The Spectrum, Impact, and Management of Cardiovascular Disease in Ontario Women with Early Stage Breast Cancer
Year: 2018
Type: dissertation
Study design: Observational Study
Abstract: Background: There are limited data about the epidemiology of cardiovascular disease after early stage breast cancer. Methods: We conducted four cohort studies utilizing data from Ontario women diagnosed with early stage breast cancer between 1998 and 2015. The first study describes causes of death after breast cancer, with a focus on patient strata where death from cardiovascular causes may exceed that from breast cancer. The second study examines hospital presentations for different categories of cardiovascular disease, and their temporal relationship to heart failure, comparing early stage breast cancer cases to age-matched women without cancer. The third study develops a score for predicting cardiovascular risk after early stage breast cancer. The final study examines 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor (also known as statins) use after early stage breast cancer as a marker of cardiovascular preventative therapy, with comparison to cancer-free women of similar cardiovascular risk. Results: Breast cancer was the most common cause of death. Among patients with prior cardiovascular disease, the risks of death from breast cancer and cardiovascular disease were equivalent for the first five years, after which death from cardiovascular causes was more frequent. For women aged ≥66 years who survived ≥5 years after diagnosis, cardiovascular disease exceeded breast cancer as the leading cause of death at ten years post-diagnosis. The 10-year cumulative incidence of cardiovascular hospitalization was 11.7% after early stage breast cancer and 10.6% in controls. The ratio of cardiovascular disease rates between the cohorts increased with time. 76% of cardiovascular hospitalizations were for diagnoses other than heart failure. 36% of first heart failure presentations were preceded by hospital presentation with another cardiovascular disease. We developed a score to predict the risk of death or hospitalization from cardiovascular disease. Model calibration and discrimination were good. The c-index in the validation cohort was 81.3% at 5 years. Finally, we observed that women with early stage breast cancer were less likely to dispense statins compared to cancer-free women, though the differences were small. Relevance: These data provide useful insights into the importance of cardiovascular disease and how its management can be improved in women with early stage breast cancer.
Source: TSpace (University of Toronto)
Author: Husam Abdel‐Qadir
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W3097713249