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Schlam I, Debnath D, Gallagher C, Dilawari AA, Tiwari SR, Aschalew M, Guebre-Xabiher H, Malloy S, Graves K, Barac A, Chitalia A. Abstract P6-05-09: Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p6-05-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Introduction: Breast cancer (BC) is the most common cancer in women in the United States (US). With advances in screening and treatment, there are increasing numbers of BC survivors. Preexisting or emerging cardiovascular (CV) risk factors and some cancer therapies put BC survivors at risk for long-term CV disease (CVD). ASCO clinical practice guidelines for prevention and monitoring of cardiac dysfunction recommend treatment of CV risk factors in cancer survivors, however, the application of these guidelines in clinical practice presents several challenges. In this pilot study, we describe the feasibility of performing CVD risk assessment in a cohort of BC survivors in a single institution in an urban area that serves mostly Black/African American (AA) populations.
Methods: We identified patients with early-stage BC treated between 2015 and 2022. Patients underwent CVD risk assessment including vital signs, hemoglobin A1c, lipid panel, transthoracic echocardiogram (TTE), 6-minute walk test (6MWT), troponin T, and B-type natriuretic peptide (NT-ProBNP). The primary objective of the study was to describe the feasibility of performing a CVD risk assessment.
Results: Out of 69 eligible patients who were approached for the study, 50 were enrolled and completed the CVD risk assessment (72%). Among 19 patients who did not enroll or complete the risk assessment, time constraints to complete the work up was the predominant factor. The median age was 60.5 years (SD = 13.65; range 34-86), 76% self-identified as Black/AA, 14% as White, and 95% as Non-Hispanic. Half of the patients had hormone-receptor-positive BC, 34% human epidermal growth factor receptor 2 (HER2) positive disease (and received HER2-targeted therapies), and 28% triple-negative breast cancer (TNBC). In terms of treatment, 34% received anthracycline-containing regimens. CVD risk assessment results are shown in Table 1. Twenty-four (48%) of the patients had metabolic syndrome defined as the presence of 3 out of 5 CV risk factors (waist circumference, hypertension, low HDL, high triglycerides, insulin resistance). Although all patients had an ejection fraction (EF) above 55%, 7 patients (14%) had an abnormal global longitudinal strain (GLS). The median number of meters in the 6MWT was 369 (SD 94.46, range 67-531); 74% of patients walked a shorter distance than predicted by age and body mass index, indicating significant physical impairment. All patients had a troponin T value below the 99th percentile. The most frequent modifiable CVD-risk factors included obesity and hypertension.
Conclusion: Performing a low-cost CVD risk assessment in a population of mostly Black/AA BC survivors was feasible in this pilot study. We identified a high prevalence of CVD risk factors, with 48% of patients meeting metabolic syndrome criteria and the majority of patients demonstrated a very high level of functional impairment measured by 6MWT. Our findings underscore the importance of survivorship care focused on CVD risk in BC survivors. Limitations include the small sample size, single-institution study, and lack of CV and BC-related outcomes. The higher incidence of TNBC could be explained by a selection bias of patients receiving cytotoxic chemotherapy and the higher incidence of TNBC in the Black/AA population. Future research will focus on implementing this assessment in the survivorship clinic and establishing interventions to decrease CVD risk in cancer survivors.
Table 1. Clinical Measurements & Outcomes (n=50).
Citation Format: Ilana Schlam, Dipanjan Debnath, Christopher Gallagher, Asma A. Dilawari, Shruti R. Tiwari, Malate Aschalew, Hiwot Guebre-Xabiher, Stacy Malloy, Kristi Graves, Ana Barac, Ami Chitalia. Cardiovascular Risk Evaluation for Breast Cancer Survivors: A Pilot Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-09.
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Affiliation(s)
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- 10MedStar Washington Hospital Center
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Malloy S, Genova H, Chiaravalloti N, DeLuca J, Holtzheimer P, Wylie GR. Cognitive fatigue in traumatic brain injury: a pilot study comparing state and trait fatigue. Brain Inj 2021; 35:1254-1258. [PMID: 34487467 DOI: 10.1080/02699052.2021.1972144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Cognitive fatigue is a common and disabling symptom following a traumatic brain injury (TBI). Literature on cognitive fatigue has distinguished between two types of fatigue: "state" fatigue refers to the acute experience of fatigue, whereas "trait" fatigue refers to the susceptibility to fatigue over an extended period. However, it is not clear whether state and trait fatigue are distinguishable constructs. Here, we examine the relationship between state and trait fatigue in individuals with TBI, hypothesizing that trait and state measures assess different constructs. PARTICIPANTS Twenty-one participants with moderate-severe TBI were recruited. DESIGN Participants underwent a cognitively fatiguing task while in an MRI scanner and completed self-report measures examining trait and state fatigue. RESULTS No correlation was found between state and trait fatigue. However, the two measures of trait fatigue, Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS), correlated with one another; additionally only trait fatigue correlated with depression scores, consistent with the literature. CONCLUSION These findings suggest that trait and state fatigue may not be interdependent and that it is important to carefully define the type of fatigue under consideration when assessing fatigue in individuals with TBI.
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Affiliation(s)
- S Malloy
- Geisel School of Medicine at Dartmouth, Departments of Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center (116d), White River Junction, Vermont, USA.,Beth Israel Deaconess Medical Center, Department of General Medicine, Division of Research, Boston, Massachusetts, USA
| | - H Genova
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA
| | - N Chiaravalloti
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA
| | - J DeLuca
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA.,Department of Neurology, Rutgers University, Newark, New Jersey, USA
| | - P Holtzheimer
- Geisel School of Medicine at Dartmouth, Departments of Psychiatry and Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,National Center for Posttraumatic Stress Disorder, Veterans Affairs Medical Center (116d), White River Junction, Vermont, USA
| | - G R Wylie
- Kessler Foundation, West Orange, USA.,Department of Physical Medicine and Rehabilitation, Rutgers University, Newark, New Jersey, USA.,The Department of Veterans' Affairs, The War Related Illness and Injury Center, New Jersey Healthcare System, East Orange, New Jersey, USA
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Malloy S, Root E, McAfee K, Newton E, Abernathy D, Sauer A, Steen A, Horack J. Risk communication of zoonotic spillover: initial lessons from a satellite-based forecasting platform. Int J Infect Dis 2019. [DOI: 10.1016/j.ijid.2018.11.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Jungklaus T, Malloy S, Anderson S, Cleeton T, Perez J, Anderson T, Schmalfuss C, Schofield R. Preservation of Quality of Life in Patients Enrolled in a Multidisciplinary Heart Failure Disease Management Program within the Veterans Administration. Heart Lung 2013. [DOI: 10.1016/j.hrtlng.2013.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jungklaus T, Malloy S, Mullikin A, Anderson S, Reeder D, Chapman D, Schmalfuss C, Schofield R, Schofield R. A novel heat failure disease management strategy reduces heart failure readmissions in veterans with heart failure. Heart Lung 2010. [DOI: 10.1016/j.hrtlng.2010.05.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Knouff C, Malloy S, Wilder J, Altenburg MK, Maeda N. Doubling expression of the low density lipoprotein receptor by truncation of the 3'-untranslated region sequence ameliorates type iii hyperlipoproteinemia in mice expressing the human apoe2 isoform. J Biol Chem 2001; 276:3856-62. [PMID: 11076954 DOI: 10.1074/jbc.m009423200] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The primary receptor mediating clearance of apolipoprotein (apo)E- and apoB100-containing lipoproteins from the circulation is the low density lipoprotein (LDL) receptor. Reduced expression of the LDLR is believed to be a precipitating factor in the pathogenesis of type III hyperlipoproteinemia (HLP) in some humans homozygous for the apoE2 allele (APOE*2). To test the effect of genetic changes in LDL receptor expression on the pathogenesis of type III HLP, we have generated a variant allele at the endogenous mouse Ldlr locus that expresses the human LDL receptor transcript. Transcription of the human LDLR minigene is regulated by the endogenous mouse promoter sequence, but a truncation of 3'-untranslated region results in increased mRNA stability. Consequently, in liver of heterozygotes, steady state levels of mouse and human LDLR transcripts are 50 and 180% the levels of total transcript in wild type mice, respectively. Overall, the 2.3-fold normal level of LDLR message in heterozygotes completely ameliorates type III HLP caused by the homozygosity for the human APOE*2 allele, normalizing their plasma lipoprotein profile. We conclude that a modest increase in expression of the LDLR through message stabilization is sufficient to prevent precipitation of type III HLP in mice.
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Affiliation(s)
- C Knouff
- Curriculum in Genetics and Molecular Biology and the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina 27599-7525, USA
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