Diversity of Cardiologic Issues in a Contemporary Cohort of Women With Breast Cancer

Abstract

Background: Women with breast cancer (BC) represent a special population particularly exposed to cardiovascular disease (CVD) risk. However, cardiologic assessment in BC is mostly limited to detection of left ventricular dysfunction cardiotoxicity (LVD-CTX) due to anticancer treatments. Our aim was to comprehensively investigate CV profile and events in a contemporary BC cohort.Methods and Results: Records of BC patients referred for a Cardio-Oncologic evaluation before starting anticancer treatments, between 2016 and 2019, were retrospectively reviewed (n = 508). Information regarding prevalence and control of CV risk factors, and novel CVD diagnoses were extracted. Occurrence of LVD-CTX, CV events other than LVD-CTX and mortality was assessed. Mean age of study population was 64 ± 13 years; 287 patients were scheduled to receive anthracycline and 165 anti-HER2 therapy. Overall, 53% of BC women had ≥2 CV risk factors, and 67% had at least one of arterial hypertension, dyslipidaemia or diabetes mellitus not adequately controlled. Eighteen (4%) patients were diagnosed a previously unknown CVD. Over a mean follow-up of 2.5 ± 1 years, 3% of BC patients developed LVD-CTX, 2% suffered from other CV events and 11% died. CV risk factors were not associated with LVD-CTX, except for family history of CAD. On the contrary, patients with other CV events exhibited a worse CV profile. Those who died more commonly experienced CV events other than LVD-CTX (p = 0.02).Conclusions: BC women show a suboptimal CV risk profile and are at risk of CV events not limited to LVD-CTX. A baseline Cardio-Oncologic evaluation was instrumental to implement CV prevention and to optimize CV therapies.

Exploring the influence of takotsubo syndrome on oncologic patients’ mortality

“…prognosis), and is particularly true in the case of heart failure (11), but has been postulated also in TTS (4,12). Nevertheless, since the prevalence of malignancy in heart failure and in TTS is not low, as seen also in our cohort (11,13,14), and similarly is the prevalence of cardiovascular conditions and risk factors in oncologic patients (10), an integrated approach caring for bidirectional cardiovascular and oncologic needs appears fundamental, though frequently challenging to be pursued (15). In fact, dedicated guidelines for management of cancer patients in cardiovascular settings are lacking, and oncologic patients are often under-represented or not adequately phenotyped in cardiovascular clinical trials, and viceversa (11,13,16).…”

Does the HFA/ICOS tool overestimate the risk of cardiovascular toxicities in oncologic patients scheduled to receive anti-VEGF agents?

“…5,6 Nevertheless, we have previously shown that, if recognized and well treated, the association of cardiovascular risk factors with cardiovascular toxicities may be blunted or even absent. 7,8 This also holds true in the case of anti-VEGF agents, 4 and accounts for the concept of 'actionable cardiotoxicity' proposed by Colan. 9 For instance, about a half of our cohort were taking cardioactive therapies at baseline, and in 13% of cases the Cardio-Oncologic evaluation was instrumental in optimizing these treatments.…”

“…This is particularly important as cardiovascular risk factors, especially arterial hypertension, are very common (though frequently overlooked) among anti-VEGF agents’ recipients, and more in general in cancer patients 5,6 . Nevertheless, we have previously shown that, if recognized and well treated, the association of cardiovascular risk factors with cardiovascular toxicities may be blunted or even absent 7,8 . This also holds true in the case of anti-VEGF agents, 4 and accounts for the concept of ‘actionable cardiotoxicity’ proposed by Colan 9 .…”

Evolving data on cardiovascular complications in cancer

“…We mention the following examples. In breast cancer patients, more than half of women had 2 or more CV risk factors and 67% had suboptimally controlled hypertension, dyslipidemia or diabetes [30]. In post-menopausal women with estrogen receptor positive breast carcinoma adjuvant treatment with tamoxifen has substantially reduced mortality and aromatase inhibitors appear to further improve outcomes, although estrogen reducing effects may have impact on cardiovascular complications.…”