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

Abstract

BackgroundCardiovascular 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.MethodsIn 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).ResultsPostmenopausal 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).ConclusionCVD 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.

Changes in cardiovascular disease risk and risk factors among women with and without breast cancer

“…A recent systematic review examined the risk of CVD mortality after breast cancer, and concluded that approximately 2% to 10% of women with breast cancer die of CVD, and that CVD mortality is elevated among women with breast cancer compared with women without a breast cancer history . Similar to women in the general population, traditional risk factors for CVD, such as hypertension and excess adiposity, have been associated with CVD incidence and mortality among survivors of breast cancer . However, to our knowledge, whether breast cancer and its treatment exacerbate these risk factors, contributing to greater increases in CVD risk over time compared with among women without breast cancer, has not been well established to date.…”

The connection between the breast and heart in a woman: Breast cancer and cardiovascular disease

“…Based on the most recent statistics available, 236 968 women were diagnosed with breast cancer in 2014 and 41 211 women died from breast cancer in the United States . The Surveillance, Epidemiology and End Results data and numerous other population studies have demonstrated an increased incidence in cardiovascular disease in breast cancer survivors, compared to other women without breast cancer …”

“…Advancements in early detection and breast cancer therapy have resulted in over 90% of women surviving 5 years past their diagnosis of breast cancer, with a related mortality reduction of ~2% per year over the last decade . Nonetheless, with increased survivorship from breast cancer there has been an increase in cardiovascular disease in these women . For breast cancer survivors, deaths due to cardiovascular diseases account for 35% of the non–cancer‐related deaths in those age 50 years and older, and cardiovascular mortality is the greatest single non–cancer‐related cause of death …”

“…Those individuals with breast cancer have been shown to have a greater prevalence of cardiovascular risk factors . Given that increased cardiovascular risk appears to manifest approximately 5 to 7 years after the initial diagnosis of breast cancer, a potential window of opportunity exists for possible preventive intervention strategies, although there are limited intervention trials available to assess effectiveness of specific interventions to date.…”

Prevention, Monitoring, and Management of Cardiac Dysfunction in Patients with Metastatic Breast Cancer

“…There is a need for cardiac monitoring during treatment, with underdiagnosis and undertreatment of cardiovascular disease (CVD) an important issue for patients with breast cancer . CVD is the leading cause of death for women worldwide ; among patients with breast cancer, CVD is a primary cause of death in women aged ≥75 years with stage I or localized disease . Seven years postdiagnosis, patients with breast cancer have nearly twice the risk of CVD‐related mortality compared with patients without a diagnosis of breast cancer .…”