Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis

Akhmetzhan Galimzhanov, Sedralmontaha Istanbuly, Han Naung Tun, Benay Ozbay, Mirvat Alasnag, Bonnie Ky, Alexander R Lyon, Meral Kayikcioglu, Erhan Tenekecioglu, Maria Panagioti, Evangelos Kontopantelis, Husam Abdel-Qadir, Mamas A Mamas

Research output: Contribution to journalArticlepeer-review


BACKGROUND: It is unclear whether the future risk of cardiovascular events in breast cancer (BC) survivors is greater than in the general population.

OBJECTIVES: This meta-analysis quantifies the risk of cardiovascular disease development in breast cancer patients, compared to the risk in a general matched cancer-free population and reports the incidence of cardiovascular events in patients with BC.

METHODS: We searched PubMed, Scopus, and Web of Science databases (up to March 23, 2022) for observational studies and post-hoc analyses of RCTs. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I^2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk.

RESULTS: 142 studies were identified in total, 26 (836,301 patients) relevant to the relative risk, and 116 (2,111,882 patients) relevant to IRs. Compared to matched cancer-free controls, BC patients had higher risk for cardiovascular death within five years of cancer diagnosis (HR = 1.09; 95% CI: 1.07, 1.11), HF within ten years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within three years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischemic stroke.

CONCLUSION: breast cancer exposure was associated with the increased risk for cardiovascular death, HF and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.

Original languageEnglish
JournalEuropean Journal of Preventive Cardiology
Early online date27 Jul 2023
Publication statusE-pub ahead of print - 27 Jul 2023


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