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Cardiovascular disease (CVD) remains the leading cause of mortality in women, yet many people perceive breast cancer to be the number one threat to women's health. CVD and breast cancer have several overlapping risk factors, such as obesity and smoking. Additionally, current breast cancer treatments can have a negative impact on cardiovascular health (eg, left ventricular dysfunction, accelerated CVD), and for women with pre-existing CVD, this might influence cancer treatment decisions by both the patient and the provider. Improvements in early detection and treatment of breast cancer have led to an increasing number of breast cancer survivors who are at risk of long-term cardiac complications from cancer treatments. For older women, CVD poses a greater mortality threat than breast cancer itself. This is the first scientific statement from the American Heart Association on CVD and breast cancer. This document will provide a comprehensive overview of the prevalence of these diseases, shared risk factors, the cardiotoxic effects of therapy, and the prevention and treatment of CVD in breast cancer patients. The number one cause of mortality in US women is cardiovascular disease (CVD), 1 yet the general public awareness of this remains suboptimal despite large-scale public education campaigns. Awareness is particularly low in racial and ethnic minority communities.2,3 CVD and breast cancer have individually received significant publicity with media campaigns (such as the Red Dress and Pink Ribbon campaigns); however, there is inadequate public awareness of the coexistence of common risk factors associated with these 2 conditions.Although cardiology and oncology are often considered separate medical fields, they are frequently intertwined. Multidisciplinary care is critical in the management of cancer patients. Cancer outcomes can be influenced by cardiovascular health: antecedent cardiovascular health can affect cancer treatment selection, and furthermore, cancer care can result in cardiovascular toxicities that could impact ongoing cancer treatment. Finally, latent effects of CVD from cancer treatment can alter cancer survivorship. Much of the intersection between CVD and breast cancer pertains to similarities in predisposing risk factors such as age, tobacco use, diet, obesity, and sedentary lifestyle. CVD risk factors are increased in long-term cancer survivors; however, discussion of CVD prevention and modification of these risk factors during and after cancer treatment is limited. 4 The risk of CVD (heart failure [HF], myocardial ischemia, hypertension) is high, and development of CVD risk factors (obesity and dyslipidemia) is higher in older breast cancer survivors than the risk of tumor recurrence. In addition, with advancements

In women with coronary disease, hormone therapy reduced the incidence of diabetes by 35%. This observation provides important insights into the metabolic effects of postmenopausal hormones but is insufficient to recommend the use of hormones for secondary prevention of heart disease.