Aug 2026· European Heart Journal, Supplement· 0 citations
TL;DR
Women with non-metastatic breast cancer frequently present with suboptimal control of cardiovascular risk factors at the time of qualification for anticancer therapy, and cardio-oncology care should focus on optimal blood pressure management and aggressive modification of metabolic risk factors, including obesity and dyslipidemia.
Abstract
The long-term prognosis of non-metastatic breast cancer is favorable, with 5-year survival rates exceeding 80%. Standard management includes surgery followed by adjuvant anticancer therapy, comprising systemic anticancer treatment and/or radiotherapy. Prevention of cancer recurrence and late cardiovascular toxicity related to anticancer therapy is a key component of comprehensive care. The risk of premature cardiovascular mortality increases with each additional atherosclerotic risk factor.
The aim of the study was to assess the control of classic cardiovascular risk factors in women referred for baseline cardio-oncology assessment prior to anticancer therapy.
Before initiation of anticancer therapy, baseline cardiovascular risk assessment was performed in accordance with the 2022 ESC Guidelines on cardio-oncology. This included medical history, assessment of comorbidities, performance status, and office blood pressure (BP) measurement. Laboratory evaluation comprised fasting glucose, glycated hemoglobin (HbA1c), and lipid profile. Normal values were defined as: office BP <140/90 mmHg; glucose 3.9–5.5 mmol/L; HbA1c 4.8–5.9%; total cholesterol <4.9 mmol/L; LDL cholesterol <3.0 mmol/L; triglycerides <1.2 mmol/L. Ambulatory blood pressure monitoring (ABPM) was used to confirm insufficient BP control. Elevated BP and hypertension were defined as ≥115/65 mmHg and ≥130/80 mmHg, respectively, according to the 2024 ESC Guidelines.
The study included 100 women (mean age 56.1 ± 10.7 years) with left-sided (57%) or right-sided (43%) breast cancer. Hormone receptor positivity was frequent (estrogen receptor 83%, progesterone receptor 75%, HER2 23%). Most tumors were of intermediate or high histological grade (G2–G3, 80%). A family history of breast cancer was reported in 57% of patients. The most common comorbidities were arterial hypertension (43%), dyslipidemia (19%), diabetes mellitus (12%), and hypothyroidism (9%); 17% of patients were active smokers. Excess body weight was present in 66% of women. Elevated office BP was observed in 50% (systolic) and 45% (diastolic) of patients. ABPM confirmed elevated BP in up to 94% and hypertension in approximately 20%. Metabolic abnormalities were highly prevalent, particularly dyslipidemia: elevated total cholesterol in 68%, LDL cholesterol in 63%, and triglycerides in 54%. Statin therapy was associated with a significantly lower likelihood of elevated LDL cholesterol (OR = 0.14; p = 0.0007). Obesity was strongly associated with elevated systolic and diastolic BP.
Women with non-metastatic breast cancer frequently present with suboptimal control of cardiovascular risk factors at the time of qualification for anticancer therapy. Cardio-oncology care should focus on optimal blood pressure management and aggressive modification of metabolic risk factors, including obesity and dyslipidemia, while accounting for psychosocial aspects.
Evaluating the occurrence of new-onset CVD in women with breast cancer undergoing chemotherapy and identifying factors associated with increased risk of cardiovascular disease highlights the need for sustained cardiovascular surveillance in breast cancer survivors.
V. Dvorovy, L. Kováčová, M. Selvek et al.· European Heart Journal, Supp...· 0 citations
Breast cancer [BC] is the most diagnosed cancer among women worldwide. Thanks to advancements in early detection, systemic therapies, and supportive care, survival rates have significantly improved. As more patients survive BC, cardiovascular disease [CVD] has emerged as a leading cause of long-term morbidity and mortality in this population. This is largely due to a combination of shared risk factors, such as obesity, diabetes and metabolic syndrome, combined to cardiotoxic effects of certain anticancer therapies, particularly anthracyclines, HER2-targeted therapies and radiotherapy. This review explores the cardiovascular [CV] implications of modern breast cancer treatments, including chemotherapy, endocrine therapy, targeted agents, radiotherapy, and emerging modalities such as immunotherapy. It also highlights the impact of patient-specific factors—such as diabetes, lipid profile, and treatment duration—on CVD risk. Current data suggest that breast cancer survivors are at increased risk of CVD compared to the general population, and that risk persists for years after treatment completion. CVD risk profile of each patient is different because of patient age, previous risk factors, and type of oncological treatment, and must be carefully delineated and keep well in mind during and after cancer treatment.
F. Felicetti, G. Mittica, C. Cavallin et al.· Endocrines· 0 citations
Cardiovascular disease (CVD) is the leading cause of non–cancer-related morbidity and mortality among patients treated for head and neck cancer (HNC). However, the extent to which these patients are screened for CVD remains unclear, and the long-term impact of different anticancer treatment modalities for HNC on the CVD risk is also not well established. A validated marker of subclinical atherosclerosis such as the carotid intima–media thickness (cIMT) might be useful to predict CVD in these patients.
The aim of this study was to assess cIMT and cardiovascular risk factors in patients treated for HNC more than two years after treatment completion.
This is a single-centre, cross-sectional observational study, in which patients ≥18 years old who had completed treatment for HNC (surgery or radiotherapy, post-operative radio(chemo)therapy, or radio(chemo)therapy) at least two years prior underwent an outpatient cardiovascular risk assessment. Primary endpoint was the maximum cIMT, measured in μm on both sides by means of ultrasound. Secondary endpoints included associations of cIMT with low-density lipoprotein cholesterol, systolic blood pressure, use of lipid-lowering drugs, and use of antihypertensives via linear regression, as well as the proportion of patients who required modifications in medication for cardiovascular risk management. Differences between two independent groups were analysed using independent-samples t-tests, and comparisons among more than two groups were performed using one-way ANOVA.
From December 2022 to December 2025, 112 patients were included with a median time after treatment completion of 32.5 months (IQR 26.0-46.2). Compared to their expected cIMT based on their sex and age reference population, patients had a significantly higher cIMT (cIMT observed 927 μm, expected 679 μm; mean difference (MD) 248 μm; 95% CI: 213 to 282 μm; p<0.001). No significant differences in cIMT were found between the different HNC treatment modalities (p=0.453). After correction for age, sex, smoking, diabetes and alcohol use, both LDL-cholesterol (B= 32.8 μm per mmol/L; 95% CI: -7.53 to 73.2; p= 0.110) and systolic blood pressure (B: 1.68 μm per mmHg; 95% CI: -0.23 to 3.59; p= 0.097) tended to associate with cIMT. Patients treated with lipid-lowering drugs (MD: -44.3 μm; 95%CI: -108 to 19.1 μm; p=0.169) or antihypertensive medication (MD: -103 μm; 95%CI: -79.4 to 59.2 μm; p=0.773) did not have a lower cIMT than patients without these treatments. Lipid-lowering therapy was initiated in 41% of previously untreated patients and antihypertensive therapy in 14%.
Patients treated for head and neck cancer exhibited a substantially increased cIMT, suggesting elevated vascular risk. Preventive therapy was frequently initiated, highlighting the importance for systematic cardiovascular risk assessment in these patients.
T. Uyl, A. Yusof, S. Soerahi et al.· European Heart Journal, Supp...· 0 citations
Among breast cancer patients receiving cytotoxic chemotherapy, primary prevention with cardioprotective pharmacological therapy was significantly associated with prolonged time to major adverse cardiovascular events, which support proactive cardioprotective strategies to mitigate treatment-related cardiovascular risk and reinforce the value of integrating preventive cardiology into cardio-oncology care pathways.
A. Kawatkar, A. Baecker, E. Estrada et al.· European Heart Journal, Supp...· 0 citations
The integration between cardiology and oncology, with individualized risk stratification and longitudinal follow-up, are essential for reducing cardiovascular morbidity and mortality among breast cancer patients and survivors.
Ana Flávia, Pessoa de Almeida, Beatriz de et al.· 0 citations
Breast cancer survival is shaped by a complex interaction of tumor-specific, biological, and patient-related factors. Stage at diagnosis remains the strongest predictor of outcome. Tumor size, nodal involvement, and histologic grade further aid in prognostic prediction by reflecting the biological aggressiveness of the disease. Since the early 2000s, molecular characteristics gained importance in risk stratification. Hormone receptor-positive cancers generally respond well to endocrine therapy, while HER2-positive tumors, once associated with poor outcomes, now benefit from targeted therapy. Newer agents and combinations such as CDK4/6 and PI3K/AKT/mTOR inhibitors are being investigated recently. Patient factors, including age, comorbidities, and overall health, also influence outcome and treatment tolerance. Cardiovascular toxicity from chemotherapy and radiotherapy has become an important consideration, particularly in the elderly. Although modern radiotherapy techniques have reduced cardiac risks, long-term cardiovascular mortality remains a competing cause of death in many survivors. Studies comparing breast-conserving therapy with mastectomy suggest improved overall survival with the former, partly due to reduced treatment morbidity. Early detection through mammography, ultrasound, and awareness campaigns greatly improves survival, yet access remains unequal in low-resource settings. Strengthening healthcare systems, tailoring treatments, expanding multidisciplinary care and improving public education are essential. Affordable personalized therapies, better infrastructure, and international collaboration can reduce disparities and enhance global breast cancer outcomes. Our international team researched literature information as well as summarizing up-to-date opinions from global experts, including those with limited resources and war-torn regions.
Lorent Sijarina, O. Alqaisi, Drilon Bytyçi et al.· Exploration of Medicine· 0 citations
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