Blood Pressure and Cardiovascular Risk in Women With Breast Cancer: The Pathways Heart Study

Area of Science:

• Cardiology
• Oncology
• Epidemiology

Background:

• Hypertension significantly contributes to cardiovascular disease (CVD) risk in breast cancer (BC) survivors.
• Limited research exists on blood pressure (BP) and CVD outcomes specifically within this population.

Purpose of the Study:

• To investigate the association between blood pressure and CVD outcomes in a large, longitudinal cohort of breast cancer patients.
• To characterize the relationship between systolic blood pressure (SBP) and diastolic blood pressure (DBP) and CVD risk in breast cancer survivors.

Main Methods:

• Utilized electronic health records from Kaiser Permanente Northern California for invasive BC patients (2005-2013) and matched controls.
• Employed multivariable Cox regression and penalized spline models to analyze linear and nonlinear relationships between BP and CVD outcomes.
• Included 12,713 BC cases and 55,886 controls with a median follow-up of 9.6 years.

Main Results:

• For every 10 mmHg increase in SBP/DBP, BC survivors showed increased risk for ischemic heart disease (IHD) (1.23/1.10) and stroke (1.45/1.91).
• A U-shaped relationship was observed between heart failure/cardiomyopathy and BP levels.
• Risks for IHD, stroke, and any primary CVD were not significantly different between BC survivors and controls; however, heart failure/cardiomyopathy risk varied by BC status (P interaction = 0.01).

Conclusions:

• Breast cancer survivors and women without BC exhibit comparable risks for IHD, stroke, and overall primary CVD.
• Current findings suggest that blood pressure management targets should be consistent for both breast cancer survivors and the general population.
• Further research may be warranted to explore the nuances of heart failure/cardiomyopathy risk in relation to BP in BC survivors.