Cardiovascular disease after breast cancer linked to poorer oncologic outcomes
Key takeaways:
- Women with incident myocardial infarction or heart failure had a greater risk for cancer death.
- They also exhibited greater risk for new non-breast malignancy.
Breast cancer survivors who developed incident myocardial infarction or heart failure exhibited increased risk for adverse oncologic outcomes, according to a population-based cohort study.
The findings highlight the importance of prioritizing cardiovascular care for these individuals, researchers concluded.
“The results themselves did not come as a surprise, since they were in line with our hypothesis and rationale for the study,” Oscar Calvillo-Argelles, MD, a cardiologist and cardio-oncologist at University of Toronto, told Healio. “Among breast cancer survivors, incident myocardial infarction or heart failure is associated with increased risk for adverse cancer outcomes — particularly cancer death. It is unlikely that a single cause can explain the observed associations. Although the results can motivate for more aggressive cardiovascular risk factor modification among breast cancer survivors, it is still unknown how and if this can be translated into improved cancer outcomes.”
Prior research has showed cardiovascular disease (CVD) is associated with higher rates of incident cancer. However, limited data exist regarding the association of incident CVD and oncologic outcomes after cancer diagnosis, according to study background.
Calvillo-Argelles and colleagues conducted a population-based cohort study in Ontario to evaluate whether incident myocardial infarction or heart failure is associated with oncologic outcomes among breast cancer survivors.
The study included 30,694 women (median age, 60 years) diagnosed with a first breast cancer from April 2007 through March 2015.
Researchers conducted a landmark analysis with women aged at least 40 years who remained alive 2 years after diagnosis. All women had staging data available. None had recurrent/distant disease or preceding CVD.
Cancer mortality, diagnosis of a new non-breast malignancy and initiation of new chemotherapy served as the primary outcomes.
At a median 3.9 years after the landmark date, 1,346 women (4.38%) developed incident myocardial infarction or heart failure.
Results showed 5-year cumulative incidence rates of 5.9% (95% CI, 5.6-6.1) for cancer death, 4.3% (95% CI, 4.1-4.6) for new non-breast malignancy and 25.7% (95% CI, 25.2-26.2) for initiation of new chemotherapy.
Women with incident myocardial infarction or heart failure exhibited higher risk for cancer death (HR = 3.94; 95% CI, 3.38-4.59), new non-breast malignancy (HR = 1.39; 95% CI, 1.06-1.82) and new chemotherapy initiation (HR = 1.25; 95% CI, 1.02-1.53).
Researchers acknowledged study limitations, including potential residual confounding and reverse causation. They also noted use of administrative data sets meant they did not have the ability to detect breast cancer recurrence, and they highlighted the potential that some cancer deaths had been misclassified.
For more information:
Oscar Calvillo-Argelles, MD, can be reached at ocalvillo@hsnsudbury.ca.
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Calvillo-Argϋelles O, et al. JACC CardioOncol. 2024;doi:10.1016/j.jaccao.2024.08.008.