Wernhart S; Department for Preventive Sports Medicine and Sports Cardiology, Munich, Germany.
Fiorentini C; Glowka S; Madl B;Grill S; Kiechle M;Mueller S; Schmid V; Foulkes S; Haykowsky MJ; Halle M;
International journal of cardiology [Int J Cardiol] 2025 May 25; Vol. 436, pp. 133421.
Date of Electronic Publication: 2025 May 25.
Background: Breast cancer survivors (BCS) have an increased risk of developing cardiovascular disease risk factors (CVDRF). However, the role of cardiopulmonary fitness, echocardiography and treatment regimen e.g. anthracycline, HER2-targeted therapy (AC/H) or endocrine therapy (ET) are uncertain.
Methods: This single-center, retrospective study included BCS without visceral metastases, who had been treated with either AC/H or ET and assessed by echocardiography, cardio-pulmonary exercise testing (CPET) and the H 2 FPEF score at baseline. We included BCS with a left ventricular ejection fraction ≥50 % and absence of CVDRF at baseline. The primary outcome was the incidence of CVDRF.
Results: A total of 112 BCS were included (mean age of 54.6 ± 9.9 years, BC stage I-III). After a median follow-up of 21 months new-onset arterial hypertension was the most common CVDRF observed (n = 17). New onset hypertension was related to higher baseline resting systolic blood pressure (127.4 ± 9.2 mmHg vs. 117.3 ± 13.1 mmHg, p = 0.002) and H 2 FPEF scores (1.2 ± 0.8 vs. 0.8 ± 1.1, p = 0.043). Echocardiographic and CPET findings associated with new-onset arterial hypertension included greater left ventricular mass index (77.3 ± 24.2 g/m 2 vs. 65.6 ± 15.5 g/m 2 , p = 0.007), higher peak systolic blood pressure (193.1 ± 19.5 mmHg vs. 173.3 ± 21.2 mmHg, p = 0.017) and ventilatory power (6.4 ± 1.3 mmHg vs. 5.7 ± 1.2 mmHg, p = 0.022). Treatment regimen had no influence on the development of CVDRF.
Conclusions: The most common CVDRF among BCS is hypertension, underscoring the importance of monitoring this outcome irrespective of breast cancer treatment regimens. The H 2 FPEF score, CPET and echocardiography may help identify BCS at risk of developing hypertension. Strain and biomarkers were not available, impeding detection of cardiotoxicity.
Competing Interests: Declaration of competing interest Simon Wernhart has received honoraria for lectures from Bristol-Myers Squibb. Stephan Mueller has received personal fees from Bristol-Myers Squibb (consulting services). Mark Haykowsky is funded, in part, by a Research Chair in Aging in the Faculty of Nursing, College of Healthy Sciences at UofA. Martin Halle reports honoraria for lectures beyond this cancer topic from Abbott, Amgen, Astra-Zeneca, Boehringer-Ingelheim, BMW, Bristol-Myers Squibb, Daiichi-Sankyo, Lilly, Medi, MSD Sharp & Dohme GmbH, Norsan, Novartis, Pfizer and Roche, consulting fees from Medical Park. Sabine Grill has received honoraria for lectures from AstraZeneca, Roche, Pfizer and Daiichi Sankyo. No other potential conflicts of interest are reported.