Atherosclerotic Cardiovascular Disease Risk and Longitudinal Risk Factor Management Among Patients With Breast Cancer

This retrospective cohort study of patients with nonmetastatic breast cancer details individual estimated atherosclerotic cardiovascular disease (ASCVD) risk at the time of cancer diagnosis and longitudinal preventive medication exposure during post-treatment follow up. Primary or secondary preventive interventions were indicated for a majority of patients at baseline. Modifiable ASCVD risk factors were frequently untreated or uncontrolled during longitudinal follow up. Background: Cardiovascular disease is the leading cause of noncancer mortality for breast cancer survivors. Data are limited regarding patient-level atherosclerotic cardiovascular disease (ASCVD) risk estimation and preventive medication use. This study aimed to characterize ASCVD risk and longitudinal preventive medication use for a cohort of patients with nonmetastatic breast cancer. Patients and Methods: This retrospective cohort study included 326 patients at an academic medical center in Boston, Massachusetts diagnosed with nonmetastatic breast cancer or ductal carcinoma in situ from January 2009 through December 2015. Patient demographics, clinical characteristics, laboratory studies, medication exposure, and incident cardiovascular outcomes were collected. Estimated 10-year ASCVD risk was calculated for all patients from nonlaboratory clinical parameters. Results: Median follow up time was 6.5 years (IQR 5.0, 8.1). At cancer diagnosis, 23 patients (7.1%) had established ASCVD. Among those without ASCVD, 10-year estimated ASCVD risk was >20% for 77 patients (25.4%) and 7.5% to < 20% for 114 patients (37.6%). Two-hundred and sixteen patients (66.3%) had an indication for lipid-lowering therapy at cancer diagnosis, 123 of whom (57.0%) received a statin during the study. Among 100 patients with ASCVD or estimated 10-year ASCVD risk >20%, 92 (92.0%) received an antihypertensive medication during the study. Clinic blood pressure > 140/90 mmHg was observed in 33.0% to 55.6% of these patients at each follow up assessment. Conclusion: A majority of patients in this breast cancer cohort had an elevated risk of ASCVD at the time of cancer diagnosis. Modifiable ASCVD risk factors were frequently untreated or uncontrolled in the years following cancer treatment.