Arterial stiffness analyzing in breast cancer patients after receiving antracycline based chemotherapy regimens with trastuzumab

Aim: Cardiovascular diseases are the primary cause of premature morbidity and mortality in early breast cancer patients cured by cardiotoxic agents. Currently, cumulative antracyclin dosage is restricted to 450 mg/m2 to avoid cardiotoxicity. Especially in HER2(+) patients, trastuzumab, another cardiotoxic agent, is widely used with anthracyclines, however; the potential cardiovascular effects are not yet well defined and, inexpensive, non-invasive and practical tools are needed in this era. Arterial stiffness is an independent risk factor for future cardiovascular diseases and might be used as a predictive marker of subclinical cardiac damage. The aim of this study was to analyze the arterial stiffness in breast cancer patients in the follow-up period without heart failure and cancer recurrence after receiving antracycline based chemotherapy regimens with trastuzumab, to evaluate their risk status for late cardiovascular complications. Methods: We enrolled 45 HER2(+) patients in follow-up at least for six months after completion of adjuvant antracycline based chemotherapy with trastuzumab for breast cancer and 30 age, sex and cardiovascular risk matched controls (totally 75 women). In laboratuary analyzes routine fasting blood glucose, lipid profiles and hemograms were obtained from the patients records. The measurements obtained by pulse wave analyzes machine (Mobil-O-Graph®) were obtained by the same operator after 15 minutes rest period. The data were analyzed by Statistical Package for Social Sciences for Windows version 17 packet programme. Results: Mean pulse wave velocity as an indicator of arterial stiffness, was higher in patients compared to controls (7,27±1,24 vs. 5,78±1,43 respectively, p<0,05). There was no correlation in-between the type of the operation for breast cancer and the existence of radiotherapy with arterial stiffness. The patients' pulse wave velocity was not affected related to their different anthracycline based chemotherapy regimens with trastuzumab. Existence of hormonal treatment and the type of medication (tamoxifen or aromatase inhibitor) had influence on pulse wave velocity. In patients receiving aromatase inhibitors, the pulse wave velocity was significantly higher compared to patients under tamoxifen or no treatment. Advanced age (p<0,01; r = 0,871), sytolic hypertension (p<0,008; r = 0,396) and postmenopausal status were the factors correlated with pulse wave velocity for the patients. Pulse wave velocity was 5,93±0,19 in premenopausal, 5,50±0,43 in perimenopausal and 7,54±0,24 in postmenopausal patients (p<0,04). The pulse wave velocity was significantly higher in postmenapausal patients as compared to postmenopausal controls (8,18±0,19 vs. 6,48±0,42 respectively, p=0,001). Conclusions: Pulse wave velocity is increased in patients who had received anthracycline based chemotherapy with trastuzumab for breast cancer. In the follow-up of patients, arterial stiffness measurements might predict the ones with higher risk for cardiovascular events earlier and enable the necessary preventive approaches and/or treatments. Further studies may be appropriate for the reduction of cardiovascular morbidity and mortality in early breast cancer patients.