Ideal Cardiovascular Health in Patients with a Recent Diagnosis of Colorectal Cancer - European Medical Journal
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Ideal Cardiovascular Health in Patients with a Recent Diagnosis of Colorectal Cancer

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Authors:
*Ana Ruiz-Casado, Javier Ramos, Alejandro Alvarez-Bustos, Beatriz Núñez, María Soriano, Raquel Gomez, Lourdes Gutierrez
Disclosure:

The authors have declared no conflicts of interest.

Acknowledgements:

The authors would like to thank Janice Hicks for her writing assistance.

Citation
EMJ Oncol. ;5[1]:46-48. Abstract Review No. AR6.

Each article is made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.

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Colorectal cancer survivors have an elevated risk of comorbid disease, particularly cardiovascular (CV) disease, due to both the age at diagnosis (around 60 years) and shared lifestyle risk factors; namely, being overweight/obese, physical inactivity, poor diet, and smoking.1,2 BMI is the strongest correlate of comorbid CV disease in cancer survivors.2 Comorbid chronic conditions can have a negative impact on colorectal cancer survival and can be a cause of death in these patients.3 In fact, coronary artery disease is the leading cause of death in colorectal cancer survivors 10 years after diagnosis.  There is mechanistic evidence that obesity induces alterations in proinflammatory cytokines, lipid metabolites, adipokines, and insulin growth factor signalling pathways.4

Health behaviours seem to have an impact on outcomes after the diagnosis of colorectal cancer.5 There is strong evidence of the benefits of physical activity in cancer outcomes after the diagnosis of colorectal cancer.6 Unfortunately, most of these studies were conducted using a questionnaire, which is very well-known to constitute an important bias, since patients overestimate physical activity and underestimate sedentarism.7 A number of studies have documented the prevalence of comorbid chronic conditions in colorectal cancer survivors.3 However, there is no study of cancer survivors that focusses on the current American Heart Association (AHA) policy on CV health. To define CV health, the Committee of the Strategic Planning Task Force of the AHA adopted positive language, defining health factors instead of risk factors, and health behaviours instead of risk behaviours.8 Whereas behaviours are modifiable, factors are not.

The objective of our study was to describe the CV health of a cohort of recently diagnosed colorectal cancer patients. The criteria used to define an ideal CV health in our sample were very restrictive. In order to adhere to current recommendations, ≥150 minutes of moderate-to-vigorous physical activity needed to be recorded through accelerometers. Diet was evaluated using the PREDIMED questionnaire, which evaluated the adherence of participants to a Mediterranean diet. Patients who did not report CV risk factors had their values for blood pressure, BMI, glucose, and cholesterol measured at hospital (Table 1). Ideal CV health was considered only when both four behaviours and three health factors were present at the same time.

Table 1: The cardiovascular health of a cohort of patients with recently diagnosed colorectal cancer.
CV: cardiovascular; DL: dyslipidaemia; DM: diabetes mellitus; HT: hypertension; ICVH: ideal cardiovascular health; MVPA: moderate-to-vigorous physical activity.

Of the 91 patients who were recruited, only 1 patient achieved seven metrics, which represented 1.1% of our sample having ideal CV health. Even when objectively measured, our sample was overall compliant with physical activity recommendations, confirming previous findings in Spanish cancer survivors.9 Being overweight/obese was the most prevalent unhealthy behaviour.

Becoming overweight or obese is the result of chronic energy imbalance. A significant controversy in the field is the so-called ‘obesity paradox’, which confers a better prognosis to obese metastatic colorectal cancer survivors.10 The relationships between energy balance and prognosis, sarcopenia, sarcopenic obesity, and cancer outcomes, in addition to the biologic mechanisms that mediate this relationship, are promising areas that warrant additional investigation.

References
Pursnani A et al. Guideline-based statin eligibility, cancer events and noncardiovascular mortality in the Framingham Heart Study. J Clin Oncol. 2017;35(25):2927-33. Hawkes AL et al. Lifestyle factors associated concurrently and prospectively with co-morbid cardiovascular disease in a population-based cohort of colorectal cancer survivors. Eur J Cancer. 2011;47(2):267-76. Tong L et al. Temporal trends in the leading causes of death among a large national cohort of patients with colorectal cancer from 1975 to 2009 in the United States. Ann Epidemiol. 2014;24(6):411-7. Park J et al. Obesity and cancer-mechanisms underlying tumour progression and recurrence. Nat Rev Endocrinol. 2014; 10(8):455-65. Vrieling A, Kampman E. The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: A review of the literature. Am J Clin Nutr. 2010; 92(3):471-90. Campbell PT et al. Associations of recreational physical activity and leisure time spent sitting with colorectal cancer survival. J Clin Oncol. 2013;31(7):876-85. Ruiz-Casado A et al. Validity of the physical activity questionnaires IPAQ-SF and GPAQ for cancer survivors: Insights from a Spanish cohort. Int J Sports Med. 2016;37(12):979-85. Lloyd-Jones DM et al.; American Heart Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586-613. Ruiz-Casado A et al. Objectively assessed physical activity levels in Spanish cancer survivors. Oncol Nurs Forum. 2014; 41(1):E12-20. Kokarnik JM et al. Long-term weight loss after colorectal cancer diagnosis is associated with lower survival: The Colon Cancer Family Registry. Cancer. 2017. [Epub ahead of print].