Cardiotoxicity and the 10-year cardiovascular risk profiles of breast cancer patients in a resource-poor setting

Abstract

The gains made with treating breast cancer patients are threatened by the emergence of cardiovascular disease (CVD) as a significant driver of mortality in this population, either directly from the use of cardiotoxic agents or the increasing prevalence of CVD risk factors. Though there are validated tools for assessing these CVD risks in this specific population, there is a lack of data in Ghana on the assessment of cardiotoxicity risk among breast cancer patients. We aimed to assess the cardiotoxicity and the 10-year CVD risk profiles of breast cancer patients attending clinic at our Hospital. Breast cancer patients 18years and above accessing care from two specialist-led clinics (breast and oncology clinics) at our hospital from January 2024 to December 2024 were recruited in this cross-sectional study. Data on tumour characteristics, chemotherapy, radiotherapy, and endocrine therapy were obtained from hospital records. Cardiotoxicity risk was calculated using the Cardiotoxicity Risk Score, a risk-stratification tool introduced by the Mayo Clinic. The WHO/ISH CVD non-laboratory risk chart was used to assess the 10-year cardiovascular risk of breast cancer patients. A modified Poisson regression was used to assess the association between patient and clinical characteristics and cardiotoxicity at 5% significance level. Among the 208 participants studied, most (56.7%) had a high to very high cardiotoxicity risk score, whereas 17.0% had a moderate to high 10-year CVD risk. Patients with high or very high cardiotoxicity scores were generally younger (median age: 51 vs. 55 years, p = 0.024) and more likely to have positive Human Epidermal growth factor receptor 2 (HER2) status, negative hormone receptor status (both estrogen and progesterone), and advanced TNM stage, particularly stage III (p < 0.001 for all). Human epidermal growth factor receptor 2 positivity is strongly associated with cardiotoxicity (RR = 1.43, 95% CI: 1.18–1.74, p = <0.001), indicating a substantial risk factor for cardiotoxicity. In contrast, estrogen receptor positivity is associated with significantly lower risk (RR = 0.71, 95% CI: 0.54–0.93, p = 0.015), while progesterone receptor positivity trends toward a similar effect but does not reach significance (p = 0.071). About 1 in 2 breast cancer patients receiving treatment at our hospital has a high to very high cardiotoxicity risk strongly associated with HER receptor positivity. Nearly one out of every five breast cancer patients has a moderate to high-risk 10-year CVD risk.