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Coronary heart disease and mortality following a breast cancer diagnosis
Aixia Guo1, Kathleen W Zhang2, Kristi Reynolds3,4
1Institute for Informatics (I2), Washington University School of Medicine, 600 S. Taylor Avenue, Suite 102, Campus Box 8102, St. Louis, MO, 63110, USA.
Insights
Adverse cardiovascular health (CVH) combined with cardiotoxic cancer treatments significantly increases coronary heart disease (CHD) and death risk in breast cancer survivors. Maintaining ideal CVH is crucial for better outcomes.
Area of Science:
- Cardiology
- Oncology
- Public Health
Background:
- Coronary heart disease (CHD) is a major cause of death in breast cancer survivors.
- The combined impact of poor cardiovascular health (CVH) and cardiotoxic cancer treatments on CHD and mortality is not well understood.
Purpose of the Study:
- To quantify the 10-year risk of CHD and death in breast cancer survivors based on CVH and cancer treatment toxicity.
- To evaluate the independent and joint effects of CVH and cardiotoxic treatments on post-treatment outcomes.
Main Methods:
- Statistical and machine learning models were used to assess 10-year risks in 1934 breast cancer patients (2006-2007).
- Cardiovascular health (CVH) was assessed using 5 factors (smoking, BMI, blood pressure, glucose, cholesterol) prior to diagnosis.
- Cardiotoxic treatments included anthracyclines or hormone therapies.
Main Results:
- The combination of poor CVH and cardiotoxic treatments led to significantly higher rates of CHD (75.9%) and death (39.5%) compared to independent effects.
- Poor CVH alone increased CHD risk to 55.9% and death risk to 29.4%.
- Cardiotoxic treatments alone increased CHD risk to 43.6% and death risk to 35.8%.
Conclusions:
- Ideal cardiovascular health (CVH) offers protection against CHD, even for survivors who received cardiotoxic cancer treatments.
- Achieving ideal CVH is critical for improving CHD and mortality outcomes in breast cancer survivors.
Background:
Coronary heart disease (CHD) is a leading cause of morbidity and mortality for breast cancer survivors, yet the joint effect of adverse cardiovascular health (CVH) and cardiotoxic cancer treatments on post-treatment CHD and death has not been quantified.
Methods:
We conducted statistical and machine learning approaches to evaluate 10-year risk of these outcomes among 1934 women diagnosed with breast cancer during 2006 and 2007. Overall CVH scores were classified as poor, intermediate, or ideal for 5 factors, smoking, body mass index, blood pressure, glucose/hemoglobin A1c, and cholesterol from clinical data within 5 years prior to the breast cancer diagnosis. The receipt of potentially cardiotoxic breast cancer treatments was indicated if the patient received anthracyclines or hormone therapies. We modeled the outcomes of post-cancer diagnosis CHD and death, respectively.
Results:
Results of these approaches indicated that the joint effect of poor CVH and receipt of cardiotoxic treatments on CHD (75.9%) and death (39.5%) was significantly higher than their independent effects [poor CVH (55.9%) and cardiotoxic treatments (43.6%) for CHD, and poor CVH (29.4%) and cardiotoxic treatments (35.8%) for death].
Conclusions:
Better CVH appears to be protective against the development of CHD even among women who had received potentially cardiotoxic treatments. This study determined the extent to which attainment of ideal CVH is important not only for CHD and mortality outcomes among women diagnosed with breast cancer.
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