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Life’s Essential 8 and CVD in Breast Cancer Survivors
Quick Takes
- Higher cardiovascular health scores prior to breast cancer are significantly associated with lower risk of CVD in women.
- These findings confirm that adherence to a better lifestyle and modifiable risk factors after breast cancer can ward off CVD-related morbidity and mortality.
Study Questions:
What is the relationship between lifestyle risk factors and cardiovascular disease (CVD) risk factors in women with breast cancer (BC)?
Methods:
Data from the Women’s Health Initiative were utilized. The primary exposure was the Life’s Essential 8 (LE8) score assessed prior to BC diagnosis. LE8 includes key metrics including diet, physical activity, avoidance of nicotine, sleep, weight, lipid levels, blood glucose, and blood pressure. The LE8 score was stratified into low (0-59), moderate (60-79), and high (80-100) cardiovascular health (CVH). Sociodemographic variables, hypertension, heart failure, waist circumference, and cancer stages were compared between the groups. The primary endpoint was a composite of incident CVD events, which included coronary heart disease (CHD), defined as myocardial infarction (MI) along with coronary revascularization, CVD death, and stroke. The cumulative incidence of CVD and estimated hazard ratios was calculated.
Results:
Among 7,165 participants, the median age was 70.1 years at BC diagnosis. The mean LE8 score was 62.0 ± 12.2. Over a median follow-up period of 6 years, 490 composite CVD events occurred. The risk of CVD events was highest for low CVH compared with moderate and high CVH. Compared with low CVH, the hazard ratio for incident CVD was 0.57 (95% confidence interval [CI], 0.46-0.69) for moderate CVH and 0.34 (95% CI, 0.20-0.59) for high CVH. LE8, in conjunction with age, provided a C-statistic of 0.74 for the composite risk of CVD.
Conclusions:
The study investigated the association between CVH, as measured by the LE8 score, and incident CVD in women with BC and found the following: 1) a higher LE8 score prior to BC diagnosis was significantly associated with lower risk of incident CVD in women with BC; 2) a combination of the LE8 score with age was highly predictive of incident CVD after BC diagnosis, with a C-index of 0.74; and 3) LE8 was predictive of incident CHD/MI but lacked accuracy in identifying individuals at increased risk for stroke.
Perspective:
Women with BC face elevated risks for incident CVD events and CVD-associated mortality compared with women without BC. Given the high clinical and economic burden from downstream CVD morbidity and mortality in women with BC, there is an urgent need to better characterize which underlying lifestyle, clinical, socioeconomic, or cancer treatment exposures may be contributing to elevated CVD risk in this population. Exposure to cardiotoxic BC treatment (including anthracyclines and radiation therapy) in the presence of traditional CV risk factors can potentiate an increase in risk for CVD. These findings contribute to the limited body of evidence supporting the association between CVH and development of incident CVD in women with BC.
Clinical Topics: Cardiovascular Care Team, Cardio-Oncology, Prevention
Keywords: Breast Neoplasms, Cardio-oncology, Life Style, Heart Disease Risk Factors, Women
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