Cardiovascular Disease in Males With Breast Cancer

Figures

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  Figure 1. Cohort Flow Diagram for Male BC Patients and Matched Controls The left panel shows the selection of males diagnosed with BC between 1998 and 2021 in Ontario, Canada, and their age-matched female BC comparators. The right panel illustrates the selection of the same male BC cohort and their age-matched cancer-free male controls. Exclusion criteria applied to both cohorts are detailed, with final sample sizes indicated at the bottom of each panel. Matching was performed in a 1:3 ratio based on age and eligibility criteria. ∗Cells with <6 people suppressed as per ICES privacy policy. BC = breast cancer; LTC = long-term care; OHIP = Ontario Health Insurance Plan.

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  Figure 2. Outcome Rates for Males With BC and Matched Comparators The crude rates of adverse outcomes (per 100 person years) for male BC with comparison to (A) matched female BC patients and (B) matched cancer-free males. Males and females with BC were matched on calendar year at BC diagnosis, age (±1 year), and BC stage. Males with BC were matched to cancer-free males on age (±1 year), with index dates assigned from the empirical distribution of BC diagnosis dates. Outcomes include cause-specific mortality, CVD hospitalizations or ED visits, and specific CVD events/interventions. Asterisks (∗) indicate subgroup analyses excluding individuals with baseline HF or AF. Error bars denote 95% CIs. CABG = coronary artery bypass graft surgery; CVD = cardiovascular disease; ED = emergency department; HF = heart failure; IHD = ischemic heart disease; MI = myocardial infarction; PCI = percutaneous coronary intervention; other abbreviation as in Figure 1.

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  Figure 3. Cumulative Incidence of CVD Hospitalization/ED Visit in BC by Sex (A) Data for the full cohort. (B) Data for people without a prior history of heart failure or atrial fibrillation. AF = atrial fibrillation; CIF = cumulative incidence function; other abbreviations as in Figures 1 and 2.

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  Figure 4. HRs for Adverse Outcomes in Male BC vs Comparators Adjusted HRs for adverse outcomes associated with male BC status, relative to (A) matched female BC patients and (B) matched cancer-free males. HRs were adjusted for rural residence, neighborhood income quintile, hypertension, diabetes, ischemic heart disease, stroke, peripheral arterial disease, chronic obstructive pulmonary disease, HF, and AF. Outcomes include cause-specific mortality, CVD hospitalizations or ED visits, and specific CVD events/interventions. Asterisks (∗) indicate sensitivity analyses excluding individuals with baseline HF or AF. Error bars denote 95% CIs. The dashed line represents the null value (HR = 1), indicating no difference in risk. Abbreviations as in Figure 2.

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  Figure 5. Cumulative Incidence of CVD Hospitalization/ED Visit in BC vs Cancer-Free Males Cumulative Incidence of CVD Hospitalizations/ED Visits in Males with BC vs Cancer-Free Males (A) Data for the full cohort. (B) Data for people without a prior history of heart failure or atrial fibrillation. Abbreviations as in Figures 2 and 3.

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  Central Illustration. HRs for Adverse Outcomes in Male BC vs Comparators Adjusted hazard ratios for adverse outcomes associated with male breast cancer, relative to matched female breast cancer patients and matched cancer-free males. ∗Higher relative to females with BC and cancer-free males. COPD = chronic obstructive pulmonary disease; CVD = cardiovascular disease; ED = emergency department; HF = heart failure; IHD = ischemic heart disease; MI = myocardial infarction.