Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines
Background Anthracycline‐based chemotherapy is a vital treatment for various cancers but carries notable risks of cardiotoxicity. This study aimed to assess how different body mass index values and glycemic status influence the risk of major adverse cardiovascular events (MACE) in chemotherapy‐naïve...
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Wiley
2025-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.040876 |
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| author | Iokfai Cheang Xu Zhu Xinyi Lu Ying Li Gehui Ni Ying Yang Yue Zhang Qing‐Wen Ren Mei‐Zhen Wu Rongrong Gao Kai‐Hang Yiu Xinli Li |
| author_facet | Iokfai Cheang Xu Zhu Xinyi Lu Ying Li Gehui Ni Ying Yang Yue Zhang Qing‐Wen Ren Mei‐Zhen Wu Rongrong Gao Kai‐Hang Yiu Xinli Li |
| author_sort | Iokfai Cheang |
| collection | DOAJ |
| description | Background Anthracycline‐based chemotherapy is a vital treatment for various cancers but carries notable risks of cardiotoxicity. This study aimed to assess how different body mass index values and glycemic status influence the risk of major adverse cardiovascular events (MACE) in chemotherapy‐naïve adult patients with cancer treated with anthracyclines. Methods This retrospective cohort included 11 393 chemotherapy‐naïve patients who initiated anthracycline‐based chemotherapy between 2000 and 2019. Follow‐up began from the first anthracycline dose. Body mass index was categorized as underweight/normal weight (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Glycemic status was classified as normoglycemic or diabetes/prediabetes (diabetes: hemoglobin A1c ≥6.5% or fasting glucose ≥126 mg/dL; prediabetes: hemoglobin A1c 5.7%–6.4% or fasting glucose 100–125 mg/dL). Results Over a median follow‐up of 8.7 years, 985 (8.64%) patients experienced MACE. Obesity was significantly associated with an increased risk of MACE (hazard ratio [HR], 1.38 [95% CI, 1.10–1.73], reference: underweight/normal weight) and heart failure hospitalization, and diabetes/prediabetes also significantly predicted MACE (HR, 1.28 [95% CI, 1.10–1.50], reference: normoglycemic). Notably, overweight (HR, 0.85 [95% CI, 0.80–0.91]) and obesity (HR, 0.85 [95% CI, 0.74–0.96]) were associated with lower risk of all‐cause mortality. Joint analysis revealed that patients with both obesity and diabetes/prediabetes had the highest risk of MACE (HR, 1.74 [95% CI, 1.28–2.37]) and heart failure hospitalization (HR, 1.99 [95% CI, 1.41–2.81]). Conclusions In patients with cancer undergoing anthracycline‐based chemotherapy, both body mass index and glycemic status significantly affect cardiovascular risks, with the highest risk observed in those with concurrent obesity and diabetes/prediabetes, emphasizing the need for tailored risk assessment and management. |
| format | Article |
| id | doaj-art-2fdef5f480724613a85fd9f82cdbdb8e |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-2fdef5f480724613a85fd9f82cdbdb8e2025-08-20T03:28:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-06-01141110.1161/JAHA.124.040876Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With AnthracyclinesIokfai Cheang0Xu Zhu1Xinyi Lu2Ying Li3Gehui Ni4Ying Yang5Yue Zhang6Qing‐Wen Ren7Mei‐Zhen Wu8Rongrong Gao9Kai‐Hang Yiu10Xinli Li11State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaDivision of Cardiology, Department of Medicine The University of Hong Kong‐ShenZhen Hospital Shenzhen 518009 ChinaDivision of Cardiology, Department of Medicine The University of Hong Kong‐ShenZhen Hospital Shenzhen 518009 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaDivision of Cardiology, Department of Medicine The University of Hong Kong‐ShenZhen Hospital Shenzhen 518009 ChinaState Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 ChinaBackground Anthracycline‐based chemotherapy is a vital treatment for various cancers but carries notable risks of cardiotoxicity. This study aimed to assess how different body mass index values and glycemic status influence the risk of major adverse cardiovascular events (MACE) in chemotherapy‐naïve adult patients with cancer treated with anthracyclines. Methods This retrospective cohort included 11 393 chemotherapy‐naïve patients who initiated anthracycline‐based chemotherapy between 2000 and 2019. Follow‐up began from the first anthracycline dose. Body mass index was categorized as underweight/normal weight (<25 kg/m2), overweight (25–29.9 kg/m2), and obese (≥30 kg/m2). Glycemic status was classified as normoglycemic or diabetes/prediabetes (diabetes: hemoglobin A1c ≥6.5% or fasting glucose ≥126 mg/dL; prediabetes: hemoglobin A1c 5.7%–6.4% or fasting glucose 100–125 mg/dL). Results Over a median follow‐up of 8.7 years, 985 (8.64%) patients experienced MACE. Obesity was significantly associated with an increased risk of MACE (hazard ratio [HR], 1.38 [95% CI, 1.10–1.73], reference: underweight/normal weight) and heart failure hospitalization, and diabetes/prediabetes also significantly predicted MACE (HR, 1.28 [95% CI, 1.10–1.50], reference: normoglycemic). Notably, overweight (HR, 0.85 [95% CI, 0.80–0.91]) and obesity (HR, 0.85 [95% CI, 0.74–0.96]) were associated with lower risk of all‐cause mortality. Joint analysis revealed that patients with both obesity and diabetes/prediabetes had the highest risk of MACE (HR, 1.74 [95% CI, 1.28–2.37]) and heart failure hospitalization (HR, 1.99 [95% CI, 1.41–2.81]). Conclusions In patients with cancer undergoing anthracycline‐based chemotherapy, both body mass index and glycemic status significantly affect cardiovascular risks, with the highest risk observed in those with concurrent obesity and diabetes/prediabetes, emphasizing the need for tailored risk assessment and management.https://www.ahajournals.org/doi/10.1161/JAHA.124.040876anthracycline‐based chemotherapybody mass indexcardiotoxicitycardiovascular outcomesglycemic statusheart failure |
| spellingShingle | Iokfai Cheang Xu Zhu Xinyi Lu Ying Li Gehui Ni Ying Yang Yue Zhang Qing‐Wen Ren Mei‐Zhen Wu Rongrong Gao Kai‐Hang Yiu Xinli Li Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease anthracycline‐based chemotherapy body mass index cardiotoxicity cardiovascular outcomes glycemic status heart failure |
| title | Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines |
| title_full | Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines |
| title_fullStr | Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines |
| title_full_unstemmed | Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines |
| title_short | Interaction of Body Mass Index and Glycemic Status on Cardiovascular Outcomes in Patients With Cancer Treated With Anthracyclines |
| title_sort | interaction of body mass index and glycemic status on cardiovascular outcomes in patients with cancer treated with anthracyclines |
| topic | anthracycline‐based chemotherapy body mass index cardiotoxicity cardiovascular outcomes glycemic status heart failure |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.040876 |
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