Disparities in cardiometabolic and cardiovascular risk after breast cancer: the Pathways Heart Study

BACKGROUND: Cardiometabolic risk factors and cardiovascular disease (CVD) incidence in racially and ethnically underrepresented women with breast cancer are not well characterized. METHODS: The Pathways Heart Study is a prospective cohort of 14 942 women diagnosed with invasive breast cancer between 2005 and 2013 at Kaiser Permanente Northern California. Incidence of cardiometabolic risk factors and CVD outcomes was determined from electronic health records and calculated with a competing risk framework for non-CVD death. Fine-Gray proportional hazards regression estimated subdistribution hazard ratios by race and ethnicity compared with non-Hispanic White women, with additional Asian subgroup analysis. RESULTS: Participants were, on average, 61 years old at diagnosis; 65% were non-Hispanic White, 7.5% were Black, 14.4% were Asian, 11.9% were Hispanic, 0.4% were Pacific Islander, and 0.8% were American Indian or Alaska Native. Black and Asian women had 1.2 to 1.3 times higher incident hypertension risk; Black, Asian, Hispanic, and Pacific Islander women had 1.5 to 3.0 times higher incident diabetes risk; and Asian women had 1.2 times higher incident dyslipidemia risk. Black women had 1.3 to 1.4 times higher risk of incident ischemic heart disease, heart failure, and overall CVD. Filipino women had 1.6 times higher risk of stroke. South Asian women had 2.5 to 2.6 times higher ischemic heart disease and heart failure risk. CONCLUSIONS: Compared with non-Hispanic White women, racially and ethnically diverse women with breast cancer experienced a higher risk of incident diabetes, hypertension, and dyslipidemia. Black and Asian women, particularly Filipino and South Asian women, had a higher risk of incident CVD. Better characterization of health disparities in cardio-oncology is critical to inform future CVD prevention and treatment.