What question did this study set out to answer?

This study aims to investigate cardiovascular disease and mortality risks in women with breast cancer compared to those without.

April 6, 2022Journal of Clinical OncologyOpen Access

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Breast cancer (n=81844). Intervention: Anthracyclines and trastuzumab vs. Matched controls without breast cancer. Primary outcome: Heart failure and/or cardiomyopathy (HR 3.68, 95% CI 1.79 to 7.59, p=<0.01).

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Key result

Women with breast cancer who received both anthracyclines and trastuzumab had a significantly higher risk of heart failure and/or cardiomyopathy compared to matched controls without breast cancer (HR 3.68).

Why the study?

Cardiovascular disease and mortality risk in women with breast cancer according to cancer therapy received relative to women without breast cancer had not been fully examined.

Do specific breast cancer therapies increase the risk of incident cardiovascular disease and mortality in women with breast cancer compared to women without breast cancer?

Population

13,642 women with invasive BC matched to 68,202 controls without BC

Comparison

Women with BC by cancer therapy received vs matched controls without BC

Design

Matched cohort study

Follow-up

Average 7 years (range < 1-14 years)

Authors

HGHeather GreenleeUniversity of Washington CICarlos IribarrenGeneral / Preventive / Lipids JRJamal S. RanaPreventive Cardiology

Discussion

Member takes

Implication

Supports intensified cardiac monitoring after anthracycline/trastuzumab exposure; leaves open prospective validation of risk-reduction strategies.

Key Points

This study aims to investigate cardiovascular disease and mortality risks in women with breast cancer compared to those without.
Matched women with invasive breast cancer to controls based on birth year and race/ethnicity.
CVD outcomes and treatment data were collected from electronic health records.
Used multivariable Cox proportional hazards models to estimate hazard ratios.
Women receiving anthracyclines and trastuzumab showed a hazard ratio of 3.68 for heart failure/cardiomyopathy (95% CI, 1.79 to 7.59).
Women with a history of radiation therapy had a hazard ratio of 1.38 for heart failure/cardiomyopathy (95% CI, 1.13 to 1.69).
Aromatase inhibitor use was associated with a hazard ratio of 1.31 for heart failure/cardiomyopathy (95% CI, 1.07 to 1.60).

Study Design

Type

Cohort (n=81,844)

Multicenter

Yes

Structured PICO

Do specific breast cancer therapies increase the risk of incident cardiovascular disease and mortality in women with breast cancer compared to women without breast cancer?

Population

81,844 adult women (13,642 with breast cancer and 68,202 matched controls without breast cancer) aged 21 years and older, followed for an average of 7 years.

Exposure

Breast cancer therapies including chemotherapy (anthracyclines, trastuzumab, cyclophosphamide, fluoropyrimidine, and/or taxanes), radiation therapy (left-sided or either side), and endocrine therapy (aromatase inhibitors or tamoxifen).

Comparator

Age, race, and ethnicity-matched women without breast cancer.

Outcome

Incident ischemic heart disease, heart failure, cardiomyopathy, and stroke.hard clinical

Main Result

Hazard Ratio: 3.68 (95% CI 1.79–7.59)

Absolute Event Rate: 4.4% vs 2%

p-value: p=<0.01

Women with breast cancer receiving specific therapies, particularly anthracyclines, trastuzumab, radiation, or aromatase inhibitors, have a significantly increased risk of cardiovascular events and mortality compared to women without breast cancer.

Limitations

Reduced generalizability because women in the study had higher household median incomes and education levels compared with the general US population
Did not include data about treatment combinations across different therapy types, dosage, and duration
Did not account for the specific timing or order of therapy

Cite This Study

Greenlee et al. (2022) conducted a cohort in Breast cancer (n=81,844). Anthracyclines and trastuzumab vs. Matched controls without breast cancer was evaluated on Heart failure and/or cardiomyopathy (HR 3.68, 95% CI 1.79 to 7.59, p=<0.01). Women with breast cancer who received both anthracyclines and trastuzumab had a significantly higher risk of heart failure and/or cardiomyopathy compared to matched controls without breast cancer (HR 3.68).

synapsesocial.com/papers/6a35db32e8fad655376e5076 https://doi.org/10.1200/jco.21.01736

Topics

Women and heart disease Heart failure HFrEF treatment

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Implication

Supports intensified cardiac monitoring after anthracycline/trastuzumab exposure; leaves open prospective validation of risk-reduction strategies.

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Topics

Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Topics

Also Consider