Breast cancer survivors had a significantly higher risk for cardiovascular death within 5 years of diagnosis (HR 1.09) compared to matched cancer-free controls.
Meta-Analysis (n=836,301)
Does breast cancer exposure increase the risk of cardiovascular death, heart failure, atrial fibrillation, coronary artery disease, myocardial infarction, and stroke in breast cancer survivors compared to a matched cancer-free population?
Breast cancer survivors have a significantly increased risk of cardiovascular death, heart failure, and atrial fibrillation compared to the general cancer-free population, highlighting the need for careful cardiovascular monitoring.
Effect estimate: HR 1.09 (95% CI 1.07-1.11)
AIMS: It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc. METHODS AND RESULTS: We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis HR = 1.09; 95% confidence interval (CI): 1.07, 1.11, HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke. CONCLUSION: Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied. REGISTRATION: CRD42022298741.
This sub-study of the important BETAMI trial found that beta-blocker treatment after MI did not negatively affect self-reported physical activity levels, addressing a common clinical concern.
Galimzhanov et al. (2023) conducted a meta-analysis in Breast cancer (n=836,301). Breast cancer survivorship vs. Matched cancer-free controls was evaluated on Cardiovascular death within 5 years of cancer diagnosis (HR 1.09, 95% CI 1.07-1.11). Breast cancer survivors had a significantly higher risk for cardiovascular death within 5 years of diagnosis (HR 1.09) compared to matched cancer-free controls.