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Common origins and shared opportunities for breast cancer and cardiovascular disease prevention
  1. Sonia Henry1,2,
  2. Georgeta Vaidean3,
  3. Rahul Rege4,5,
  4. Eugenia Gianos2,6
  1. 1Department of Cardiology, Sandra Atlas Bass Heart Hospital, Manhasset, New York, USA
  2. 2Department of Cardiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  3. 3Department of Translational Medicine, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
  4. 4Department of Medicine, Sandra Atlas Bass Campus, Manhasset, New York, USA
  5. 5Department of Internal Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  6. 6Department of Cardiology, Lenox Hill Hospital, New York, New York, USA
  1. Correspondence to Dr Eugenia Gianos, Cardiology, Lenox Hill Hospital, New York, NY 10022, USA; egianos{at}northwell.edu

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Learning objectives

  • Appreciate the common risk factors for breast cancer and cardiovascular disease that can be modified by lifestyle and preventive treatments.

  • Describe the secondary effects of chemotherapy, radiation therapy and hormone suppression therapy on cardiovascular risk.

  • Outline mechanisms to assess and ameliorate cardiovascular risk in breast cancer survivors.

Introduction

The contemporary landscape of cardiology, oncology and disease prevention is being shaped by complex paradigm shifts. Cardio-oncology represents one of the most rapidly growing fields of collaborative clinical practice, patient-centred care and research. Several factors contribute to the expansion of this field. Notably, remarkable therapeutic advances have been transforming breast cancer (BC) into a chronic condition and, in many cases, a curable disease. BC is the most common cancer in women worldwide, contributing about 25% of all newly diagnosed cases.1 Cardiovascular disease (CVD) is the leading cause of death in women irrespective of BC.2 High background CVD risk preceding BC diagnosis, cardiotoxic effects of oncological therapies, lifestyle changes secondary to cancer and increasing life expectancy of BC survivors all contribute to the need for a complex spectrum of care for these patients (figure 1). The recognition of shared risk factors opens opportunities for common primary prevention. Following cancer diagnosis and in survivorship, cardio-oncological care including lifestyle optimisation and CVD risk mitigation can reduce BC recurrence as well as CVD development.

Figure 1

Mechanisms and areas of CVD risk mitigation in patients with breast cancer. CVD, cardiovascular disease; DM, diabetes mellitus; HTN, hypertension; QoL, quality of life.

Overlapping breast cancer and cardiovascular risk factors, opportunities in primary prevention

Increasing epidemiological evidence has led to the ‘common soil’ hypothesis, which speculates that BC and atherosclerotic cardiovascular diseases (ASCVDs) share multiple risk factors and pathogenic mechanisms (figure 2).3 Most shared risk factors follow the same direction of association, while others display more complex relations. For instance, women with a higher socioeconomic status (SES) showed higher …

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Footnotes

  • SH and GV contributed equally.

  • Contributors All authors contributed to manuscript inception, drafting and final approval. SH, GV and EG provided critical revisions.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared for SH, GV and RR. EG: Honorarium—Moderator for AHA Satellite Symposium, Kaneka Corporation (LDL Apheresis) and NLA Satellite Symposium. Honorarium—Expert Content Reviewer and Speaker—Educational Program on Familial Hypercholesterolemia—MedAxiom. Educational Grant for Northwell ‘Beyond Diabetes’ Initiative (AstraZeneca).

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Author note References which include a * are considered to be key references.