Related Experiment Video
Updated: Jul 19, 2025
Voluntary Breath-hold Technique for Reducing Heart Dose in Left Breast Radiotherapy
Published on: July 3, 2014
Cardiovascular Disease in Patients With Breast Cancer Treated in the Modern Era
Alexandra C Murphy1, Anoop N Koshy2, Omar Farouque2
1Department of Cardiology, Austin Health, Melbourne, Vic, Australia; Department of Medicine, The University of Melbourne, Vic, Australia; Department of Oncology, The Olivia Newton John Cancer and Wellness Centre, Melbourne, Vic, Australia.
Insights
A new Cardiovascular Risk Index in Breast Cancer (CRIB) tool helps identify breast cancer survivors at high risk for major adverse cardiovascular events (MACE). This tool aids in guiding cardiac surveillance and protective therapies for these patients.
Area of Science:
- Oncology
- Cardiology
- Epidemiology
Background:
- Cardiovascular disease (CVD) is a leading cause of death in breast cancer (BC) survivors.
- Existing risk assessment tools are not specific to this growing patient population.
- There is a need for a validated tool to predict long-term cardiovascular outcomes in BC survivors.
Purpose of the Study:
- To investigate long-term cardiovascular outcomes in early-stage BC patients.
- To derive and validate a novel risk assessment tool, the Cardiovascular Risk Index in Breast Cancer (CRIB), for predicting major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective cohort study of 1,173 early-stage BC patients treated between 2009-2019.
- Assessment of MACE and predictors, including age, cardiovascular risk factors, and history of coronary artery disease.
- Development and validation of the CRIB score (renal impairment, age ≥65, BMI >27, diabetes, hypertension, smoking history).
Main Results:
- 80 (6.8%) patients experienced a MACE during a median follow-up of 4.4 years.
- Higher MACE risk was associated with older age, cardiovascular risk factors, and prior coronary artery disease.
- A CRIB score ≥3 (representing 23.9% of the cohort) showed moderate discrimination (c-statistic 0.75) and was linked to a significantly increased risk of MACE (OR 17.85, p<0.001).
- Mortality was higher in patients who experienced a MACE (HR 2.72, p<0.001).
Conclusions:
- The novel CRIB score can effectively stratify cardiovascular risk in early-stage BC patients at diagnosis.
- CRIB may guide surveillance strategies and the implementation of cardioprotective therapies.
- This tool can help identify BC survivors requiring long-term cardiac follow-up.
Aims:
With improving cancer survivorship, cardiovascular disease (CVD) has become a leading cause of death in breast cancer (BC) survivors. At present, there is no prospectively validated, contemporary risk assessment tool specific to this patient cohort. Accordingly, we sought to investigate long-term cardiovascular outcomes in early-stage BC patients utilising a well characterised database at a quaternary referral centre. With the assembly of this cohort, we have derived a BC cardiovascular risk index titled the 'CRIB (Cardiovascular Risk Index in Breast Cancer)' to estimate the risk of a major adverse cardiovascular event (MACE) in women undergoing treatment for BC.
Methods:
A retrospective cohort study was conducted examining all female patients aged ≥18 years of age who underwent treatment for early-stage BC at a cancer centre in Melbourne, Australia, between 2009 and 2019. The primary aim of this study was to assess causes and predictors of MACE.
Results:
A total of 1,173 women with early-stage BC were included. During a median follow-up of 4.4 (1.8-6.7) years, 80 (6.8%) women experienced a MACE. These women were more likely to be older, with a high burden of cardiovascular risk factors and were more likely to have a history of established coronary artery disease (CAD) (p≤0.001 for all). A CRIB ≥3 (2 points: renal impairment, 1 point: age ≥65 years, body mass index [BMI]>27, diabetes, hypertension, history of smoking) demonstrated moderate discrimination (c-statistic 0.75) with appropriate calibration. A CRIB ≥3, which represented 23.9% of our cohort, was associated with a high risk of MACE (odds ratio [OR] 17.85, 95% confidence interval [CI] 6.36-50.05; p<0.001). A total of 138 (11.8%) women died during the study period. Mortality was significantly higher in patients who experienced a MACE (HR 2.72, 95%CI 1.75-4.23; p<0.001).
Conclusion:
Cardiovascular risk stratification at the time of BC diagnosis using the novel CRIB may help guide surveillance and the use of cardioprotective therapies as well as identify those who require long-term cardiac follow-up.
More Related Videos
Related Concept Videos
01:17Ischemic Heart Disease: Overview
Atherosclerosis, the primary malefactor, orchestrates this dangerous condition. It manifests as the accumulation of fatty deposits, akin to insidious plaques, within arterial walls. As time elapses, these plaques metamorphose, hardening and...
01:30Coronary Artery Disease I: Introduction
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:18Cardiovascular Drugs: Classification based on Therapeutic Indications
01:26Coronary Artery Disease IV: Preventive Measures
01:30Coronary Artery Disease III: Clinical Manifestations