardiovascular therapy and prevention. 2017;16(6):5-56. (In Russ.)]. https://doi.org/10.15829/1727-8800-2017-6-5-56.
  18. Мареев В.Ю., Фомин И.В., Агеев Ф.Т., и др. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение // Кардиология. – 2018. – Т. 58. – № S6. – С. 8–158. [Mareev VY, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(S6):8-158. (In Russ.)]. https://doi.org/10.18087/cardio.2475.
  19. Вологдина И.В., Жабина Р.М. Оценка возрастных особенностей риска кардиоваскулярных осложнений у женщин с раком левой молочной железы при сохраненной фракции выброса на этапе проведения химиолучевой терапии // Кардиология. – 2019. – Т. 59. – № S7. – С. 23–30. [Vologdina IV, Zhabina RM. Age characteristics of risk cardiovascular complications in women with left breast cancer with preserved ejection fraction at the stage of chemotherapy and radiotherapy. Kardiologiia. 2019;59(S7):23-30. (In Russ.)]. https://doi.org/10.18087/cardio.2573.
  20. Муромцева Г.А., Концевая А.В., Константинов В.В., и др. Распространенность факторов риска неинфекционных заболеваний в российской популяции в 2012–2013 гг. Результаты исследования ЭССЕ-РФ // Кардиоваскулярная терапия и профилактика. – 2014. – Т. 13. – № 6. – С. 4–11. [Muromtseva GA, Kontsevaya AV, Konstantinov VV. The prevalence of non-infectious diseases risk factors in Russian population in 2012-2013 years. The results of ECVD-RF. Cardiovascular therapy and prevention. 2014;13(6):4-11. (In Russ.)]. https://doi.org/10.15829/1728-8800-2014-6-4-11.

Supplementary files

Supplementary Files
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1. Fig. 1. The distribution of the patients with different concomitant diseases (%)

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2. Fig. 2. Risk factors assessment according to the SCORE scale (%)

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3. Fig. 3. The level of reactive and personal anxiety according to the Spielberger-Hanin scale

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Copyright (c) 2020 Poroshina E.G., Vologdina I.V., Zhabina R.M., Stanzhevsky A.A., Krasilnikova L.A.

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