Abstract
BackgroundCardiovascular disease is a major cause of death in endometrial cancer survivors. The aim of this study was to determine whether women newly diagnosed with endometrial cancer have a higher prevalence of cardiovascular risk factors than the general population. MethodsThe prevalence of adequately treated and unrecognized/inadequately treated cardiovascular risk factors and the corresponding 10-year cardiovascular risk by QRISK2 score was measured in 150 consecutive women undergoing primary treatment for endometrioid endometrial cancer in the North West of England, and 746 age and ethnicity-matched control women from the Health Survey for England 2014. ResultsWomen with endometrial cancer had higher proportions of obesity (BMI≥30 60.7% vs. 32.4%, p<0.0001) and a preponderance of unrecognized and inadequately treated cardiovascular risk factors. Compared with controls, endometrial cancer cases had a higher prevalence of incident hyperglycemia (57.2%vs.11.5%, p<0.0001), total: HDL cholesterol ratio>4.5 (26.7%vs.13.7%, p<0.0001), and were more likely to have three or more cardiovascular risk factors (22%vs.6%, p<0.0001). This equates to a higher 10-year cardiovascular risk (median QRISK2 score 12.6% vs. 8.8%, p<0.0001). Optimization of risk factors would have a greater impact on absolute cardiovascular disease risk for cases than controls (QRISK2 score reduction 1.8% vs. 0.7%). ConclusionsWomen undergoing primary treatment for endometrial cancer have a higher prevalence of cardiovascular risk factors than women without the disease. Early identification and treatment of these risk factors could improve outcomes for endometrial cancer survivors.
Highlights
We recruited consecutive patients with newly diagnosed endometrioid endometrial cancer referred for primary treatment by hysterectomy, who provided written, informed consent to participate in the study
A detailed medical history was obtained through interview and checked against medical records regarding known diagnoses of diabetes, pre-diabetic hyperglycemia, hypertension, hypercholesterolemia and cardiovascular disease, defined as a previous myocardial infarction, angina, coronary artery bypass graft, stroke or transient ischemic attack
Interventions to promote weight loss, aiming for a body mass index (BMI) of 25 kg/m2, smoking cessation and optimization of hypertension and hypercholesterolemia treatment were shown to result in an absolute percentage reduction in cardiovascular risk of 1.8% for women with endometrial cancer compared with a reduction of 0.7% if undertaken in the control population
Summary
Women with a history of endometrial cancer have a higher mortality rate than the general population, if diagnosed at a young age [8]. Rather than dying of their endometrial cancer, cardiovascular deaths predominate in those with early stage disease and this becomes more pronounced the longer women survive their cancer diagnosis. The risk of death from myocardial infarction and stroke is estimated to be two-fold higher than the risk of death from endometrial cancer and nearly nine-fold higher than that of women from the general population [8,9]. Cardiovascular disease is a major cause of death in endometrial cancer survivors. The aim of this study was to determine whether women newly diagnosed with endometrial cancer have a higher prevalence of cardiovascular risk factors than the general population
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