Simon Abigayle B, Looney Jacob C, Blackburn Marsha, Crandall Reva, Thomas Jeffrey, Kellam Paul, Mullen McKay, Guha Avirup, Raval Priyanka, Weintraub Neal L, Harris Ryan A
Georgia Prevention Institute, Medical College of Georgia, Augusta University, Augusta, Georgia, United States.
Department of Medicine, Hematology and Oncology, Medical College of Georgia, Augusta University, Augusta, Georgia, United States.
Am J Physiol Heart Circ Physiol. 2025 Aug 1;329(2):H423-H431. doi: 10.1152/ajpheart.00323.2025. Epub 2025 Jul 10.
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 (V̇o) and near-infrared spectroscopy (NIRS) assessed skeletal muscle oxidative capacity (SMOC). Participants were enrolled 6 ± 5 mo after diagnosis. Chemotherapy exposure ( = 0.897) and cancer stage ( = 0.382) were not different between the groups. NHW women were older (59 ± 12 vs. 53 ± 12 yr; = 0.090), but body mass index (BMI), clinical laboratories, SASP, and allostatic load did not differ (all > 0.05). NHW women demonstrated higher PORH ( < 0.001), LTH ( < 0.001), and Ach responses ( = 0.033), which remained significant after adjusting for cancer stage and chemotherapy. No differences were seen in FMD, PWV, PWA, V̇o, 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. 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.
心血管疾病（CVD）是乳腺癌女性患者的主要死因，与非西班牙裔白人（NHW）女性相比，非西班牙裔黑人（NHB）女性的CVD相关死亡率更高。血管健康方面的差异可能导致了这种差距。本研究评估了患有乳腺癌的NHB和NHW女性的心血管健康状况。45名在确诊后2年内（美国癌症联合委员会（AJCC）0 - 3期）的女性（25名NHW，20名NHB）参与了研究。评估了临床实验室指标、衰老相关分泌表型（SASP）和应激负荷。通过血流介导的血管舒张（FMD）评估传导血管功能；通过皮肤闭塞后反应性充血（PORH）、局部热加热（LTH）和乙酰胆碱（Ach）离子导入评估微血管功能。分别通过脉搏波速度（PWV）和脉搏波分析（PWA）测量动脉和主动脉僵硬度。通过最大运动测试（V̇o）和近红外光谱（NIRS）评估骨骼肌氧化能力（SMOC）。参与者在确诊后6±5个月入组。两组之间的化疗暴露情况（ = 0.897）和癌症分期（ = 0.382）没有差异。NHW女性年龄更大（59±12岁 vs. 53±12岁； = 0.090），但体重指数（BMI）、临床实验室指标、SASP和应激负荷没有差异（均 > 0.05）。NHW女性表现出更高的PORH（ < 0.001）、LTH（ < 0.001）和Ach反应（ = 0.033），在调整癌症分期和化疗后这些差异仍然显著。在FMD、PWV、PWA、V̇o或SMOC方面未发现差异。与NHW女性相比，患有乳腺癌的NHB女性微血管功能受损，且不受社会决定因素、癌症分期或化疗的影响。这些发现表明微血管功能障碍可能导致乳腺癌诊断后CVD风险的种族差异。本研究首次表明，与患有乳腺癌的非西班牙裔白人女性相比，患有乳腺癌的非西班牙裔黑人女性微血管功能受损，尽管她们在健康的社会决定因素、癌症分期和化疗暴露方面相似。这些发现表明早期微血管功能障碍可能导致乳腺癌后心血管风险的种族差异，并强调了对这一高危群体进行有针对性的心血管干预的必要性。
