Insufficient control of classical atherosclerotic risk factors in patients with non-metastatic breast cancer referred for anticancer therapy

Abstract

The long-term prognosis of non-metastatic breast cancer is favorable, with 5-year survival rates exceeding 80%. Standard management includes surgery followed by adjuvant anticancer therapy, comprising systemic anticancer treatment and/or radiotherapy. Prevention of cancer recurrence and late cardiovascular toxicity related to anticancer therapy is a key component of comprehensive care. The risk of premature cardiovascular mortality increases with each additional atherosclerotic risk factor. The aim of the study was to assess the control of classic cardiovascular risk factors in women referred for baseline cardio-oncology assessment prior to anticancer therapy. Before initiation of anticancer therapy, baseline cardiovascular risk assessment was performed in accordance with the 2022 ESC Guidelines on cardio-oncology. This included medical history, assessment of comorbidities, performance status, and office blood pressure (BP) measurement. Laboratory evaluation comprised fasting glucose, glycated hemoglobin (HbA1c), and lipid profile. Normal values were defined as: office BP <140/90 mmHg; glucose 3.9–5.5 mmol/L; HbA1c 4.8–5.9%; total cholesterol <4.9 mmol/L; LDL cholesterol <3.0 mmol/L; triglycerides <1.2 mmol/L. Ambulatory blood pressure monitoring (ABPM) was used to confirm insufficient BP control. Elevated BP and hypertension were defined as ≥115/65 mmHg and ≥130/80 mmHg, respectively, according to the 2024 ESC Guidelines. The study included 100 women (mean age 56.1 ± 10.7 years) with left-sided (57%) or right-sided (43%) breast cancer. Hormone receptor positivity was frequent (estrogen receptor 83%, progesterone receptor 75%, HER2 23%). Most tumors were of intermediate or high histological grade (G2–G3, 80%). A family history of breast cancer was reported in 57% of patients. The most common comorbidities were arterial hypertension (43%), dyslipidemia (19%), diabetes mellitus (12%), and hypothyroidism (9%); 17% of patients were active smokers. Excess body weight was present in 66% of women. Elevated office BP was observed in 50% (systolic) and 45% (diastolic) of patients. ABPM confirmed elevated BP in up to 94% and hypertension in approximately 20%. Metabolic abnormalities were highly prevalent, particularly dyslipidemia: elevated total cholesterol in 68%, LDL cholesterol in 63%, and triglycerides in 54%. Statin therapy was associated with a significantly lower likelihood of elevated LDL cholesterol (OR = 0.14; p = 0.0007). Obesity was strongly associated with elevated systolic and diastolic BP. Women with non-metastatic breast cancer frequently present with suboptimal control of cardiovascular risk factors at the time of qualification for anticancer therapy. Cardio-oncology care should focus on optimal blood pressure management and aggressive modification of metabolic risk factors, including obesity and dyslipidemia, while accounting for psychosocial aspects.