Cardio-oncology in breast cancer patients: descriptive data from a north african cohort

Abstract

Cardiovascular toxicity related to cancer therapies has become a major concern in breast cancer management, particularly in low- and middle-income countries where access to structured cardio-oncology services remains limited. Data from North African populations are scarce despite potential regional specificities in cardiovascular risk profiles, cancer characteristics, and treatment patterns. This study aimed to describe the cardio-oncological profile of breast cancer patients followed in a North African tertiary center. We conducted a prospective descriptive study including breast cancer patients referred to a dedicated cardio-oncology clinic between January 1, 2023 and June 30, 2025. Clinical, oncological, and cardiovascular data were collected from medical records. Variables included demographic characteristics, cardiovascular risk factors, cancer stage, oncological treatments, baseline and follow-up cardiac function, and treatment-related cardiotoxicity. Cancer therapy–related cardiac dysfunction (CTRCD) was defined according to current international guidelines. A total of 150 patients were included, with a mean age of 58 ± 12.6 years; all patients were female. At baseline, the most prevalent cardiovascular risk factors were hypertension (47.3%), dyslipidemia (29.3%), and diabetes (26.7%). Regarding cancer characteristics, 26.7% of patients had locally advanced or metastatic disease. The main oncological treatments received were trastuzumab (58.6%), anthracyclines (44.6%), radiotherapy (43.3%), taxanes (17.3%), pertuzumab (14.6%), and alkylating agents (13.3%). Only two patients received immunotherapy and nine received hormone therapy. At baseline, mean left ventricular ejection fraction (LVEF) was 60.1% ± 7.8% and mean global longitudinal strain (GLS) was –19.2% ± 3.1%. During follow-up, CTRCD occurred in 33.3% of patients. Echocardiographic reassessment demonstrated a significant decline in systolic function, with mean LVEF decreasing to 52.9% ± 9.1% (p < 0.001) and mean GLS worsening to –17.3% ± 3.1% (p = 0.001). Cardio-protective therapy was prescribed in all cases of cardiotoxicity. This study provides one of the first comprehensive descriptions of cardio-oncological profiles in breast cancer patients from North Africa. The high prevalence of cardiovascular risk factors and treatment-related cardiac dysfunction underscores the need for structured cardio-oncology programs in the region. Larger studies with longer follow-up are required to better characterize long-term cardiovascular outcomes and optimize preventive strategies.