Framingham risk score and its relationship with cardiorespiratory fitness and physical activity levels in older breast cancer survivors
N Weeldreyer, S J Foulkes, S Paterson, E Pituskin, M J HaykowskyAbstract
Background
Older breast cancer (BC) survivors are at increased risk of developing cardiovascular disease (CVD). The Framingham Risk Score (FRS) is a widely used tool for estimating 10-year risk of atherosclerotic CVD or myocardial infarction. Cardiorespiratory fitness, objectively measured as peak oxygen uptake (VO2peak), is a strong predictor of all-cause and CVD mortality. Despite this, the relationship between VO2peak, physical activity levels, and traditional risk factors used to guide long-term CVD risk in older BC survivors remains understudied.
Purpose
This study aimed to examine whether cardiorespiratory fitness and physical activity levels are associated with 10-year FRS estimates in older, long-term BC survivors.
Methods
BC survivors (≥60 years) who were greater than one year post anthracycline or trastuzumab therapy and without established CVD were enrolled. Cardiorespiratory fitness was assessed using gas- exchange analysis during a graded maximal exercise test performed on a stationary cycle ergometer and weekly physical activity was assessed from a self-report questionnaire. FRS was determined from health history questionnaires (deriving age, smoking history and medication use), fasted blood draw (HDL- and total cholesterol) and resting blood pressure measurement (systolic blood pressure) in order to calculate 10-year risk scores. Pearsons or Spearmans correlation coefficients were used to examine associations between 10-year FRS and VO2peak and self reported physical activity levels. Data are reported as mean ± SD or median (IQR), and statistical significance was set at α < 0.05.
Results
Seventy-one participants were included in the analysis (mean age: 69 ± 5 years, BMI: 27.4 ± 5.4 kg/m2, time post treatment: 13.9 ± 6.1 years). Mean VO2peak was 19.1 ± 4.5 mL/kg/min, and participants self-reported 210 (70-300) minutes of exercise per week. The median composite FRS score was 13.0 (9.3-16.0), corresponding to a 10-year FRS of 10.0 (5.6-15.9). No significant association was found between FRS and VO2peak (ρ = -0.076, p = 0.529). In contrast, self-reported physical activity was significantly, albeit weakly, associated with 10-year FRS (ρ = −0.240, p = 0.047).
Conclusion
Despite its wide-spread clinical use, 10-year FRS score is not related to VO2peak in older BC survivors, despite VO2peak being a major predictor of all-cause and CVD mortality. Future risk stratification should consider adding physical activity and VO2peak alongside FRS to improve CVD prediction in older long-term BC survivors.Correlations between primary outcomes