Aug 2026· European Heart Journal, Supplement· 0 citations
TL;DR
Evaluating the occurrence of new-onset CVD in women with breast cancer undergoing chemotherapy and identifying factors associated with increased risk of cardiovascular disease highlights the need for sustained cardiovascular surveillance in breast cancer survivors.
Abstract
Breast cancer is the most common malignancy among women worldwide, and chemotherapy remains a cornerstone of its treatment. However, chemotherapy can increase the risk of cardiovascular disease (CVD), which is a major cause of morbidity and mortality in cancer survivors. Understanding the prevalence and risk factors for CVD in this population is essential for improving long-term outcomes. This study aimed to evaluate the occurrence of new-onset CVD in women with breast cancer undergoing chemotherapy and to identify factors associated with increased risk.
We conducted a retrospective cohort study using administrative data from a Slovak health insurance company covering 1.77 million insurees (2024). We included women with breast cancer (ICD-10: C50*) who initiated chemotherapy (ATC groups L01 or L02) between 2013 and 2024. Baseline CVD status was assessed using administrative records from the two years prior to chemotherapy initiation. New-onset CVD was ascertained from the date of treatment initiation and followed for a mean of 3.8 years (SD 3.4). To identify factors associated with incident CVD, we applied multivariate Cox proportional hazards regression in the subset of patients without prior CVD.
10,171 women with mean age of 60.2 (SD 12.6) started chemotherapy treatment for breast cancer between years 2013 and 2024. 62.8% of them had no CVD present at the start of treatment (except for hypertension), with mean age of 55.8 (SD 11.4). Share of patients with CVD increased to 49.1% at 1 year and 63.3% at 5 years after treatment initiation. In CVD-naive patients, ischaemic heart disease was the most common CVD, with 13.0% of patients developing it within 5 years, followed by arrythmia (10.5%), atherosclerosis (8.3%), embolism and thrombosis (7.8%) and heart failure (4.7%). In patients with established CVD, the prevalence of individual diagnoses shows around two-fold increase within 5 years (Table 1). Model showed that higher age (40–64 years: HR = 1.38, ≥65 years: HR = 2.13), presence of hypertension (HR = 1.69), diabetes (HR = 1.18), chronic kidney failure (HR = 1.60) and longer chemotherapy episodes (1–4 years: HR = 1.12, ≥4 years: HR = 1.18) were significantly associated with higher CVD risk, while initial chemotherapy of L02 class was associated with lower risk (HR = 0.75).
Cardiovascular disease represents a substantial and increasing burden among women undergoing chemotherapy for breast cancer. A large proportion of initially CVD-naive patients developed cardiovascular conditions over follow-up. Among incident diagnoses, ischaemic heart disease had the highest 5-year cumulative incidence, followed by arrhythmias, thromboembolic events, and atherosclerotic disease. Together with the approximately two-fold higher prevalence observed in patients with preexisting CVD, this study highlights the need for sustained cardiovascular surveillance in breast cancer survivors.Table 1Prevalence of selected CVD
Advances in cancer detection and treatment have improved 5-year survival rates, creating a growing population of cancer survivors. However, multi-modal therapies carry cardiotoxic risks, and cardiovascular events during treatment can interrupt curative care and increase morbidity, healthcare costs, and mortality. We evaluated the real-world effectiveness of primary prevention with cardioprotective pharmacological therapy on major adverse cardiovascular events (MACE) among adults with breast cancer receiving cytotoxic chemotherapy.
We conducted a retrospective cohort study within a large integrated healthcare delivery system. Adult members (≥18 years) diagnosed with primary breast cancer between January 2007 and December 2022 were identified through the cancer registry. Eligible patients maintained continuous health plan enrollment prior to diagnosis and received cytotoxic chemotherapy. Covariates, exposure, and outcome data were extracted from electronic medical records. MACE was defined as a composite of myocardial infarction, stroke, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, and all-cause mortality. Primary prevention exposure was based on prescription fills for cardioprotective pharmacological therapy during the 12 months preceding chemotherapy initiation. Parametric survival models were adjusted for demographics, lifestyle factors, tumor characteristics, insurance type, primary breast cancer surgery, and comorbidities. To address non-randomized treatment assignment, we applied the potential outcomes framework using a control function derived from a first-stage treatment selection model with two instrumental variables: (1) the number of cardiologists at the patient’s treatment center and (2) lagged prescribing preferences for cardioprotective medications among prior breast cancer patients at the same center. Statistical inference used 1,000 bootstrap replications with bias-corrected confidence intervals. Patients were followed until MACE, disenrollment, or end of follow-up (December 2025).
Among 12,203 patients, median follow-up after chemotherapy initiation was 6.6 years (mean 7.5; maximum 19). Over 91,636 person-years, 2,434 patients experienced a MACE (26.6 per 1,000 person-years). Primary prevention with cardioprotective pharmacological therapy was associated with a 95% longer time to MACE versus no therapy (Time Ratio = 1.95; 95% CI: 1.15–4.21).
Among breast cancer patients receiving cytotoxic chemotherapy, primary prevention with cardioprotective pharmacological therapy was significantly associated with prolonged time to major adverse cardiovascular events. These findings support proactive cardioprotective strategies to mitigate treatment-related cardiovascular risk and reinforce the value of integrating preventive cardiology into cardio-oncology care pathways.
A. Kawatkar, A. Baecker, E. Estrada et al.· European Heart Journal, Supp...· 0 citations
Patients with cardiovascular disease (CVD) have an increased risk of cancer, partly due to shared risk factors, chronic inflammation and systemic mediators. However, most previous studies have focused on individuals with pre-existing CVD. Whether patients with a new diagnosis of CVD are at particularly high risk of incident cancer, and whether the spectrum of cancer types differs from that of the general population, remains insufficiently explored.
To describe the five-year incidence of cancer in patients with a new diagnosis of CVD in our healthcare area and to compare the distribution of cancer types with that reported in the general population.
We conducted a population-based cohort study using clinical databases from our healthcare area. All adults (>18 years) without a previous history of cancer who were newly diagnosed with CVD between 2010 and 2022 were included. Incident cancers diagnosed between 3 months and 5 years after the index CVD diagnosis were recorded. The incidence and distribution of cancer types were analysed and compared with data from the general population.
A total of 9,900 patients with newly diagnosed CVD and no prior cancer history were identified. The mean age of the cohort was 64 years, 43% were women, and comorbidities were frequent. During follow-up, 1,922 patients (19.4%) developed incident cancer within five years. Patients who developed cancer were more often male, older, and had a higher burden of comorbidities than those who did not. Among CVD subtypes, chronic heart failure was associated with the highest risk of incident cancer. The most frequently diagnosed cancers were gastrointestinal (27%), lung (14.5%), genitourinary (13.5%) and male reproductive system cancers (13.4%).
In our healthcare area, the five-year incidence of cancer following a new diagnosis of CVD was markedly high. Moreover, the distribution of cancer types in this population differed from that of the general population, with a higher proportion of genitourinary cancers and a lower proportion of breast cancer. These findings highlight the importance of cancer awareness and surveillance strategies in patients with newly diagnosed CVD.Table.Basal characteristics. Figure.Types of incident cancer.
P. Moliner, H. Morillas, A. Ricarte-Marin et al.· European Heart Journal, Supp...· 0 citations
The long-term prognosis of non-metastatic breast cancer is favorable, with 5-year survival rates exceeding 80%. Standard management includes surgery followed by adjuvant anticancer therapy, comprising systemic anticancer treatment and/or radiotherapy. Prevention of cancer recurrence and late cardiovascular toxicity related to anticancer therapy is a key component of comprehensive care. The risk of premature cardiovascular mortality increases with each additional atherosclerotic risk factor.
The aim of the study was to assess the control of classic cardiovascular risk factors in women referred for baseline cardio-oncology assessment prior to anticancer therapy.
Before initiation of anticancer therapy, baseline cardiovascular risk assessment was performed in accordance with the 2022 ESC Guidelines on cardio-oncology. This included medical history, assessment of comorbidities, performance status, and office blood pressure (BP) measurement. Laboratory evaluation comprised fasting glucose, glycated hemoglobin (HbA1c), and lipid profile. Normal values were defined as: office BP <140/90 mmHg; glucose 3.9–5.5 mmol/L; HbA1c 4.8–5.9%; total cholesterol <4.9 mmol/L; LDL cholesterol <3.0 mmol/L; triglycerides <1.2 mmol/L. Ambulatory blood pressure monitoring (ABPM) was used to confirm insufficient BP control. Elevated BP and hypertension were defined as ≥115/65 mmHg and ≥130/80 mmHg, respectively, according to the 2024 ESC Guidelines.
The study included 100 women (mean age 56.1 ± 10.7 years) with left-sided (57%) or right-sided (43%) breast cancer. Hormone receptor positivity was frequent (estrogen receptor 83%, progesterone receptor 75%, HER2 23%). Most tumors were of intermediate or high histological grade (G2–G3, 80%). A family history of breast cancer was reported in 57% of patients. The most common comorbidities were arterial hypertension (43%), dyslipidemia (19%), diabetes mellitus (12%), and hypothyroidism (9%); 17% of patients were active smokers. Excess body weight was present in 66% of women. Elevated office BP was observed in 50% (systolic) and 45% (diastolic) of patients. ABPM confirmed elevated BP in up to 94% and hypertension in approximately 20%. Metabolic abnormalities were highly prevalent, particularly dyslipidemia: elevated total cholesterol in 68%, LDL cholesterol in 63%, and triglycerides in 54%. Statin therapy was associated with a significantly lower likelihood of elevated LDL cholesterol (OR = 0.14; p = 0.0007). Obesity was strongly associated with elevated systolic and diastolic BP.
Women with non-metastatic breast cancer frequently present with suboptimal control of cardiovascular risk factors at the time of qualification for anticancer therapy. Cardio-oncology care should focus on optimal blood pressure management and aggressive modification of metabolic risk factors, including obesity and dyslipidemia, while accounting for psychosocial aspects.
S. Mędrek, S. Szmit· European Heart Journal, Supp...· 0 citations
It is recommended that patients with lung cancer undergo screening to assess their cardiovascular risk and related complications and it is recommended that patients with lung cancer undergo screening to assess their cardiovascular risk and related complications.
M. Mamedov, P. Skopin, A. K. Karimov· Russian Journal of Preventiv...· 0 citations
Cancer and cardiovascular disease (CVD) are the two leading causes of morbidity and mortality worldwide and frequently coexist due to shared risk factors and overlapping pathophysiology. Pre-existing CVD at cancer diagnosis complicates treatment decisions, limits tolerance to anticancer therapies, and is associated with poorer outcomes. However, national-level evidence describing how the burden of pre-existing CVD at cancer diagnosis has evolved over time, and how it may change in the future, remains limited. Understanding these trends is important for health service planning and integrated cardio-oncology care.
To examine temporal trends in pre-existing CVD at cancer diagnosis from 2001 to 2020, assess the impact of common comorbidities and lifestyle risk factors, and project future CVD burden to 2050.
We conducted a population-based serial cross-sectional study using linked UK electronic health records, including primary care, hospital admissions, cancer registry, and mortality data. Adults newly diagnosed with breast, prostate, lung, colorectal, or haematological cancer between 2001 and 2020 were included. Pre-existing CVD and subtypes were identified prior to cancer diagnosis. Annual crude and age-standardised prevalence estimates were calculated. Temporal trends were assessed using logistic regression adjusted for age, sex, and cancer site, with stratified analyses by cancer type, sex, ethnicity, and deprivation. Sequential models evaluated the association of cardiometabolic conditions, behavioural factors, and chronic systemic comorbidities. Projections to 2050 were generated using restricted cubic spline models to estimate CVD prevalence from 2021 to 2050.
Among 773,590 patients with cancer, age-standardised prevalence of pre-existing CVD increased from 31.4% in 2001 to 39.2% in 2020. Lung and haematological cancers consistently showed the highest CVD burden, while breast cancer showed the lowest. The steepest increases were observed for heart failure, atrial fibrillation, and valvular heart disease, whereas myocardial infarction and stroke showed slower growth. Sequential modelling indicated that rising cardiometabolic and chronic systemic comorbidities were strongly associated with the observed temporal increase, while behavioural factors provided limited additional attenuation. Projections suggested that approximately half of patients may have pre-existing CVD at cancer diagnosis by 2050.
The burden of pre-existing CVD at cancer diagnosis has increased substantially over the past two decades in the UK and is projected to rise further. These findings highlight the growing need for integrated prevention strategies and cardio-oncology services to address increasing multimorbidity in patients with cancer.
A. Alshahrani, E. Kontopantelis, C. Morgan et al.· European Heart Journal, Supp...· 0 citations
Male breast cancer is rare and predominantly affects older patients, who face a substantial competing burden of cardiovascular disease. We aimed to characterize age-specific cumulative incidences of breast cancer, cardiovascular, and other-cause mortality and determine when cardiovascular cumulative incidence overtakes that of breast cancer. Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified men diagnosed with non-metastatic invasive breast cancer during 2000-2022. Cause-specific cumulative incidence was estimated using the Aalen-Johansen estimator, with cardiovascular-breast cancer differences at 5 and 10 years as the primary comparison. Factors associated with cardiovascular death were evaluated using cause-specific Cox and complementary Fine-Gray models. Among 6702 men followed for a median of 67 months, 665 cardiovascular deaths occurred. Mortality patterns were strongly age-dependent. In men aged 80 years or older, cardiovascular cumulative incidence exceeded breast cancer cumulative incidence by 4.6 percentage points at 5 years and 14.6 percentage points at 10 years. In men aged 70-79 years, the differences were not significant at either time point, although an exploratory sustained crossover occurred near 13.6 years. After adjustment, age 80 years or older was strongly associated with cardiovascular death compared with age 60-69 years (hazard ratio 8.54, 95% confidence interval 6.89-10.60); regional stage and unmarried status were also associated with higher cardiovascular mortality. In men with non-metastatic breast cancer, cardiovascular cumulative incidence overtakes that of breast cancer early after diagnosis in the oldest patients. These findings support age-aware cardiovascular attention during survivorship but do not establish that intensified cardiovascular surveillance improves outcomes.
İsmail Zİhnİ, Burcu Zihni, M. Z. Sabuncuoğlu· Biomolecules & biomedicine· 0 citations
