Impact of dyslipidemia and obesity on the incidence of cardiotoxicity in breast cancer patients treated with anthracyclines and Trastuzumab

Abstract

Cardiovascular diseases and cancer share many risk factors, general population with metabolic syndrome are known to have an increased risk for cardiovascular diseases, Many studies showed a greater risk of cardiotoxicity in breast cancer patients with metabolic syndrome treated with anthracyclines and/or trastuzumab To assess associations between independent metabolic syndrome components: dyslipidemia, obesity and overweight and chemotherapy-induced cardiotoxicity in patients with breast cancer. Four hundred and seventy-three patients treated with sequential anthracyclines and trastuzumab were followed in the cardio-oncology unit from June 2018 to February 2020. Cardiac monitoring included echocardiographic assessment of LV function before chemotherapy and every 12 weeks after. We then evaluated the risk for cardiotoxicity associated with being overweight defined by a body mass index BMI between 25 kg/m 2 and 29,9 kg/m 2 and obesity (BMI ≥ 30 kg/m 2 ) and dylipidemia defined by total cholestrol level > 2 g/l, LDL-cholesterol level over 1.6 g/l or TriGlycerides TG > 1.5 g/l. Among 473 patients, 90 (19,1%) were obese and 146 (31,2%) were considered overweight and 66 (14%) had dyslipidemia. Overall, the mean rate of cardiotoxicity was 9.5%. Multivariate analysis showed that obesity was significantly associated with a higher risk of cardiotoxicity ( P = 0, 042, 95% CI, 0.77–1.68) whereas overweight wasn’t ( P = 0.931, 95% CI, 0.53–0.89). Even though incidence of cardiotoxicity was higher in the dyslipedimic group versus patients without dyslipidemia, no statistically significant correlation was noted between dyslipidemia and cardiotoxicity (RR = 1.33; P = 0.88, 95% CI, 0.6–2.33) Independently a significant association was found between obesity alone and cardiotoxicity. However, dyslipidemia or high body weight solely didn’t display a significant risk for cardiotoxicity alone. These results should be verified by further studies.