Older Breast Cancer Survivors At Increased Risk For CV Events

Survivors of breast cancer may be at elevated risk for cardiovascular (CV) events, such as coronary artery disease (CAD) and heart failure, according to a new study.

There is evidence of increased CV risk among breast cancer survivors, but data on the occurrence of specific CV outcomes in this population is limited. A team of British researchers conducted a study to measure the prevalence of a range of CV events before and after diagnosis with breast cancer among women over the age of 65 years in the United States.

More than 91,000 women with breast cancer were included in the study, based on data from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Researchers measured the rates of CV events such as CAD, peripheral vascular disease (PVD), stroke, heart failure (HF), venous thromboembolism (VTE), including deep vein thrombosis (DVT), and other conditions. Participant outcomes were compared with an age-matched cohort of more than 454,000 women without breast cancer. The effects were adjusted for time since diagnosis, race and ethnicity, prior CVD, and age.

Investigators found that women with breast cancer had lower baseline prevalence of all CV events compared with the cancer-free controls. Survivors were found to have substantially increased risks of DVT (adjusted hazard ratio [HR], 1.67; 95% confidence interval [CI], 1.62-1.73) and pericarditis (HR, 1.43; 95% CI, 1.62-1.73). They also found smaller but elevated risks for cardiac arrest, arrhythmia, HF, and valvular heart disease. Survivors had a slightly lower risk of angina, myocardial infarction, PVD, and stroke compared with the matched cohort. The increased risks for arrhythmia, heart failure, pericarditis, and DVT persisted for at least five years following cancer diagnosis.

Upon stratification by race, the researchers found that Black women with breast cancer were at increased risk of CAD and myocardial infarction compared with white women (HRs 1.08 vs. 0.95, and 1.10 vs. 0.96, respectively). Increased risk of VTE and DVT was found across all races and ethnicities.

“Our results highlight the importance of periodic cardiovascular evaluation of women diagnosed with breast cancer to ensure adequate management of cardiovascular risk,” the researchers concluded.

This study was published in the Journal of the Comprehensive Cancer Network (JCCN).