The risk of cardiovascular disease following breast cancer by Framingham risk score

Abstract

ObjectivesThis study evaluates the risk of cardiovascular disease (CVD) following breast cancer, accounting for baseline CVD risk.MethodsWithin the EPIC-NL (Dutch part of the European Prospective Investigation into Nutrition and Cancer) cohort, 1103 women were diagnosed with breast cancer. For every breast cancer patient, 3–4 women without breast cancer (n = 4328) were selected matched for age, year, and time since cohort enrollment. Based on CVD risk factors at cohort enrollment, 10-year risk of CVD was calculated and categorized: low (< 10%), intermediate (10–20%), high (> 20%). Cox proportional hazard models assessed the risk of CVD events (hospitalization or mortality) and CVD mortality of women with versus without breast cancer, adjusted for baseline CVD risk.ResultsAfter median follow-up of 5 and 6 years, 92 (8.3%) and 325 (7.5%) CVD events occurred in women with and without breast cancer, respectively. In the low CVD risk group, women with breast cancer had 1.44 (95% CI 1.00–2.06) times higher risk of CVD events than women without breast cancer. In the intermediate and high CVD risk categories, risk of CVD events was similar in women with and without breast cancer. Overall, women with breast cancer had 1.77 (95% CI 1.10–2.86) times higher risk of CVD mortality than women without breast cancer.ConclusionsAmong women with low CVD risk, women with breast cancer have a higher risk of CVD event than women without breast cancer. Overall, women with breast cancer have a higher risk of CVD mortality than women without breast cancer.Electronic supplementary materialThe online version of this article (10.1007/s10549-018-4723-0) contains supplementary material, which is available to authorized users.

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“…have not yet been systematically investigated and very few studies have addressed the in uence and signi cance of these factors [16]. Baseline cardiac risk estimation could be a parameter to refer to for the indication of mDIBH use, in order to achieve a superior cardiac protection during breast radiation therapy as reported by Gaasch A. et al [17].…”

Cardiovascular risk factors in patients with breast cancer. Is there a correlation with international reference standards?

“…En el trabajo realizado por Gernaat et al del Hospital Médico Universitario de Utrecht-Holanda, demostró que las mujeres con cáncer de mama tienen un mayor riesgo de mortalidad por ECV que las mujeres sin cáncer. En general, las mujeres con cáncer de mama tuvieron más riesgo de mortalidad por (23) ECV según la puntación de riesgo de Framingham . En nuestra muestra el promedio tenía de forma basal un score de riesgo de Framingham de 5, es decir, un riesgo moderado a alto, coincidiendo con hallazgos internacionales.…”

“…En el trabajo realizado en Chile por Pereira A et al, fue significativamente mayor en los casos (37,1%) (51) . Sin embargo, el trabajo por Peeters PH et al en Holanda demuestra que no existe asociación directa (52) (23) de HTA para aumentar la incidencia del cáncer de mama per se .Está demostrado que la gravedad y (30,53) la incidencia de HTA es considerablemente más alta durante la exposición a la quimioterapia .…”

“…La combinación de obesidad y sobrepeso se asoció significativamente con un mayor riesgo de desarrollo de (22) cardiotoxicidad en pacientes en régimen quimioterápico contra el cáncer de mama . Actualmente, hay tres modelos de predicción de riesgo cardiovascular recomendados en las guías de práctica clínica: score de Framingham, SCORE (evaluación sistemática de riesgos coercitivos) y el modelo de Organización (23) Mundial de la Salud/Sociedad Internacional de HTA(OMS/ISH) . El score de Framingham usa (24) información sobre edad, sexo, presión arterial sistólica, tabaquismo y perfil lipídico .…”

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“…Breast cancer survivors have approximately double the risk of mortality from cardiovascular disease than age-matched women without a cancer history (1). Framingham risk score (FRS) has been used to estimate the 10-year risk of cardiovascular disease in breast cancer survivors (2). However, the accuracy of FRS has been limited due to the absence of in ammatory markers, glycated hemoglobin (HbA1c) and family history of cardiovascular disease in the prediction algorithm (3).…”