Cardiovascular Health among Black and White Breast Cancer Patients Initiating Aromatase Inhibitor Therapy

Gallicchio, Lisa; Calhoun, Carla; Riseberg, David; Helzlsouer, Kathy J.

doi:10.1111/tbj.12709

Cited by 11 publications

(5 citation statements)

References 12 publications

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“…In addition, a study from the USA found that African American patients with breast cancer have higher prevalence of certain CVD risk factors, such as hypertension, diabetes and obesity, prior to initiating aromatase inhibitory therapy, compared with white American patients with breast cancer of the same age. 35 Although the ethnic groups are not directly comparable, this may also be the case for some of the ethnic groups in the current study, such as the African Surinamese and Antillean women. Evidence suggests that the presence of CVD risk factors among patients with breast cancer at diagnosis is a strong predictive factor for the development of cardiovascular damage associated with breast cancer therapy.…”

Section: Discussionmentioning

confidence: 77%

Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study

et al. 2018

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ObjectivesCardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, evidence on ethnic differences in CVD among women with breast cancer is sparse. We assessed ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands.MethodsA nationwide register-based cohort study comprising all women with a first admission for breast cancer (n=127 714) between 1996 and 2010 in the Netherlands was conducted. Differences in CVD admission, CVD mortality and overall CVD event, which comprised a CVD admission and/or CVD mortality, between the largest ethnic minority groups (Surinamese, Moroccan, Turkish, Antillean and Indonesian) and the Dutch general population (henceforth, Dutch) were investigated using Cox proportional hazard models.ResultsThe incidence of cardiovascular outcomes varied by the ethnic group. The incidence of an overall cardiovascular event was significantly higher for women with breast cancer from Suriname (HR 1.46; 95% CI 1.29 to 1.64) and Turkey (HR 1.25; 95% CI 1.03 to 1.51), compared with Dutch women with breast cancer. In contrast, Indonesian women with breast cancer had a significantly lower risk (HR 0.88; 95% CI 0.81 to 0.96) of a cardiovascular event compared with Dutch women with breast cancer. The risk of a cardiovascular event did not differ between Moroccan and Dutch women with breast cancer, whereas for Antillean women the risk was not significantly higher.ConclusionsOur findings suggest that Surinamese and Turkish women with breast cancer are disadvantaged in terms of cardiovascular outcomes compared with Dutch women with breast cancer. More work is needed to unravel the potential factors contributing to these differences.

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Section: Discussionmentioning

confidence: 77%

Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study

et al. 2018

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“…Furthermore, in the general population, black women have more CVD risk factors such as hypertension compared to white women of the same age, a phenomenon observed within this BC‐focused population 32 . Black women may be more vulnerable to a higher risk of morbidity and mortality from hypertension‐related events following treatment for breast cancer 33 . Globally, BC patients are exposed to a series of sequential or concurrent adverse events (e.g., increased inflammation) that together make them more vulnerable to the development of hypertension, and other CVD events 34,35 .…”

Section: Discussionmentioning

confidence: 95%

“… 32 Black women may be more vulnerable to a higher risk of morbidity and mortality from hypertension‐related events following treatment for breast cancer. 33 Globally, BC patients are exposed to a series of sequential or concurrent adverse events (e.g., increased inflammation) that together make them more vulnerable to the development of hypertension, and other CVD events. 34 , 35 Thus, given these potential ramifications of hypertension, enhanced study, vigilance, and blood pressure control may prove pivotal.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive events after the initiation of contemporary cancer therapies for breast cancer control

Carter

Chum²,

Sanchez³

et al. 2022

Cancer Medicine

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Background Contemporary therapies improve breast cancer (BC) outcomes. Yet, many of these therapies have been increasingly linked with serious cardiotoxicity, including reports of profound hypertension. Yet, the incidence, predictors, and impacts of these events are largely unknown. Methods Leveraging two large U.S.‐based registries, the National Inpatient Sample (NIS) and the Food and Drug Administration Adverse Event Reporting System (FAERS) databases, we assessed the incidence, factors, and outcomes of hypertensive events among BC patients from 2007 to 2015. Differences in baseline characteristics, hypertension‐related discharges, and complications were examined over time. Further, we performed a disproportionality analysis using reporting‐odds‐ratios (ROR) to determine the association between individual BC drugs and hypertensive events. Utilizing an ROR cutoff of >1.0, we quantified associations by drug‐class, and individual drugs with the likelihood of excess hypertension. Results Overall, there were 5,464,401 BC‐admissions, of which 46,989 (0.8%) presented with hypertension. Hypertensive BC patients were older, and saw initially increased in‐hospital mortality, which equilibrated over time. The mean incidence of hypertension‐related admissions was 732 per 100,000 among BC patients, versus 96 per 100,000 among non‐cancer patients (RR 7.71, p < 0.001). Moreover, in FAERS, those with hypertension versus other BC‐treatment side‐effects were more frequently hospitalized (40.1% vs. 36.7%, p < 0.001), and were most commonly associated with chemotherapy (45.9%). Outside of Eribulin (ROR 3.36; 95% CI 1.37–8.22), no specific drug was associated with a higher reporting of hypertension; however, collectively BC drugs were associated with a higher odds of hypertension (ROR 1.66; 95% CI 1.09–2.53). Conclusions BC therapies are associated with a substantial increase in limiting hypertension.

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“…68 In addition, the risk of all-cause breast cancer and CVD deaths was higher among Black than White women in this study. In a single-center evaluation, Black patients initiating treatment with aromatase inhibitors had an overall higher median atherosclerotic CVD risk score and a higher number of cardiovascular risk factors than White patients, 76 suggesting that baseline CVD risk factors likely play a role in observed racial/ethnic differences in cardiovascular outcomes among patients treated with hormonal therapies. Although not specifically studied in this population, the observed differences in baseline CVD risk factors are likely a result of health inequities and disparities, which must be addressed.…”

Section: Racial/ethnic Differences In Cvd Risks Associated With Hormo...mentioning

confidence: 99%

Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association

Okwuosa¹,

Morgans

Rhee³

et al. 2021

Circ: Genomic and Precision Medicine

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Cardiovascular disease and cancer are the leading causes of death in the United States, and hormone-dependent cancers (breast and prostate cancer) are the most common noncutaneous malignancies in women and men, respectively. The hormonal (endocrine-related) therapies that serve as a backbone for treatment of both cancers improve survival but also increase cardiovascular morbidity and mortality among survivors. This consensus statement describes the risks associated with specific hormonal therapies used to treat breast and prostate cancer and provides an evidence-based approach to prevent and detect adverse cardiovascular outcomes. Areas of uncertainty are highlighted, including the cardiovascular effects of different durations of hormonal therapy, the cardiovascular risks associated with combinations of newer generations of more intensive hormonal treatments, and the specific cardiovascular risks that affect individuals of various races/ethnicities. Finally, there is an emphasis on the use of a multidisciplinary approach to the implementation of lifestyle and pharmacological strategies for management and risk reduction both during and after active treatment.

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Cardiovascular Health among Black and White Breast Cancer Patients Initiating Aromatase Inhibitor Therapy

Cited by 11 publications

References 12 publications

Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study

Ethnic differences in cardiovascular morbidity and mortality among patients with breast cancer in the Netherlands: a register-based cohort study

Hypertensive events after the initiation of contemporary cancer therapies for breast cancer control

Impact of Hormonal Therapies for Treatment of Hormone-Dependent Cancers (Breast and Prostate) on the Cardiovascular System: Effects and Modifications: A Scientific Statement From the American Heart Association

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