All ETDs from UAB

Advisory Committee Chair

Karen Meneses

Advisory Committee Members

Kelly Kenzik

Dheeraj Raju

Wendy Landier

James K Kirklin

Document Type

Dissertation

Date of Award

2018

Degree Name by School

Doctor of Philosophy (PhD) School of Nursing

Abstract

Background: There are nearly 3.5 million breast cancer survivors in the U.S., and approximately 10% are diagnosed prior to age 45 and considered “young.” The overall five-year survival rate for breast cancer survivors is approaching 90%. Living longer, many breast cancer survivors are at risk for developing cardiovascular disease due to cancer treatment, such as anthracyclines and/or trastuzumab. This study’s purpose was to examine cardiovascular disease risk, measured using excess heart age, among young breast cancer survivors. Methods: A retrospective, two-year longitudinal design was used to review electronic medical records of breast cancer survivors diagnosed between 30 and 44 years of age and treated at UAB Hospital. Heart age was calculated using chronological age, systolic blood pressure, antihypertensive medication use, body mass index, diabetes status, and smoking status. Excess heart age is the difference between heart age and chronological age. Excess heart age was examined at two time points: diagnosis and two-year follow-up. Statistical analyses included between-group and within-group mean comparison tests, linear regression modeling, and cluster analyses, conducted using R v3.2.2. Results: Records were reviewed for 152 young breast cancer survivors; 95 were treated with anthracyclines and/or trastuzumab (Group A/T) and 57 were not (Group No-A/T). Overall excess heart age was 4.2 to 5.4 years from diagnosis to follow-up (p = .08). Group A/T did not have a statistically significant difference in excess heart age from diagnosis to two-year follow-up (4.3 to 4.4 years, p = .93), whereas Group No-A/T had a significant increase (4 to 7.1 years, p <. 01). Factors that predicted excess heart age included hormone therapy and change in menopause status from premenopausal to postmenopausal. Conclusions: Overall, excess heart age increased 1.2 years and may be clinically relevant. Records of young breast cancer survivors treated with anthracyclines and/or trastuzumab did not indicate increased excess heart age at follow-up. Group No-A/T had a significant increase of 3.1 years, which may be related to hormone therapy and/or treatment-induced menopause. Future research should evaluate cardiovascular disease risk over longer follow-up, consider incorporating cancer treatment risk factors into heart age, and develop a cancer-specific heart age measure.

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