Breast cancer therapy associated changes in thoracic aortic distensibility in those with or without hypertension (UPBEAT WF-97415)

Aortic stiffness or reduced distensibility may contribute to adverse cardiovascular events including myocardial infarction and stroke. This study assessed changes in thoracic ascending aortic distensibility (AAD) in breast cancer (BC) patients receiving potentially cardiotoxic chemotherapy relative to the presence or absence of pre-existing hypertension (HTN). This pre-specified secondary analysis of studies UPBEAT (R01CA199167, WF-97415) and DETECT IV (R01CA167821, WF-99112) enrolled 97 women (77 white, 11 Black, 1 other, and 8 not disclosed) with BC receiving potentially cardiotoxic cancer therapy. The women were 56 ± 10 years in age and were grouped by HTN status (with or without). Using cardiovascular magnetic resonance imaging (CMR), AAD was measured prior to and three-months after initiating potentially cardiotoxic chemotherapy by individuals blinded to participants’ identifiers. A linear mixed model was fitted for increasing distensibility over time (with random intercepts per participant). After accounting for age, body mass index, diabetes, and tobacco use, we found a significant interaction between time and HTN ( p = 0.011) such that the 3-month change in AAD was influenced by the presence of pre-treatment HTN. Patients without pre-treatment HTN experienced a mean decrease in AAD of 0.5 mmHg-1 × 10 − 3 (95% CI: [0.0001, 0.001], p = 0.012), while patients with pre-treatment HTN did not (0.17 mmHg-1 × 10 − 3 (95% CI: [-0.0002, 0.0005], p = 0.35)). In women with BC without pre-existing HTN, AAD diminishes rapidly in the first three months after initiating potentially cardiotoxic chemotherapy to a level that is similar in magnitude to women with BC and pre-existing HTN. UPBEAT, NCT02791581 (first posted (estimated) date to clinicaltrials.gov: 2016-06-07). DETECT IV, NCT01719562 (first posted (estimated) date to clinicaltrials.gov: 2012-11-01)