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Racial disparity in microvascular function among women with newly diagnosed breast cancer
Abigayle B Simon1, Jacob Looney1, Marsha Blackburn1
1Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, United States.
Insights
Non-Hispanic Black women with breast cancer show impaired microvascular function compared to non-Hispanic White women. This suggests microvascular dysfunction may drive cardiovascular disease disparities post-diagnosis, necessitating targeted interventions.
Area of Science:
- Cardiovascular Health and Oncology
- Vascular Biology and Disparities Research
Background:
- Cardiovascular disease (CVD) is a major cause of death in women with breast cancer.
- Non-Hispanic Black (NHB) women face higher CVD mortality than non-Hispanic White (NHW) women, potentially due to vascular health differences.
- Understanding these vascular differences is crucial for addressing racial disparities in breast cancer survivorship.
Purpose of the Study:
- To assess and compare cardiovascular health, specifically microvascular function, between NHB and NHW women diagnosed with breast cancer.
- To investigate whether differences in vascular health persist independent of social determinants, cancer stage, or chemotherapy exposure.
- To identify potential mechanisms contributing to CVD disparities in this population.
Main Methods:
- Cross-sectional study involving 45 women (20 NHB, 25 NHW) within 2 years of breast cancer diagnosis (AJCC stages 0-3).
- Assessed microvascular function using cutaneous postocclusive reactive hyperemia (PORH) and local thermal heating (LTH).
- Measured conduit artery function (flow-mediated dilation), arterial stiffness (pulse-wave velocity), and skeletal muscle oxidative capacity (V̇o2peak).
Main Results:
- NHB women exhibited significantly impaired microvascular function (lower PORH and LTH responses) compared to NHW women.
- These differences remained significant after adjusting for age, cancer stage, and chemotherapy exposure.
- No significant differences were observed in conduit artery function, arterial stiffness, or skeletal muscle oxidative capacity between groups.
Conclusions:
- NHB women with breast cancer demonstrate impaired microvascular function compared to NHW counterparts, independent of key confounding factors.
- Early microvascular dysfunction may be a key contributor to the observed racial disparities in cardiovascular risk following breast cancer diagnosis.
- Findings highlight the urgent need for targeted cardiovascular risk assessment and interventions in NHB women treated for breast cancer.
Abstract:
Cardiovascular disease (CVD) is a leading cause of death in women with breast cancer, with non-Hispanic Black (NHB) women experiencing higher CVD-related mortality compared with non-Hispanic White (NHW) women. Differences in vascular health may contribute to this disparity. This study assessed cardiovascular health in NHB and NHW women with breast cancer. Forty-five women (25 NHW, 20 NHB) within 2 yr of diagnosis [American Joint Committee on Cancer (AJCC) stages 0-3] participated. Clinical laboratories, senescence-associated secretory phenotype (SASP), and allostatic load were assessed. Flow-mediated dilation (FMD) assessed conduit vessel function; cutaneous postocclusive reactive hyperemia (PORH), local thermal heating (LTH), and iontophoresis of acetylcholine (Ach) assessed microvascular function. Pulse-wave velocity (PWV) and pulse-wave analysis (PWA) measured arterial and aortic stiffness, respectively. Maximal exercise testing (V̇o2peak) and near-infrared spectroscopy (NIRS) assessed skeletal muscle oxidative capacity (SMOC). Participants were enrolled 6 ± 5 mo after diagnosis. Chemotherapy exposure (P = 0.897) and cancer stage (P = 0.382) were not different between the groups. NHW women were older (59 ± 12 vs. 53 ± 12 yr; P = 0.090), but body mass index (BMI), clinical laboratories, SASP, and allostatic load did not differ (all P > 0.05). NHW women demonstrated higher PORH (P < 0.001), LTH (P < 0.001), and Ach responses (P = 0.033), which remained significant after adjusting for cancer stage and chemotherapy. No differences were seen in FMD, PWV, PWA, V̇o2peak, or SMOC. NHB women with breast cancer exhibited impaired microvascular function compared with NHW women, independent of social determinants, cancer stage, or chemotherapy. These findings suggest microvascular dysfunction may contribute to racial disparities in CVD risk after breast cancer diagnosis.NEW & NOTEWORTHY This study is the first to show that non-Hispanic Black women with breast cancer have impaired microvascular function compared with non-Hispanic White women with breast cancer, despite similar social determinants of health, cancer stage, and chemotherapy exposure. These findings suggest early microvascular dysfunction may contribute to racial disparities in cardiovascular risk after breast cancer and highlight the need for targeted cardiovascular interventions in this high-risk group.
