Compared with those without cancer, older patients with breast cancer have a higher risk of developing cardiovascular disease, according to a study now published in the Journal of the National Comprehensive Cancer Network.
"In older women diagnosed with breast cancer, there is now a greater likelihood of dying of diseases other than the cancer itself," write the investigators, led by first author Anthony Matthews, PhD, a postdoctoral researcher at the Karolinska Institute in Sweden. "Cardiovascular disease is the most frequent cause of non–cancer-related death, and there are concerns that overlapping risk factors and cardiotoxicities associated with cancer treatments may increase cardiovascular risk in this population."
Dr. Matthews and colleagues investigated the prevalence of cardiovascular disease among breast cancer survivors in a cohort study of 545,670 female patients in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. Eligible patients were at least 65 years old, and 17% had a history of breast cancer. Prevalence of preexisting cardiovascular disease at baseline was similar between groups. The study's primary end point was the incidence of cardiovascular disease, including coronary artery disease (angina, myocardial infarction, revascularization procedures, or sudden cardiac arrest), peripheral vascular disease, stroke, arrhythmia, heart failure, pericarditis, valvular heart disease, and venous thromboembolism (deep vein thrombosis or pulmonary embolism).
Compared with patients without a history of cancer, patients with breast cancer had a significantly higher incidence of deep vein thrombosis (adjusted hazard ratio 1.67) and pericarditis (hazard ratio 1.43) and had evidence of an increased risk of sudden cardiac arrest, arrhythmia, heart failure, and valvular heart disease (hazard ratios ranging from 1.05–1.09). However, patients with breast cancer had evidence of a lower risk of incident angina, myocardial infarction, revascularization, peripheral vascular disease, and stroke (hazard ratios ranging from 0.89–0.98), which were not statistically significant. Patients with higher risks of arrhythmia, heart failure, pericarditis, and deep vein thrombosis were still experiencing these risks more than five years after their breast cancer diagnosis. Additionally, patients with stage III, grade 3, and estrogen-receptor (ER)/progesterone receptor (PR)-negative disease experienced a higher risk of all adverse cardiovascular outcomes.
"There is evidence of increased risks of several cardiovascular outcomes in older women diagnosed with breast cancer in the United States compared with similar women without cancer, with increased risks of arrhythmia, heart failure, pericarditis, and deep vein thrombosis persisting several years after diagnosis," conclude Dr. Matthews and colleagues. "Our results highlight the importance of periodic cardiovascular evaluation of women diagnosed with breast cancer to ensure adequate management of cardiovascular risk."
For More Information
Matthews AA, Hinton SP, Stanway S, et al (2021). Risk of cardiovascular diseases among older breast cancer survivors in the United States: a matched cohort study. J Natl Compr Cancer Netw. [Epub ahead of print] DOI:10.6004/jnccn.2020.7629
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