Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study

Abstract

PURPOSE The incidence of cardiometabolic risk factors in breast cancer (BC) survivors has not been well described. Thus, we compared risk of hypertension, diabetes, and dyslipidemia in women with and without BC. METHODS Women with invasive BC diagnosed from 2005 to 2013 at Kaiser Permanente Northern California (KPNC) were identified and matched 1:5 to noncancer controls on birth year, race, and ethnicity. Cumulative incidence rates of hypertension, diabetes, and dyslipidemia were estimated with competing risk of overall death. Subdistribution hazard ratios (sHRs) were estimated by Fine and Gray regression, adjusted for cardiovascular disease–related risk factors, and stratified by treatment and body mass index (BMI). RESULTS A total of 14,942 BC cases and 74,702 matched controls were identified with mean age 61.2 years and 65% non-Hispanic White. Compared with controls, BC cases had higher cumulative incidence rates of hypertension (10.9% v 8.9%) and diabetes (2.1% v 1.7%) after 2 years, with higher diabetes incidence persisting after 10 years (9.3% v 8.8%). In multivariable models, cases had higher risk of diabetes (sHR, 1.16; 95% CI, 1.07 to 1.26) versus controls. Cases treated with chemotherapy (sHR, 1.23; 95% CI, 1.11 to 1.38), left-sided radiation (sHR, 1.29; 95% CI, 1.13 to 1.48), or endocrine therapy (sHR, 1.23; 95% CI, 1.12 to 1.34) continued to have higher diabetes risk. Hypertension risk was higher for cases receiving left-sided radiation (sHR, 1.11; 95% CI, 1.02 to 1.21) or endocrine therapy (sHR, 1.10; 95% CI, 1.03 to 1.16). Normal-weight (BMI < 24.9 kg/m2) cases had higher risks overall and within treatment subgroups versus controls. CONCLUSION BC survivors at KPNC experienced elevated risks of diabetes and hypertension compared with women without BC depending on treatments received and BMI. Future studies should examine strategies for cardiometabolic risk factor prevention in BC survivors.

Peripheral Immune Cell Composition is Altered in Women Before and After a Hypertension Diagnosis

“…Associations were also examined using a minimum adjustment set that included age at blood draw, self-reported race, menopause status, and DNAm platform. Because women with a history of breast cancer experience higher rates of hypertension in the years following diagnosis, 39 women were censored for development of hypertension at the time of their breast cancer diagnosis. Associations with leukocyte subsets were examined for the population overall and stratified by time, menopause status, body mass index, and self-reported race.…”

Late Breast Cancer Survivorship: Side Effects and Care Recommendations

“…In addition, certain breast cancer therapies, including anthracycline-based chemotherapies, anti–human epidermal growth factor receptor 2 therapies, and endocrine therapies, are associated with various cardiovascular toxicities, including asymptomatic left ventricular dysfunction, overt heart failure, hypertension, arrhythmias, myocardial ischemia, valvular disease, thromboembolic disease, pulmonary hypertension, and pericarditis. 9,10 In the companion by Kwan et al 15 to this article, the authors report higher cumulative incidences of hypertension and diabetes, but a lower cumulative incidence of dyslipidemia, in 14,942 breast cancer survivors diagnosed from 2005 to 2013 at Kaiser Permanente Northern California compared with 74,702 matched controls.…”

Common origins and shared opportunities for breast cancer and cardiovascular disease prevention

“…In addition to being under-detected, CVRFs also tend to be under-treated in oncological patients 45. Patients with BC without hypertension, dyslipidaemia or diabetes mellitus at the time of diagnosis are more likely to develop these conditions following diagnosis and cancer treatment compared with non-cancer counterparts 46. Optimising both BC and cardiovascular prognosis requires a team-based, patient-centred approach (figure 3).…”