Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure

Advances in breast cancer (BC) treatment have contributed to improved survival, but BC survivors experience significant short-term and long-term cardiovascular mortality and morbidity, including an elevated risk of heart failure with preserved ejection fraction (HFpEF). Most research has focused on HF with reduced ejection fraction (HFrEF) after BC; however, recent studies suggest HFpEF is the more prevalent subtype after BC and is associated with substantial health burden. The increased HFpEF risk observed in BC survivors may be explained by treatment-related toxicity and by shared risk factors that heighten risk for both BC and HFpEF. Beyond risk factors with physiological impacts that drive HFpEF risk, such as hypertension and obesity, social determinants of health (SDOH) likely contribute to HFpEF risk after BC, impacting diagnosis, management and prognosis.Increasing clinical awareness of HFpEF after BC and screening for cardiovascular (CV) risk factors, in particular hypertension, may be beneficial in this high-risk population. When BC survivors develop HFpEF, treatment focuses on initiating guideline-directed medical therapy and addressing underlying comorbidities with pharmacotherapy or behavioural intervention. HFpEF in BC survivors is understudied. Future directions should focus on improving HFpEF prevention and treatment by building a deeper understanding of HFpEF aetiology and elucidating contributing risk factors and their pathogenesis in HFpEF in BC survivors, in particular the association with different BC treatment modalities, including radiation therapy, chemotherapy, biological therapy and endocrine therapy, for example, aromatase inhibitors. In addition, characterising how SDOH intersect with these therapies is of paramount importance to develop future prevention and management strategies.

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Unveiling Hidden Battles: Exploring the Link Between Breast Cancer Survival and Heart Failure Vulnerability

Obeidat,

Abughazaleh

et al. 2024

Angiology

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This study explores the link between a history of breast cancer and the vulnerability to heart failure. Analyzing data from the National Inpatient Sample (NIS) for women diagnosed with breast cancer between 2016 and 2019 in the US, our research utilized logistic regression, adjusting for demographics, comorbidities, and lifestyle factors, and employed propensity score matching. With 2,276,639 weighted cases, our findings reveal a slight but significant elevation in heart failure risk among the breast cancer cohort, specifically in acute, chronic, and isolated systolic heart failure types. Racial differences were pronounced; Black women with breast cancer showed higher risks for all heart failure types, particularly chronic and systolic, while Asian or Pacific Islander patients had a lower incidence of certain heart failure types. This research underscores a modest increase in heart failure risk post-breast cancer, highlighting the critical need for integrated cardio-oncology care and personalized healthcare approaches to address and mitigate this risk effectively.

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Interconnected Clinical and Social Risk Factors in Breast Cancer and Heart Failure

Cited by 3 publications

References 106 publications

Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives

Evolving perspectives in reverse cardio-oncology: A review of current status, pathophysiological insights, and future directives

A narrative review of heart failure with preserved ejection fraction in breast cancer survivors

Unveiling Hidden Battles: Exploring the Link Between Breast Cancer Survival and Heart Failure Vulnerability

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