New Study Data Suggests Revising Heart Disease Management Guidelines for Colon Cancer Survivors

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No evidence found to support current practice using BMI to manage heart attack risk
Released: Thursday, May 16, 2019

Baton Rouge, Louisiana -- Colorectal cancer survivors' risk for heart attack – five times that of the average person – is linked to the amount of fat stored within the abdomen and abdominal muscles, not to survivor's body-mass index (BMI), according to a new study of 2,800 colon cancer survivor health outcomes published in JAMA Oncology this month.

Justin BrownJustin Brown, PhD, Director of Cancer Metabolism Program, Pennington Biomedical

Current clinical practice guidelines for colorectal cancer survivors now recommend using BMI, a measure of weight over height, to guide heart disease risk management. "At the time the guidelines were developed, little data had been gathered on the best way to manage colorectal cancer survivors' heart disease risk," said Dr. Justin Brown, primary investigator of the study and director of the Cancer Metabolism Program at LSU's Pennington Biomedical Research Center.

Researchers reviewed long-term cardiovascular outcomes of colorectal cancer survivors in Kaiser Permanente's Northern California region. Colon cancer patients typically undergo a CT scan before surgery to determine if the cancer has spread to the chest, abdomen or pelvis; these results were used to assess body fat and the subsequent risk of cardiovascular disease.

Bette J. CaanBette J. Caan, DrPH, Kaiser Permanente

Kaiser Permanente's Northern California Division of Research, Pennington Biomedical, the Dana-Farber Cancer Institute, and the University of Alberta partnered on the project.

Colorectal Cancer Survivors' Risks
  • There are around 1 million colorectal cancer survivors in the U.S.
  • Heart attack is the No. 2 cause of death for colorectal cancer survivors, trailing only a recurrence of cancer.
  • 20 percent of survivors will have a nonfatal heart attack or stroke or die of cardiac disease.
  • Survivors with high levels of fat in their abdomen are 54 percent more likely to have a heart attack or stroke or to die of heart disease.
  • Survivors with low levels of fat in their muscle had a 33 percent lower risk of heart attack or stroke or to die from heart disease.

"This study demonstrates the importance at every BMI level of having more precise measures of muscle and fat to help identify those patients who are at high risk of developing cardiovascular disease," said co-author Bette J. Caan, DrPH, research scientist in the Kaiser Permanente Division of Research.

Dr. Jeffrey A. MeyerhardtDr. Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute

"Once patients complete curative-intent therapy for colon and rectal cancer, it is so important to manage other comorbidities and disease that can affect them later," said Dr. Jeffrey A. Meyerhardt, MD, the clinical director of the Gastrointestinal Cancer Center at Dana-Farber Cancer Institute.

"Studies like this one define how best to screen and eventually treat survivors."

An Easy Fix?

"If a patient has a high amount of fat in their abdomen, his or her physician might recommend some combination of diet, exercise and medication to reduce the risk of heart attack," Dr. Brown pointed out. "The study shows physicians already have the tools and information needed to identify the patients at the highest risk for heart attacks."

Dr. Carla PradoDr. Carla Prado, University of Alberta

"Contrary to popular belief, a person may have a normal body weight (and BMI) but have a lot of fat in their bodies; therefore it can be a hidden condition, hence the need for a more sophisticated measurement, like we did in this study," said Carla Prado, Associate Professor at the University of Alberta and study co-author.

The research was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers K99-CA218603; R01-CA175011; and R25-CA203650.


About Dana-Farber

Dana-Farber Cancer Institute is one of the world's leading centers of cancer research and treatment. It is the only center ranked in the top 4 of U.S. News and World Report's Best Hospitals for both adult and pediatric cancer care. Dana-Farber's mission is to reduce the burden of cancer through scientific inquiry, clinical care, education, community engagement, and advocacy. We provide the latest in cancer for adults through Dana-Farber/Brigham and Women's Cancer Care and for children through Dana-Farber/Boston Children's Cancer and Blood Disorders Center. Dana-Farber is dedicated to a unique and equal balance between cancer research and care, translating the results of discovery into new treatments for patients locally and around the world.

About the Kaiser Permanente Division of Research

The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR's 600-plus staff is working on more than 350 epidemiological and health services research projects. For more information, visit or follow us @KPDOR.

About the University of Alberta

The University of Alberta in Edmonton is one of Canada's top teaching and research universities, with an international reputation for excellence across the humanities, sciences, creative arts, business, engineering, and health sciences. Home to more than 38,000 students and 15,000 faculty and staff, the university has an annual budget of $1.9 billion and attracts more than $500 million in sponsored research revenue. The U of A offers close to 900 rigorous undergraduate, graduate, and professional programs in 18 faculties on five campuses—including one rural and one francophone campus. The university has more than 275,000 alumni worldwide. The university and its people remain dedicated to the promise made in 1908 by founding president Henry Marshall Tory that knowledge shall be used for "uplifting the whole people."


About the Pennington Biomedical Research Center

The Pennington Biomedical Research Center is at the forefront of medical discovery as it relates to understanding the triggers of obesity, diabetes, cardiovascular disease, cancer and dementia. The Center conducts basic, clinical, and population research, and is affiliated with Louisiana State University. The research enterprise at Pennington Biomedical includes over 450 employees within a network of 40 clinics and research laboratories, and 13 highly specialized core service facilities. Its scientists and physician/scientists are supported by research trainees, lab technicians, nurses, dietitians, and other support personnel. Pennington Biomedical is located in state-of-the-art research facilities on a 222-acre campus in Baton Rouge, Louisiana.