Prevalence of cardiovascular disease risk and its association with survival outcomes in women with newly diagnosed metastatic breast cancer – Preliminary Analysis

INTRODUCTION: Emerging evidence suggests cardiovascular disease (CVD) may be causally linked to carcinogenesis and cancer progression. Given their tumorigenic environment, women with metastatic breast cancer (MBC) may be particularly vulnerable; however, the clinical relevance of CVD in this emerging population remains unexplored. PURPOSE: 1) To characterize the prevalence of CVD risk in a broad population of women newly diagnosed with MBC prior to initiation of cancer treatment, and 2) To identify the optimal screening tool using three different recommended CVD risk calculator tools.HYPOTHESIS: Women with lower CVD risk will be demonstrate better overall survival (OS) and progression free survival (PFS) compared to those with higher CVD risk.METHODS: In this retrospective cohort study, clinical data were retrieved from the electronic health records (EHR) of MBC-treatment naïve women at the time of diagnosis at two cancer centers. CVD risk was assessed using three clinically recommended tools: a) the Framingham Heart Study (FHS) CVD risk calculated with laboratory lipid values, b) the FHS CVD risk calculated using body mass index (BMI), and c) the American Heart Association PREVENT CVD risk. OS was defined as the time of diagnosis until death. PFS was defined as the time between diagnosis and the evidence of disease progression or death. Each CVD risk tool was modeled separately in multivariable Cox proportional hazard regression analyses.RESULTS: Data were collected on 276 MBC women (age: 60.5±14.1 yrs; BMI: 30.4±7.9 kg/m 2 ). Only 33% of patients had laboratory lipid values available around the time of diagnosis needed for FHS Lipid and PREVENT risk calculations; 100% of patients had BMI values for FHS BMI risk calculation. Average CVD risk (95% CI) was 15.7 (13.2, 18.3), 17.8 (15.9, 19.7), and 22.4 (17.6, 27.2) for FHS Lipid Risk, FHS BMI risk, and CVD PREVENT risk, respectively. The prevalence of medium/high CVD risk was 57.8%, 60.2% and 66.7% for the risk tools overall, respectively. All three tools demonstrated a significant inverse association between CVD risk and OS, while also adjusting for hormone receptor and human epidermal growth factor receptor 2 (HER2) disease subtype. For each unit increase in the FHS lipid risk, there was a 3% increase in the hazard of death over time (HR = 1.03, 95% CI 1.01–1.05, p = 0.014). For each unit increase in the FHS BMI risk, there was a 1% increased hazard of death over time (HR = 1.01, 95% CI 1.00–1.02, p = 0.049). For each unit increase in the CVD PREVENT risk, there was a 2% increased hazard of progression over time (HR = 1.02, 95% CI 1.01–1.03, p = 0.002). Women with triple-negative MBC consistently displayed the highest inverse risk for CVD with OS and PFS across all three models (p 57%) of women with newly diagnosed MBC demonstrate medium/high CVD risk, which is substantially higher than the general U.S. population (20.2% for elevated CVD risk), and 3) CVD risk at the time of MBC diagnosis is significantly associated with increased hazard of death and decreased PFS, even after adjusting for MBC subtype. Identifying CVD risk reduction strategies may represent a promising area to improve survivorship in this growing population. Future studies are needed to evaluate these findings more comprehensively by disease subtype. DISCLOSURES: This study is funded by the Center for Health Outcomes and Informatics Research (CHOIR) at Loyola University Chicago, and Rush University. This abstract was presented at the American Physiology Summit 2026 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.