Curing breast cancer and killing the heart: A novel model to explain elevated cardiovascular disease and mortality risk among women with early stage breast cancer |
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| Affiliation: | 1. Department of Biomedical Engineering, University of Alberta, Edmonton, Canada;2. Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing and Health Innovation, The University of Texas at Arlington, Arlington, USA;3. Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Canada;4. Department of Oncology, University of Alberta, Edmonton, Canada;5. Medical Oncology, Cross Cancer Institute, Edmonton, Canada;1. Department of Physical Therapy and Integrated Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA;2. Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School -the University of Queensland School of Medicine, New Orleans, LA, USA;3. Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU-Norwegian University of Science and Technology, Trondheim, Norway;1. Department of Internal Medicine, Vermont Center on Behavior and Health, Vermont Cancer Center, University of Vermont, Burlington, VT;2. Memorial Sloan Kettering Cancer Center, New York, NY;3. Washington University School of Medicine, St Louis, MO;4. Division of Cardiology, Washington University School of Medicine, St Louis, MO;5. NASA Johnson Space Center; Universities Space Research Association, Houston, TX;1. Keele Cardiovascular Research Group, Keele University, Stoke on Trent, UK;2. Department of Cardiology, University Hospital of Split, Split, Croatia;3. Department of Cardiac Sciences, University of Calgary, Calgary, Canada;4. Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA;5. Department of Medicine and Oncology, University of Calgary, Calgary, Canada;6. Departments of Oncology and Community Health Sciences, University of Calgary, Calgary, Canada;7. Division of Cardiology, Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada;8. Division of Cardiology, University of Alberta, Edmonton, Canada;9. Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV, USA;10. Department of Cardiology, Thomas Jefferson University, Philadelphia, USA;1. Hormone Laboratory, Haukeland University Hospital, Bergen, Norway;2. Department of Clinical Science, University of Bergen, Bergen, Norway;3. Division of Medicine, Akershus University Hospital, Oslo, Norway;4. Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway |
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| Abstract: | Due to advances in prevention, early detection and treatment, early breast cancer mortality has decreased by nearly 40% during the last four decades. Yet, the risk of cardiovascular disease (CVD) mortality is significantly elevated following a breast cancer diagnosis, and it is a leading cause of death in this population. This review will discuss the most recent evidence for risks, pathology, mechanisms, and prevention of CVD morbidity and mortality in women with breast cancer. This evidence will be synthesized into a new model ‘the compounding risk and protection model.’ This model proposes that the balance between risk factors (i.e., older age, pre-existing traditional CVD risk factors and shared biologic pathways for CVD and cancer such as inflammation, as well as treatment-related and lifestyle toxicity) and potential protection factors (i.e., lifelong non-smoking, regular physical activity, a healthy diet rich in fruits and vegetables, and management of body weight and stress, heart failure therapy) determine the individual risk of CVD morbidity and mortality after diagnosis of early breast cancer. |
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