Cardiovascular reserve and risk profile of postmenopausal women after chemoendocrine therapy for hormone receptor - Positive operable breast cancer

Purpose. To examine cardiovascular function and risk profile of postmenopausal women treated with chemoendocrine therapy ( CET) for hormone receptor positive operable breast cancer. Methods. Forty-seven breast cancer patients and 11 age-matched healthy controls were studied. Participants performed a cardiopulmonary exercise test with expired gas analysis and impedance cardiography to assess peak aerobic power ( VO2peak) and cardiovascular function ( stroke volume, cardiac output, cardiac power output, and cardiac reserve). Traditional ( i. e., body mass index, lipid profile, and fasting insulin and glucose) and novel ( i. e., C-reactive protein, brain natriuretic peptide) cardiovascular risk biochemical factors were also assessed. Results. Breast cancer patients had significantly lower peak exercise stroke volume ( 68 +/- 9 versus 76 +/- 11 ml/beat), cardiac output ( 10.4 +/- 1.5 versus 11.7 +/- 2.4 l/minute), cardiac power output ( 3.0 +/- 0.5 versus 3.5 +/- 0.9 Watts), cardiac power output reserve ( 1.7 +/- 0.6 versus 2.4 +/- 0.8 Watts), and VO2peak ( 1.3 +/- 0.3 versus 1.6 +/- 0.2 l.min(-1)) than control subjects ( p-values <.05). Patients with the greatest impairment in VO2peak had the worse cardiovascular risk profile. Exploratory analyses revealed several differences in study outcomes between the 26 patients receiving hormonal therapy with tamoxifen ( TAM) and the 21 patients receiving aromatase inhibitor ( AI) therapy. Conclusion. Breast cancer patients treated with adjuvant CET have a significantly and markedly lower cardiorespiratory fitness and cardiac functional reserve compared with age- and sex-matched controls. AI therapy may be associated with a more unfavorable cardiovascular risk profile than TAM. Prospective studies are required to further investigate the clinical value of these findings.