ATHEROSCLEROSIS PROGRESSION IN PATIENTS WITH BREAST CANCER IN THE SHORT-TERM PERIOD

Abstract

Objective: The cardiovascular care of patients who have cancer, have received broad attention. Inflammatory status associated with malignancies and promoted atherosclerosis during cancer therapies have been established. Lipoprotein (a) [Lp(a)] is a proven risk factor for atherosclerosis (AS) progression. Lp(a) blood level is quite stable during proinflammatory conditions. We aimed to evaluate the association between Lp(a), IgM and IgG autoantibodies against apoB100-containing lipoproteins and its Cu2+ oxidized (ox) modifications with the progression of carotid AS in patients with breast cancer after 6 months of cancer therapy.Design and method: 50 women with newly diagnosed breast cancer (HER2-positive, stage II-III), mean age 50 (40;57) years were enrolled. Lipid profile, serum Lp(a), IgM and IgG autoantibodies against Lp(a) and low density lipoprotein (LDL) or oxLp(a) and oxLDL were assessed before the onset of neoadjuvant cancer therapy with trastuzumab, paclitaxel, doxorubicin, cyclophosphamide. Carotid intima-media thickness (CIMT), the percentage of stenosis of the common carotid (CCA) and internal carotid (ICA) arteries was analyzed at baseline and after 6 months. New stenosis >20% or increase of preexisting stenosis >5% of carotid arteries was considered as AS progression. CIMT increase was considered at > 0.1 mm. Results: AS progression was revealed in 25 (50%) patients; CIMT increase was observed in 20 (40%) patients. Patients with CIMT increase had the higher values of Lp(a) concentrations at baseline (18.8 mg/dl (11.2;32.6) against 5.6 mg/dl (3.7;17.9), p = 0.01). Lp(a) plasma level above 11.5 mg/dl was a risk factor for CIMT increase (OR 6.0 (1.7;21.2), p = 0.005; AUC 0.71 (95% CI 0.56–0.86, p = 0.01, figure 1). The conventional risk factors (age, BMI, arterial hypertension, smoking) as well as the plasma levels of total cholesterol, LDL, triglycerides, IgM and IgG autoantibodies against Lp(a), LDL or its oxidized modification did not possess the prognostic value for carotid AS progression in this 6-month study. Conclusions: We speculate that Lp(a) level above 11.5 mg/dl in HER2+ breast cancer patients may indicate a predisposition to the progression of atherosclerosis in the short-term period of cancer treatment.