Cardiovascular disease and mortality after breast cancer in postmenopausal women: Results from the Women's Health Initiative

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of morbidity and mortality among older postmenopausal women. The impact of postmenopausal breast cancer on CVD for older women is uncertain. We hypothesized that older postmenopausal women with breast cancer would be at a higher risk of CVD than similar aged women without breast cancer and that CVD would be a major contributor to the subsequent morbidity and mortality.

Methods: In a prospective Women's Health Initiative study, incident CVD events and total and cause-specific death rates were compared between postmenopausal women with (n = 4,340) and without (n = 97,576) incident invasive breast cancer over 10 years post-diagnosis, stratified by 3 age groups (50-59, 60-69, and 70-79).

Results: Postmenopausal women, regardless of breast cancer diagnosis, had similar and high levels of CVD risk factors (e.g., smoking and hypertension) at baseline prior to breast cancer, which were strong predictors of CVD and total mortality over time. CVD affected mostly women age 70-79 with localized breast cancer (79% of breast cancer cases in 70-79 age group): only 17% died from breast cancer and CVD was the leading cause of death (22%) over the average 10 years follow up. Compared to age-matched women without breast cancer, women age 70-79 at diagnosis of localized breast cancer had a similar multivariate-adjusted hazard ratio (HR) of 1.01 (95% confidence interval [CI]: 0.76-1.33) for coronary heart disease, a lower risk of composite CVD (HR = 0.84, 95% CI: 0.70-1.00), and a higher risk of total mortality (HR = 1.20, 95% CI: 1.04-1.39).

Conclusion: CVD was a major contributor to mortality in women with localized breast cancer at age 70-79. Further studies are needed to evaluate both screening and treatment of localized breast cancer tailored to the specific health issues of older women.

Fig 1. Flow diagram of participants included in the present study.

WHI indicates Women’s Health Initiative; CT, clinical trials; OS, observational study; CVD, cardiovascular disease; and BC, breast cancer.

Fig 2. Median years of follow up scheme of the study for women with and without breast cancer.

CHD indicates coronary heart disease; MI, myocardial infarction; CREVS, coronary revascularization; and WHI, Women’s Health Initiative.

Fig 3. Age adjusted survival curves for total mortality among women with localized breast cancer vs. no breast cancer comparisons.

BC indicates breast cancer. For more details regarding each age group, see S1–S3 Figs.

Fig 4. Hazard ratios of myocardial infarction (MI) and coronary heart disease (CHD)-related death by the number of baseline risk factors (i.e., smoking, hypertension, hypercholesterolemia, and diabetes) in women with (A) and without (B) breast cancer ^a.

^aCox models were adjusted for age, ethnicity, education, body mass index, and waist circumference.