Cardiovascular Disease Mortality Among Breast Cancer Survivors

Abstract

Background Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown. Methods We compared deaths due to CVD in a population-based sample of 1,413 women with incident breast cancer diagnosed in 1996-1997, and 1,411 age-matched women without breast cancer. Date and cause of death through December 31, 2009 were assessed through the National Death Index and covariate data was gathered through structured interviews and medical record abstraction. Hazard ratios and 95% confidence intervals (CI) were calculated using Cox regression for overall mortality (HR) and CVD-specific death (cause-specific HR). Subdistribution hazard ratios (sHR) for CVD death were estimated from the Fine-Gray model. Results Risk of death was greater among breast cancer survivors compared to women without breast cancer [HR: 1.8 (1.5, 2.1)]. An increase in CVD-related death among breast cancer survivors was evident only 7 years after diagnosis [years 0-7, cause-specific HR: 0.80 (0.53, 1.2), subdistribution HR: 0.59 (0.40, 0.87)]; years 7+, cause-specific HR: 1.8 (1.3, 2.5), subdistribution HR: 1.9 (1.4, 2.7); p-interaction: 0.001]. An increase in CVD-related mortality was observed among breast cancer survivors receiving chemotherapy. Conclusions Breast cancer survivors are at greater risk for CVD-related mortality compared to women without breast cancer and this increase in risk is manifest approximately 7 years after diagnosis. Efforts should be made to identify risk factors and interventions that can be employed during this brief window to reduce the excess burden of CVD in this vulnerable population.

Prevention and Monitoring of Cardiovascular Complications in Patients With Luminal Her2-Negative Metastatic Breast Cancer

“…Этот повышенный риск проявля-ется примерно через 7 лет после постановки диагноза РМЖ. В течение этого периода целесообразны ранняя диагностика и активное лечение факторов риска ССЗ, поскольку могут снизить вероятность развития самого ССЗ [11].…”

Cardiovascular disease risk among breast cancer survivors: an evolutionary concept analysis

“…Cardiovascular disease risk was often conceptually defined as incidence of cardiovascular diseases including ischemic heart disease, congestive heart failure, myocardial infarction, coronary artery disease, stroke, angina, atrial fibrillation, paroxysmal tachycardia, nonrheumatic valve disease, cardiomyopathy, aortic aneurysm, and arteriosclerosis. [3][4]8,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] While one study included angina as a cardiovascular disease risk factor, 15 Darby et al indicated that angina would not be included as a risk factor due to difficulty with clinical identification of angina. 19 Other investigators conceptually defined cardiovascular disease risk as the presence of cardiovascular disease risk factors including smoking and having an overweight or obese body mass index.…”

“…Incidence of cardiovascular diseases using morbidity and mortality was a common measure of cardiovascular disease risk among breast cancer survivors. 4,8,[14][15][16][17][18][19][20][21][22][24][25][26][27]29 Authors of these studies used electronic health records, large databases, and/or linkages to death indexes as data sources. Physical measurements of cardiovascular disease risk are ideal to reduce self-report bias; however, fewer studies conducted physical measurements of cardiovascular disease risk.…”

“…Chemotherapy agents used to treat breast cancer, such as anthracyclines and taxanes, were associated with heart failure and ischemic heart disease. 15,17,24,38 The mechanism of action for anthracyclines, including epirubicin and doxorubicin, may lead to the production of free radicals. Anthracyclines were associated with the development of cardiomyopathy, arrhythmias, aortic stiffness, and heart failure.…”

Insights into etiological factors of pulmonary hypertension in cancer patients

“…The growing population of cancer-survived patients have a substantial risk of developing cardiovascular diseases due to ageing, co-morbid CV risk factors and cancer-specific adverse effects related to the malignancy itself or treatment toxicity [2]. Cardiovascular diseases have a significant impact on the quality of life and prognosis of cancer-survived patients and are considered the major non-malignant cause of mortality [3][4][5]. The incidence of CV complications is difficult to estimate precisely due to variability in definitions, the presence of comorbid diseases affecting CV system and data collection stems mainly from registries and case series.…”