Prevalence of cardiovascular diseases and risk factor assessment in breast cancer survivors exposed to cardiotoxic therapy

Background: Patients having been treated for breast cancer (BC) are at increased risk of cardiovascular disease (CVD). Participation of patients with high cardiovascular risk (CVR) in comprehensive cardiac rehabilitation programs seems to be a promising area of prevention; however, at present there is no understanding of the scope of the need for such programs in Russia. Aim: To evaluate the frequency of CVDs and their risk factors, and total CVR in BC patients who have undergone cardiotoxic antitumor treatment to determine the need for the development of cardiac rehabilitation programs in this patient category. Methods: This was a single center cross-sectional study performed in 2021 to 2023 in a specialized cardiology clinic in 90 women who had undergone cardiotoxic breast cancer therapy. The patients were examined for CVDs and their risk factors, with assessment of clinical status, serum lipids, glucose, creatinine, and C-reactive protein, levels of physical activity (International Physical Activity Questionnaire), stress (Visual Analog Scale), anxiety and depression (Hospital Anxiety and Depression Scale, HADS), and sleep quality (Pittsburgh Sleep Quality Questionnaire). Electrocardiography (ECG), echocardiography, exercise tolerance ECG test, including cardiorespiratory exercise test (n = 53), and bioimpedancemetry (n = 83) were also performed. Results: The median patient age was 49 [46; 56] years. All patients (100%) had undergone surgery and anthracycline-based chemotherapy. The median time after the end of anthracycline-based chemotherapy was 36 [11.8; 56.5] months. Radiation therapy had been performed in 68 (75.6%) patients, including 42 patients with left-sided BC. Nine (10%) patients were smokers, 52 (57.8%) were overweight or obese, 37 (41.1%) had abdominal obesity, 70 (77.8%) dyslipidemia, 42 (46.7%) arterial hypertension, and 6 (6.7%) diabetes mellitus. Insufficient physical activity was reported by 69 (76.7%) patients. The cardiorespiratory endurance was reduced, with median peak oxygen consumption being 71% of the predicted values. Anxiety symptoms were found in 45 (50%) patients, depressive symptoms in 16 (17.8%), high stress levels in 51 (56.7%), and sleep disorders in 80 (88.9%). Heart failure was diagnosed in 11 (12.2%) patients, coronary heart disease in 1 (1.1%), and paroxysmal atrial fibrillation in 3 (3.3%). Fifty six (56, 62.2%) patients had a high/very high CVR (according to the 2022 ESC Guidelines on cardio-oncology). Conclusion: There is a high prevalence of cardiovascular risk factors in the patients who underwent cardiotoxic antitumor treatment for BC. The most frequent CVD was heart failure; two thirds of the patients had a high cardiovascular risk. Given the prevalence of BC in Russia, there is a clear need to develop programs for cardiac rehabilitation and CVD prevention in this patient category.