Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

By FYH News Team

Published on April 7, 2022

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Abstract

To examine cardiovascular disease (CVD) and mortality risk in women with breast cancer (BC) by cancer therapy received relative to women without BC.

The study population comprised Kaiser Permanente Northern California members. Cases with invasive BC diagnosed from 2005 to 2013 were matched 1:5 to controls without BC on birth year and race/ethnicity. Cancer treatment, CVD outcomes, and covariate data were from electronic health records. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs of CVD incidence and mortality by receipt of chemotherapy treatment combinations, radiation therapy, and endocrine therapy.

A total of 13,642 women with BC were matched to 68,202 controls without BC. Over a 7-year average follow-up (range < 1-14 years), women who received anthracyclines and/or trastuzumab had high risk of heart failure/cardiomyopathy relative to controls, with the highest risk seen in women who received both anthracyclines and trastuzumab (HR, 3.68; 95% CI, 1.79 to 7.59). High risk of heart failure and/or cardiomyopathy was also observed in women with BC with a history of radiation therapy (HR, 1.38; 95% CI, 1.13 to 1.69) and aromatase inhibitor use (HR, 1.31; 95% CI, 1.07 to 1.60), relative to their controls. Elevated risks for stroke, arrhythmia, cardiac arrest, venous thromboembolic disease, CVD-related death, and death from any cause were also observed in women with BC on the basis of cancer treatment received.

Women with BC had increased incidence of CVD events, CVD-related mortality, and all-cause mortality compared with women without BC, and risks varied according to the history of cancer treatment received. Studies are needed to determine how women who received BC treatment should be cared for to improve cardiovascular outcomes.

CONTEXT

Key Objective
Many breast cancer (BC) treatments confer risk of cardiovascular disease (CVD), but risks by exposure to certain BC treatments alone or in specific clinically appropriate combinations have not been well quantified. This prospective study at Kaiser Permanente Northern California compared risk of incident CVD events and death in 13,642 women with BC diagnosed from 2005 to 2013 who received chemotherapy, radiation therapy, or endocrine therapy with 68,202 women without BC.
Knowledge Generated
Compared with age and race/ethnicity-matched controls without BC, women who received anthracyclines and/or trastuzumab, radiation therapy, or aromatase inhibitors had increased risk of developing heart failure/cardiomyopathy, stroke, arrhythmia, cardiac arrest, and venous thromboembolic disease, and of experiencing a CVD-related or all-cause death.
Relevance
Women with BC who receive specific treatment therapies may be at increased risk of incident CVD events. Development and testing of clinical pathways to manage these risks is needed.

PRIOR PRESENTATION

Presented in part at the 2020 ASCO annual meeting, virtual, May 29-31, 2020.

SUPPORT

Supported by NCI R01CA214057 and U01CA195565.

Conception and design: Heather Greenlee, Dawn L. Hershman, Lawrence H. Kushi, Romain Neugebauer, Marilyn L. Kwan

Financial support: Heather Greenlee, Lawrence H. Kushi, Marilyn L. Kwan

Administrative support: Heather Greenlee, Marilyn L. Kwan

Provision of study materials or patients: Lawrence H. Kushi, Marilyn L. Kwan

Collection and assembly of data: Zaixing Shi, Cecile A. Laurent, Janise M. Roh, Margarita Santiago-Torres, Hanjie Shen, Marilyn L. Kwan

Data analysis and interpretation: Heather Greenlee, Carlos Iribarren, Jamal S. Rana, Richard Cheng, Mai Nguyen-Huynh, Eileen Rillamas-Sun, Zaixing Shi, Cecile A. Laurent, Valerie S. Lee, Hanjie Shen, Dawn L. Hershman, Lawrence H. Kushi, Marilyn L. Kwan

Manuscript writing: All authors

Final approval of manuscript: All authors

Accountable for all aspects of the work: All authors

AUTHORS’ DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated unless otherwise noted. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO’s conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/authors/author-center.

Open Payments is a public database containing information reported by companies about payments made to US-licensed physicians (Open Payments).

Carlos Iribarren

Consulting or Advisory Role: Gen in CODE, LLC

Research Funding: Genentech/Roche

Dawn L. Hershman

Consulting or Advisory Role: AIM Specialty Health

Romain Neugebauer

Employment: Kaiser Permanente

No other potential conflicts of interest were reported.

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