The impact of cardiovascular disease on all-cause and cancer mortality: results from a 16-year follow-up of a German breast cancer case-control study

• Published in: Breast cancer research : BCR Vol. 25; no. 1; p. 89
• Main Authors: Möhl, Annika, Behrens, Sabine, Flaßkamp, Fabian, Obi, Nadia, Kreienbrinck, Annika, Holleczek, Bernd, Gali, Kathleen, Chang-Claude, Jenny, Becher, Heiko
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.07.2023; BioMed Central; BMC
• Subjects: Age groups; Analysis; Angina pectoris; Body mass index; Breast cancer; Cancer; Cardiotoxicity; Cardiovascular disease; Cardiovascular diseases; Cardiovascular system; Case–control study; Death & dying; Diabetes; Germany; Investigations; Medical diagnosis; Mortality; Oncology, Experimental; Patient outcomes; Prevention; Recruitment; Regression analysis; Risk factors; Womens health; Germany; United States > US; Cardiovascular disease; Breast cancer; Case–control study; Mortality
• ISSN: 1465-542X; 1465-5411; 1465-542X
• DOI: 10.1186/s13058-023-01680-x

Cardiovascular disease (CVD) is the leading cause of death worldwide. The aim of this study was to examine if CVD affects the mortality of women after a breast cancer diagnosis and population controls differently. The analysis included a total of 3,555 women, diagnosed with primary stage 1-3 breast cancer or in situ carcinoma between 2002 and 2005 and 7,334 controls breast cancer-free at recruitment, all aged 50-74 years, who were followed-up in a German breast cancer case-control study until June, 30 2020. Kaplan-Meier and cumulative incidence function were calculated for all-cause mortality and mortality from any cancer, stratified for case-control status and CVD, separately for women aged < 65 and ≥ 65 years. Cox regression and Fine-Gray subdistribution hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between case-control-status, CVD and mortality from all causes/any cancer. The median follow-up was 16.1 years. In total, 1,172 cases (33.0%) and 1,401 initial controls (19.1%) died. CVD prevalence at recruitment was 15.2% in cases and controls. Cases with CVD had the highest and controls without CVD the lowest mortality during the entire observation period in both age groups (< 65 and ≥ 65 years). CVD was identified as a risk factor for all-cause mortality in both cases and controls aged < 65 years (HR 1.22, 95%CI 0.96-1.55 and HR 1.79, 95%CI 1.43-2.24) as well as at ages of ≥ 65 years (HR 1.44, 95%CI 1.20-1.73 and HR 1.59, 95%CI 1.37-1.83). A significant association of CVD and cancer mortality was found only for cases aged ≥ 65 years. CVD was significantly associated with all-cause mortality of both cases and controls and CVD was identified as a risk factor for cancer mortality of cases aged ≥ 65 years at recruitment. Therefore, attention should be paid on monitoring and preventing CVD in breast cancer patients, especially in those diagnosed at older ages.