Cardiovascular Screening and Lipid Management in Breast Cancer Survivors

Abstract

Background: Cardiovascular disease (CVD) is the leading cause of death among breast cancer (BC) survivors. BC survivors are at increased risk of CVD due to a higher prevalence of risk factors. Current data are limited on the cardiovascular screening practices and lipid management in this population in primary care settings.

Methods: A retrospective case control study was performed with 105 BC survivors and 210 matched controls (based on age and medical comorbidities of diabetes, hypertension, and hyperlipidemia). BC survivors were established with primary care practices within a large academic institution and had completed primary cancer treatment. Data on screening for CVD and lipid management were collected via a retrospective chart review.

Results: The average BC survivor was 63 years old, with 9 years since diagnosis. Compared with matched controls, BC survivors had more cholesterol screening (88% vs 70%, P < .001) and active statin prescriptions (63% vs 40%, P < .05) if indicated by the Atherosclerotic Cardiovascular Disease Calculator. There were no differences in CVD screening in White and African American BC survivors. However, African American BC survivors were more likely to have hypertension (P < .01) and have a body mass index in the overweight and obese category (P < .001) than White BC survivors. Older BC survivors were more likely to receive cholesterol screening.

Discussion: This study demonstrates that BC survivors who have an established primary care provider have improved cholesterol screening and statin therapy based on their risk of developing chronic diseases.

Keywords: Cardiovascular Diseases; Case-Control Studies; Hyperlipidemias; Obesity; Prevalence; Retrospective Studies; Risk Factors; Statins; Survivorship.

Figure 1:

Cardiovascular screening and statin therapy in breast cancer survivors. A) Breast cancer survivors are more likely to have received cholesterol screening and statin therapy than matched controls B) Subgroup analysis of breast cancer survivors with a diagnosis of hypertension have no differences in blood pressure control compared with comorbidity matched peers. C) Subgroup analysis of breast cancer survivors are more likely than matched controls to have an active statin prescription if indicated. Sample size is indicated in parentheses for each group. *p<0.05, ** p<0.01, ***p<0.001

Figure 2:

Cardiovascular screening, management, and comorbidities in African American and White breast cancer survivors. A) No differences in cardiovascular screening and management were observed between White and African American breast cancer survivors however African American breast cancer survivors were found to have a decreased incidence of having a body mass index less than 25 B) African American breast cancer survivors are more likely to have a diagnosis of hypertension. Sample size is indicated in parentheses for each group. *p<0.05, ***p<0.001.

Figure 3:

Impact of age on cardiovascular screening breast cancer survivors. A) Cardiovascular screening and management of breast cancer survivors stratified by age. Older individuals are more likely to have received cholesterol screening than younger counterparts. B) Incidence of comorbidities based on age in breast cancer survivors. Older breast cancer survivors have a higher incidence of hypertension. Sample size is indicated in parentheses for each group. *p<0.05, **p<0.01, ***p<0.001.