Women with breast cancer at higher risk for cardiovascular disease events, mortality
Women with breast cancer exhibited higher risk for heart failure, cardiomyopathy and other cardiovascular disease events than women without breast cancer, according to prospective study results published in Journal of Clinical Oncology.
Researchers also reported higher rates of cardiovascular disease-related mortality and all-cause mortality in the breast cancer cohort.
Risks varied according to the type of cancer treatment women received.
“The most important take-home message here is that women who receive anthracycline and/or trastuzumab-based chemotherapy, radiation therapy and aromatase inhibitors have increased risk [for] developing multiple cardiovascular diseases,” study author Heather Greenlee, ND, PhD, MPH, public health researcher at Fred Hutchinson Cancer Research Center, told Healio. “It is highly important for oncology programs to provide, and for clinicians to encourage the use of, comprehensive ongoing follow-up care for cardiovascular health for women who have received breast cancer treatment.”
Prior research has revealed an association between breast cancer treatment and development of cardiovascular disease risk factors. In fact, a decade after breast cancer diagnosis, women are more likely to die of cardiovascular disease then breast cancer, Greenlee said.
“That said, few studies have been able to quantify how much individual and combination breast cancer treatments increase the risk [for] developing specific cardiovascular diseases,” Greenlee said. “We thought it was important to quantify those risks and to identify groups of women at high risk [for] having a cardiovascular disease event.”
Greenlee and colleagues compared risk for incident cardiovascular disease events and death among a prospective cohort of more than 81,000 Kaiser Permanente Northern California members.
The study population included 13,642 women diagnosed with invasive breast cancer between 2005 and 2013, all of whom received chemotherapy, radiation therapy or endocrine therapy. A control group included 68,202 women without breast cancer matched for age and race/ethnicity.
Investigators used electronic health records to determine cancer treatments, assess cardiovascular disease outcomes and obtain covariate data.
During an average follow-up of 7 years (range < 1 to 14), women treated with anthracyclines and/or trastuzumab (Herceptin, Genentech) demonstrated higher risk for heart failure or cardiomyopathy than controls. Women who received anthracyclines and trastuzumab exhibited the greatest risk (HR = 3.68; 95% CI, 1.79-7.59).
Women with breast cancer who underwent radiation therapy (HR = 1.38; 95% CI, 1.13-1.69) or received aromatase inhibitors (HR = 1.31; 95% CI, 1.07-1.6) also exhibited significantly higher risk for heart failure or cardiomyopathy than controls.
In addition, women with breast cancer demonstrated elevated risks for cardiac arrest, stroke, arrhythmia, venous thromboembolic disease, cardiovascular disease-related death and all-cause mortality.
“Our findings show that, compared [with] women without a history of breast cancer, women with a history of breast cancer who received any of the chemotherapy combinations we examined had a 50% or greater increased risk [for] having a cardiovascular disease event,” Greenlee told Healio. “This highlights the need for this population to be regularly monitored and for appropriate clinical pathways to be developed within medical institutions.
“An increasing number of cancer centers are providing cardio-oncology services to their patients,” she added. “These findings further support the need for those programs to be readily available to [patients with breast cancer] as they undergo treatment and throughout survivorship.”
Researchers plan to conduct further study to investigate treatment combinations across different therapy types, doses and durations. More emphasis must be placed on development of clinical strategies to manage risk and protect the cardiovascular health of breast cancer survivors, they added.
“There are two important basic questions that remain to be answered,” Greenlee said. “The first is how do we prevent these cardiotoxicities while still maintaining effective breast cancer treatment strategies? The second is how best do we manage cardiotoxicities when they do develop?”