Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis
Galimzhanov A. Istanbuly S. Tun H.N. Ozbay B. Alasnag M. Ky B. Lyon A.R. Kayikcioglu M. Tenekecioglu E. Panagioti M. Kontopantelis E. Abdel-Qadir H. Mamas M.A.
1 December 2023Oxford University Press
European Journal of Preventive Cardiology
2023#30Issue 182018 - 2031 pp.
Aims It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in BC patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with BC.Methods and results We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger’s test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.Conclusion Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.
Breast cancer , Cardiovascular diseases , Epidemiology , Heart disease risk factors , Incidence , Systematic review
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Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan
Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Keele, Stoke on Trent, United Kingdom
Faculty of Medicine, University of Aleppo, Aleppo, Syrian Arab Republic
Larner College of Medicine, University of Vermont, Burlington, VT, United States
Basaksehir Cam and Sakura State Hospital, Department of Cardiology, Istanbul, Turkey
Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
Division of Cardiology, Department of Medicine, Perelman School of Medicine, the University of Pennsylvania, Philadelphia, PA, United States
Abramson Cancer Center, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA, United States
Cardio-Oncology Service, Royal Brompton Hospital, National Heart, Lung Institute, Imperial College London, London, United Kingdom
Department of Cardiology, Faculty of Medicine, Ege University, Izmir, 60521, Turkey
Department of Cardiology, Bursa Yuksek İ htisas Training and Research Hospital, Health Sciences University, Bursa, Turkey
Department of Cardiology, Erasmus MC, Thorax Center, Erasmus University, Rotterdam, Netherlands
Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, National Institute for Health Research School for Primary Care Research, University of Manchester, Manchester, United Kingdom
Department of Medicine, Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
Department of Propedeutics of Internal Disease
Keele Cardiovascular Research Group
Faculty of Medicine
Larner College of Medicine
Basaksehir Cam and Sakura State Hospital
Division of Cardiology
King Fahd Armed Forces Hospital
Division of Cardiology
Abramson Cancer Center
Cardio-Oncology Service
Department of Cardiology
Department of Cardiology
Department of Cardiology
Division of Population Health
Department of Medicine
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