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. 2024 Dec 19;10(1):89.
doi: 10.1186/s40959-024-00286-2.

Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999-2020: a population-based retrospective study

Yong-Hao Yeo  1 , Boon-Jian San  2 , Jia-Yi Tan  3 , Min-Choon Tan  3   4 , Teodora Donisan  5 , Justin Z Lee  6 , Laura M Franey  7 , Salim S Hayek  8   9
Affiliations

Cardiovascular mortality trends and disparities in U.S. breast cancer patients, 1999-2020: a population-based retrospective study

Yong-Hao Yeo et al. Cardiooncology. .

Abstract
in English, French

Background: Breast cancer survivors face a higher risk of cardiovascular disease (CVD) compared to non-breast cancer patients, yet contemporary data on CVD-related mortality within this group remains scarce.

Objective: To investigate trends and disparities in CVD mortality among breast cancer patients.

Methods: We queried the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (CDC Wonder) and conducted serial cross-sectional analyses on national death certificate data for CVD mortality in breast cancer patients aged 25 and above from 1999 to 2020. We calculated age-adjusted mortality rates (AAMR) per 100,000 individuals and analyzed trends over time using the Joinpoint Regression Program, with further analyses stratified by age, race, census region, and urbanization level.

Results: A total of 74,733 CVDs with comorbid breast cancer in the United States were identified between 1999 and 2020. The AAMR from CVDs with comorbid breast cancer decreased from 2.57 (95% CI [2.50-2.65]) in 1999 to 1.20 (95% CI [1.15-1.24]) in 2020, with an average annual percent change (AAPC) of - 4.3. The three most common causes of CVDs were ischemic heart disease (47.8%), cerebrovascular disease (17.1%), and hypertensive disease (10.6%). Our analysis revealed a significant decrease in AAMR for all CVD subtypes, except for hypertensive diseases and arrhythmias. The decrease in annual percent change (APC) was more pronounced in individuals aged ≥ 65 years compared to those < 65 years (-4.4, 95%CI [-4.9, -3.9] vs. -2.9, 95%CI [-4.1, -1.7], respectively. Notably, non-Hispanic Blacks consistently exhibited the highest AAMR (1.95, 95%CI [1.90-1.99]), whereas Hispanic or Latina patients had the lowest AAMR (0.75, 95% CI [0.72-0.78]). The AAMR was also higher in rural regions than in urban areas (1.64, 95%CI [1.62-1.67] vs. 1.55, 95%CI [1.53-1.56]).

Conclusion: The study highlights a significant decline in CVD mortality among breast cancer patients over two decades, with persistent disparities by race and region. Exceptionally, hypertensive diseases and arrhythmias did not follow this declining trend.

WHAT IS NEW?: There was a significant decline in CVD mortality among breast cancer patients from 1999 to 2020. However, deaths from hypertensive diseases and arrhythmias did not follow this declining trend. Non-Hispanic Black patients consistently had higher age-adjusted mortality rates from CVD than non-Hispanic White and Hispanic or Latina patients, showing ongoing racial disparities. Rural areas also had higher cardiovascular mortality rates than urban areas, indicating geographical disparities in health outcomes. WHAT ARE THE CLINICAL IMPLICATIONS?: While there was an improvement in population-level CVD mortality in patients with comorbid breast cancer, efforts are essential to address racial and geographical disparities.

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Conflict of interest statement

Declarations. Ethical approval: Data is deidentified and publicly available; no IRB approval is needed. Disclosures: All authors have no relationships relevant to the contents of this paper to disclose. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Trends in Number of Deaths of All-Cause Mortality vs. Cardiovascular Death among Patients with Comorbid Breast Cancer between 1999 and 2020
Fig. 2
Fig. 2
Trends in Age-Adjusted Mortality Rates of Cardiovascular Death among Patients with Comorbid Breast Cancer between 1999 and 2020. *The dashed line represents the trendline
Fig. 3
Fig. 3
Comparison of Trends of Age-Adjusted Mortality Rate of CVDs in Breast Cancer vs. A. Age-Adjusted Mortality Rate of Overall Breast Cancer. B. Age-Adjusted Mortality Rate of Overall CVDs in Women
Fig. 4
Fig. 4
Etiologies of Cardiovascular Deaths among Patients with Comorbid Breast Cancer
Fig. 5
Fig. 5
Trends in Age-Adjusted Mortality Rates of Cardiovascular Death among Patients with Comorbid Breast Cancer between 1999 and 2020, Stratified by Races and Ethnicities. *The dashed line represents the trendline
See this image and copyright information in PMC

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