Comparison of cardiovascular disease risk in women with and without breast cancer: secondary data analysis with the 2014-2018 korean national health and nutrition examination survey.

BACKGROUND: Aging breast cancer survivors may be at an elevated risk of cardiovascular disease (CVD), but little is known about CVD risk assessment and breast cancer in Korean women. We hypothesized that Korean breast cancer survivors would have higher risks of future CVD within the next 10 years (i.e., Framingham Risk Score [FRS]) than women without cancer. OBJECTIVES: (1) To compare FRS-based CVD risks in women with and without breast cancer based on propensity score matching; and (2) To explore adiposity-related measures in relation to FRS in Korean women with breast cancer. METHODS: Using the cross-sectional data from the 2014-2018 Korean National Health and National Survey (KNHANES), we identified 136 women with breast cancer aged 30-74 years who had no other cancer and no CVD. The comparison group of 544 women with no cancer were selected by 1:4 nearest-neighbor propensity score matching based on breast cancer diagnosis. CVD risk was assessed by FRS based on multiple traditional risk factors (e.g., cholesterol, blood pressure, diabetes, and smoking). Adiposity was measured by physical examination, including body mass index (BMI) and waist-to-height ratio (WHtR). Physical activity and health behaviors were assessed by self-reports. RESULTS: Women with breast cancer (mean age of 57 years) had similar FRS levels at a low-risk category (< 10%) to women with no cancer (4.9% vs. 5.5%). Breast cancer survivors (mean 8.5 survival years) presented at significantly lower levels of total cholesterol, BMI, and WHtR (all p values < 0.05) than their counterpart. Within the breast cancer group, WHtR ≥ 0.5 was associated with higher FRS, compared to WHtR < 0.5. FRS was not different by survival < 5 years or ≥ 5 years after breast cancer diagnosis. CONCLUSIONS: FRS-based CVD risks were not different in Korean, mostly postmenopausal, women by breast cancer status. Whereas breast cancer survivors had even lower levels of lipid and adiposity measures than women without cancer, those values indicating borderline cardiometabolic risk suggest continued screening and management efforts for these aging women. Future studies are needed to examine longitudinal trajectories of CVD risk factors and CVD outcomes among Korean breast cancer survivors.

Handgrip Strength and All-Cause Mortality in Middle-Aged and Older Koreans.

Aging-related decline in handgrip strength has been associated with adverse functional and metabolic morbidity and mortality. Korea is one of the fastest aging countries, and the prospective relationship of handgrip strength with all-cause mortality in Korean adults has not been studied. We conducted a prospective observation study to examine whether baseline handgrip strength predicted mortality over eight years of follow-ups in Korean adults aged 45 years or older. We analyzed the nationwide survey data based on 9393 Korean adults (mean age of 61 ± 10.7 years) from the 2006⁻2014 Korean Longitudinal Study of Aging. The mean handgrip strength values measured using a dynamometer, and were divided into quartiles for each gender. Cox models were conducted in order to estimate the hazard ratios (HRs) of all-cause mortality with 95% confidence intervals (CIs) in relation to handgrip strength adjusting for covariates. There was a robust independent relationship between a weaker handgrip strength and higher all-cause mortality in both women and men, adjusting for selected covariates (e.g., age, income, smoking, exercise, and comorbidities). Compared to the strongest quartile (i.e., reference), women and men in the weakest group had higher HRs of mortality, 2.5 (95% CI: 1.7⁻3.8) vs. 2.6 (95% CI: 1.8⁻3.9), respectively. The robust independent relationships between weaker handgrip strength and higher all-cause mortality found in the study suggest that simply assessing and monitoring the handgrip strength during adulthood demonstrates great potentials for the public health of aging populations, and protects against premature death in Korean adults.

The Influence of Psychological Stress, Depressive Symptoms, and Cortisol on Body Mass and Central Adiposity in 10- to-12-Year-Old Children.

PURPOSE: The purpose of this study was to examine the influence of psychological stress and depressive symptoms on body mass and central adiposity in 10-to-12-year-old children and to determine the mediating role of cortisol in the relationships among psychological stress, depressive symptoms, body mass, or central adiposity. DESIGN AND METHODS: The convenience sample included 147 children (84 females; 63 males) who were recruited from one middle school and three elementary schools in a rural area of a southeastern state. Height, weight, waist circumference (WC), and salivary cortisol were measured. Children completed the Rating Scale for Pubertal Development for screening, Children's Depression Inventory, and the Feel Bad Scale. Bivariate correlation, multiple regression analyses, and univariate regression techniques were used in data analyses. RESULTS: A positive relationship between psychological stress and depressive symptoms (r = 0.559, p < .001) was found. Depressive symptoms explained a significant amount of the variance in body mass index (BMI) (ß = 0.37, p ≤.001) and central adiposity (ß = 0.40, p ≤ .001) when sex, race/ethnicity, puberty, and socioeconomic status were controlled. No statistically significant relationships were found between psychological stress and cortisol or between depressive symptoms and cortisol. CONCLUSIONS: Depressive symptoms were reported by normoweight, overweight, and obese children. Depressive symptoms accounted for variance in body mass and central adiposity. Practice Implications In addition to regular screening of BMI and WC, nurses and other health care professionals need to consider psychological factors that contribute to childhood obesity.

Cardiovascular disease and mortality after breast cancer in postmenopausal women: Results from the Women's Health Initiative.

BACKGROUND: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among older postmenopausal women. The impact of postmenopausal breast cancer on CVD for older women is uncertain. We hypothesized that older postmenopausal women with breast cancer would be at a higher risk of CVD than similar aged women without breast cancer and that CVD would be a major contributor to the subsequent morbidity and mortality. METHODS: In a prospective Women's Health Initiative study, incident CVD events and total and cause-specific death rates were compared between postmenopausal women with (n = 4,340) and without (n = 97,576) incident invasive breast cancer over 10 years post-diagnosis, stratified by 3 age groups (50-59, 60-69, and 70-79). RESULTS: Postmenopausal women, regardless of breast cancer diagnosis, had similar and high levels of CVD risk factors (e.g., smoking and hypertension) at baseline prior to breast cancer, which were strong predictors of CVD and total mortality over time. CVD affected mostly women age 70-79 with localized breast cancer (79% of breast cancer cases in 70-79 age group): only 17% died from breast cancer and CVD was the leading cause of death (22%) over the average 10 years follow up. Compared to age-matched women without breast cancer, women age 70-79 at diagnosis of localized breast cancer had a similar multivariate-adjusted hazard ratio (HR) of 1.01 (95% confidence interval [CI]: 0.76-1.33) for coronary heart disease, a lower risk of composite CVD (HR = 0.84, 95% CI: 0.70-1.00), and a higher risk of total mortality (HR = 1.20, 95% CI: 1.04-1.39). CONCLUSION: CVD was a major contributor to mortality in women with localized breast cancer at age 70-79. Further studies are needed to evaluate both screening and treatment of localized breast cancer tailored to the specific health issues of older women.

Auricular Point Acupressure to Manage Aromatase Inhibitor-Induced Arthralgia in Postmenopausal Breast Cancer Survivors: A Pilot Study.

PURPOSE/OBJECTIVES: To assess the feasibility of auricular point acupressure to manage aromatase inhibitor-induced arthralgia.
. DESIGN: Wait list control design.
. SETTING: Outpatient clinics and oncology center.
. SAMPLE: 20 women with aromatase inhibitor-induced arthralgia.
. METHODS: After baseline data were collected, participants waited one month before they received acupressure once per week for four weeks at a convenient time. The baseline data served as the control comparison. Self-reported measures and blood samples were obtained at baseline, at preintervention, weekly during the intervention, and at post-intervention.
. MAIN RESEARCH VARIABLES: The primary outcomes included pain intensity, pain interference, stiffness, and physical function. Inflammatory cytokines and chemokines were tested.
. FINDINGS: After the four-week intervention, participants reported decreases in worst pain and pain interference, and improvements in physical function, cancer-related symptom severity, and interference. The proinflammatory cytokines and chemokines displayed a trend of a mean percentage reduction. The anti-inflammatory cytokine interleukin-13 increased from pre- to postintervention.
. CONCLUSIONS: Auricular point acupressure is feasible and may be effective in managing arthralgia in breast cancer survivors.
. IMPLICATIONS FOR NURSING: Nurses can administer acupressure in clinical settings, which could enhance the management of aromatase inhibitor-induced arthralgia and contribute to a shift from traditional disease-based biomedical models to a broader, integrative, medical paradigm for managing aromatase inhibitor-induced arthralgia.

Child and Maternal Factors That Influence Child Blood Pressure in Preschool Children: An Exploratory Study.

PURPOSE: Hypertension is a risk factor for cardiovascular disease (CVD) in adults and children and has its origins in childhood. While the prevalence of hypertension in children is estimated to be 2 to 5%, instance elevations in blood pressure readings (BPRs) in school-age children and adolescents are more common, track to adulthood, and are an independent risk factor for CVD. Less information is available about BPR in the preschool period and what child factors could influence those BPR. The primary aims of this exploratory study were to determine child blood pressure (BP) levels and determine effect sizes of the relationships between child and maternal factors that can influence child BP. METHODS: A convenience sample of 15 rural and 15 urban children enrolled in Head Start programs (13 males; 14 females; all black) with ability to understand and speak English and with mothers who gave consent and could understand, read and speak English were enrolled. Mothers completed demographic information about their child including, gender, birth history and age. Height, weight, waist circumference and BP were measured in the mothers and the children. Children gave saliva specimens for cortisol and C-reactive protein. RESULTS: Over 37% of the children had elevated BPR with over 20% at or above the 95th percentile. Effect sizes of relationships ranged from very small to large. CONCLUSION: Elevations in BPR may be seen as early as preschool. It is important to examine factors, both child and maternal that influence BP.

Designing an Internet-Based Intervention Tailored to Psychological Factors for CVD Risk Reduction: Role of Stress and Anger.

PURPOSE: To examine the mediating role of occupational stress on the relationship of anger expression to cardiovascular disease (CVD) risk using Framingham risk score equation in Korean adults with metabolic syndrome. METHODS: This cross-sectional study was a secondary analysis of baseline data from a longitudinal study conducted in 91 Korean male workers. Psychological variables were assessed using structured questionnaires. RESULTS: Occupational stress was significantly predictive of CVD risk (ß=.278, p=.008). The inclusion of occupational stress non-significantly decreased the standardized beta by 33.6% for anger expression as a predictor of CVD risk (ß=.152, p=.163). The Sobel test showed a significant mediating effect between occupational stress and CVD risk (p<0.01). CONCLUSION: This mediating role of occupational stress has important clinical implications as interventions designed to manage anger expression to reduce CVD risk in this population.

Inflammatory cytokine levels and breast cancer risk factors: racial differences of healthy Caucasian and African American women.

PURPOSE/OBJECTIVES: To examine racial differences in inflammatory cytokine levels (interleukin [IL]-6 and interferon-gamma [IFN-γ]) and breast cancer (BC) risk factors between healthy Caucasian and African American women; to examine differences in relationships of inflammatory cytokine levels with BC risk factors between these groups of women; and to determine the independent contribution of race to IL-6 and IFN-γ after controlling for relevant covariates. DESIGN: Cross-sectional and correlational descriptive design. SETTING: Community surrounding a state university health system in the southeastern United States. SAMPLE: 113 healthy women (65 Caucasians and 48 African Americans) aged 20 years or older and not pregnant. METHODS: Secondary analysis of data collected from self-report questionnaires and blood samples. MAIN RESEARCH VARIABLES: Inflammatory cytokine levels, BC risk factors (age, age at menarche, age at first live birth, family history of BC, breast biopsy, breastfeeding history and duration, body mass index, and physical activity), and race. FINDINGS: Significant racial differences were noted in IL-6 and IFN-γ levels, reproductive or hormonal and lifestyle BC risk factors, and relationships between African American and Caucasian women. Controlling for all other effects, race appeared to be a significant predictor for IL-6 and IFN-γ. CONCLUSIONS: Racial differences in inflammatory cytokines and BC risk factors may provide partial evidence for existing racial disparities in BC for African American and Caucasian women. Additional studies are needed to confirm that potential. IMPLICATIONS FOR NURSING: Additional biobehavioral research in racial disparities in BC may help to inform nurses to target race-specific modifications of lifestyle and behavioral factors to reduce BC health disparity between African American and Caucasian women. KNOWLEDGE TRANSLATION: Being an African American woman predicted a higher level of inflammatory cytokine production after controlling for selected BC risk factors. Great potential exists for inflammatory responses as one of the underlying biologic mechanisms for existing BC disparity and for culturally tailored lifestyle or behavioral modification interventions for reducing BC risk and racial disparity.

Cancer-specific stress and mood disturbance: implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer.

Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.

Dose effects of relaxation practice on immune responses in women newly diagnosed with breast cancer: an exploratory study.

PURPOSE/OBJECTIVES: To determine the dose effects of relaxation practice on immune responses and describe the types of relaxation techniques preferred and the extent of relaxation practice over 10 months. DESIGN: Descriptive, prospective, repeated measures. SETTING: An interdisciplinary breast clinic at a university-affiliated comprehensive cancer center in the United States. SAMPLE: 49 women with newly diagnosed breast cancer and undergoing adjuvant therapy who participated in a stress management intervention. METHODS: Relaxation practice was assessed twice a month for 10 months with immune measurements (e.g., natural killer cell activity; lymphocyte proliferation; interferon [IFN]-γ; interleukin [IL]-2, -4, -6, and -10) at the beginning and end of 10-month practice. MAIN RESEARCH VARIABLES: Relaxation practice (representing the concepts of stress and adherence), relaxation technique, and immune response. FINDINGS: After adjusting for covariates, the extent of relaxation practice significantly contributed to the variance of natural killer cell activity, lymphocyte proliferation, IL-4, and IL-10 responses in a positive direction; the higher the relaxation practice, the higher the immune responses. In comparison, IFN-γ, IL-2, and IL-6 responses were not affected. The deep-breathing method was most preferred by participants, followed by progressive relaxation and imagination or visualization. The mean weekly frequency of relaxation practice was 5.29 (SD = 3.35), and the mean duration of relaxation practice was 19.16 (SD = 10.81) minutes per session. CONCLUSIONS: Persistent relaxation practice may have positive effects on multiple immune responses in a dose-dependent manner. IMPLICATIONS FOR NURSING: Allowing the choice of preferred techniques and emphasizing the importance of long-term adherence, a relaxation program may need to be routinely offered to women under high stress.

Stress and inflammation: a biobehavioral approach for nursing research.

Despite known advantages, the use of biobehavioral approaches in nursing research remains limited. The purposes of this article are to (1) present applications of stress and inflammation in various health conditions as examples of biobehavioral concepts and (2) stimulate similar applications of biobehavioral concepts in future nursing research. Under a biobehavioral conceptual framework, studies on stress and selective inflammatory biomarkers in cardiovascular, cancer, and pulmonary health are reviewed and summarized. Inflammation underlies many diseases, and stress is a significant source of increased inflammation. Biobehavioral concepts of stress and inflammation are highly relevant to nursing research concerned with health-related issues. Diverse biobehavioral concepts are readily applicable and should be utilized in nursing research with children and adults. To stimulate further biobehavioral research, more training and resources for nurse scientists, more unified conceptual definitions and biobehavioral conceptual frameworks, rigorous and expanded methodologies, and more collaboration are essential.

Objective and subjective breast cancer risk: relationships with natural killer cell activity and psychological distress in healthy women.

BACKGROUND: Breast cancer (BC) risk, based on either known risk factors (objective) or self-assessment (subjective), may influence natural killer cell activity (NKCA) directly or through psychological distress. OBJECTIVE: The main objective of this study was to examine the relationships of objective and subjective BC risks with NKCA and a mediating role of psychological distress in a community sample of healthy women. METHODS: In a cross-sectional descriptive study, a convenience sample of 117 healthy women (mean age, 36.5 years) completed questionnaires for BC risk and psychological distress and provided blood for NKCA measurement. RESULTS: Objective and subjective BC risks were positively correlated (P < .001). Regression analyses revealed that objective BC risk had a significant negative relationship with NKCA at the 12.5:1 effector-to-target cell ratio (P = .011), whereas subjective risk was not associated with NKCA at any effector-to-target cell ratio tested. Only subjective risk had a positive association with both BC-specific (P = .002) and general (P < .001) psychological distress. Psychological distress failed to mediate the relationship between subjective risk and NKCA. CONCLUSIONS: Objective BC risk had a limited but significant relationship with NKCA. Subjective risk was highly associated with psychological distress but was not associated with NKCA. IMPLICATIONS FOR PRACTICE: Despite the limited relationships between BC risk and NKCA, the impact of BC risk on other tumor defense mechanisms needs to be further explored. Collective findings in this area will suggest early preventive strategies for monitoring BC risk and maintaining better tumor defense in healthy women.

Work environment stressors, social support, anxiety, and depression among secondary school teachers.

Work environment stress, a salient health and safety issue for secondary school teachers, school administrators, parents, and students, was examined in 168 teachers from two urban and five suburban high schools. The purpose of this study was to examine relationships between ongoing and episodic stressors and anxiety and depression, as well as the extent to which anxiety and depression may be predicted by stressors and coworker and supervisor support. The Ongoing Stressor Scale (OSS) and the Episodic Stressor Scale (ESS), the Coworker and Supervisor Contents of Communication Scales (COCS), the State Anxiety inventory (S-Anxiety), and the Center for Epidemiological Studies Depression Scale (CES-D) were used to measure the variables. Ongoing and episodic stressors were significantly and positively associated with anxiety and depression. Ongoing stressors and coworker support were significant in explaining anxiety and depression among secondary school teachers. Coworker support had an inverse relationship to anxiety and depression.

Significant impairment in immune recovery after cancer treatment.

BACKGROUND: Although immunosuppression from cancer adjuvant therapy has been documented, how these suppressed immune responses recover to baseline values after completion of cancer adjuvant therapy has not been studied systematically. OBJECTIVES: The objective of this study was to examine the probability of immune recovery after cancer adjuvant therapy and the potential impact of cancer adjuvant therapy type and cancer stage on immune recovery in patients with newly diagnosed breast cancer. METHODS: In a repeated-measures design, immune responses were measured four times in 80 patients with early-stage breast cancer: before and at 2, 6, and 12 months from the beginning of cancer adjuvant therapy. Natural killer cell activity, lymphokine-activated killer cell activity, lymphocyte proliferation, CD subsets (CD4, CD8, and CD56), and cytokines (interferon-gamma, interleukin [IL]-2, IL-4, IL-6, and IL-1alpha) were selected for their relevance to breast cancer. Immune recovery was defined by the level of immune response reaching to and above baseline levels. Data were analyzed using a multivariate generalized linear mixed-model approach. RESULTS: Delayed immune recovery to pretreatment baseline levels continued to the 12-month time point in all parameters. The percentages of immune recovery ranged from 6% to 76% of the patients, varying among immune parameters. Overall, immune recovery was poorer for interferon-gamma, IL-2, IL-4, lymphocyte proliferation, and natural killer cell activity than was for CD subsets and IL-6. The type of cancer adjuvant therapy, not cancer stage, showed selective influence on immune recovery. Chemotherapy or chemotherapy and radiotherapy combination significantly delayed IL-2 recovery, whereas radiotherapy significantly delayed IL-4 recovery. DISCUSSION: Immune recovery after breast cancer adjuvant therapy is delayed significantly for an extended time period in numerous immune parameters. The type of cancer adjuvant therapy has selective influence on immune recovery. Future investigations are warranted to elucidate the time course of immune recovery, clinical significance of poor immune recovery, and factors influencing immune recovery to develop potential interventions.

Breast cancer risk and immune responses in healthy women.

PURPOSE/OBJECTIVES: To summarize the findings of objective and subjective breast cancer risk assessments and their association with psychological distress and immune responses in healthy women with a family history of breast cancer. DATA SOURCES: Published articles and book chapters. DATA SYNTHESIS: Healthy women with a family history of breast cancer have shown decreased immune responses (i.e., low natural killer cell activity and low Th1 cytokine production), exaggerated biophysiologic reactivity to stimuli, and increased psychological distress. CONCLUSIONS: Objective and subjective breast cancer risk is associated with impaired immune responses and exaggerated biophysiologic responses in healthy women with a family history of breast cancer. Increased psychological distress can contribute further to negative immune responses. Additional studies are warranted to substantiate and extend the findings based on more comprehensive assessments of objective and subjective breast cancer risk. IMPLICATIONS FOR NURSING: Biophysiologic assessment is a useful approach for nurses in early identification of women at risk for breast cancer and developing appropriate strategies to reduce the risk.