Table 1.
Characteristics of breast cancer cases and matched controls, overall and by incident heart failure with preserved ejection fraction (HFpEF, LVEF≥45%) and heart failure with reduced ejection fraction (HFrEF, LVEF<45%)
| Cases (n=14,804) | Controls (n=74,034)a | P-valuec | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total n=14,804 | HFpEF n=182 | HFrEF n=90 | P-valueb | Total n=74,034 | HFpEF n=732 | HFrEF n=258 | P-valueb | ||||||||
| mean | sd | mean | sd | mean | sd | mean | sd | mean | sd | mean | sd | ||||
| Age at diagnosis (years) | 61.1 | 12.8 | 70.2 | 9.8 | 65.7 | 10.5 | <0.01 | 61.1 | 12.8 | 73.3 | 10.1 | 71.5 | 9.8 | 0.01 | NA |
| Body Mass Index (kg/m 2 ) | 28.5 | 6.5 | 32.1 | 7.6 | 29.5 | 6.7 | 0.01 | 28.3 | 6.5 | 30.1 | 7.4 | 29.2 | 7.0 | 0.08 | <0.01 |
| Median neighborhood household income (% census tract) | 80,498 | 34,081 | 77,227 | 34,169 | 74,358 | 35,370 | 0.52 | 79,605 | 34,052 | 74,506 | 32,112 | 75,114 | 29,987 | 0.79 | <0.01 |
| Neighborhood education level (% census tract) | |||||||||||||||
| High school or less | 32% | 18% | 34% | 18% | 38% | 20% | 0.08 | 33% | 18% | 35% | 18% | 36% | 17% | 0.33 | <0.01 |
| Some college or associate degree | 31% | 10% | 31% | 11% | 30% | 11% | 0.66 | 31% | 10% | 31% | 10% | 31% | 10% | 0.81 | 0.96 |
| College degree | 23% | 11% | 23% | 12% | 20% | 12% | 0.15 | 23% | 11% | 22% | 11% | 21% | 11% | 0.59 | <0.01 |
| Graduate degree | 14% | 12% | 13% | 11% | 12% | 10% | 0.31 | 13% | 11% | 13% | 11% | 12% | 11% | 0.20 | <0.01 |
| n | % | n | % | n | % | P-valueb | n | % | n | % | n | % | P-valueb | P-valuec | |
| Race and/or ethnicity | 0.18 | 0.79 | NA | ||||||||||||
| White | 9,601 | 65% | 127 | 70% | 51 | 57% | 48,026 | 65% | 516 | 70% | 188 | 73% | |||
| Black | 1,105 | 7% | 17 | 9% | 17 | 19% | 5,528 | 7% | 73 | 10% | 21 | 8% | |||
| Asian | 2,147 | 15% | 13 | 7% | 10 | 11% | 10,722 | 15% | 68 | 9% | 19 | 7% | |||
| Hispanic | 1,769 | 12% | 22 | 12% | 11 | 12% | 8,844 | 12% | 66 | 9% | 27 | 10% | |||
| Native Hawaiian and/or Pacific Islander | 65 | 0% | 1 | 1% | 0 | 0% | 324 | 0% | 1 | 0% | 0 | 0% | |||
| American Indian and/or Alaska Native | 117 | 1% | 2 | 1% | 1 | 1% | 590 | 1% | 8 | 1% | 3 | 1% | |||
| Smoking status at baseline | 0.37 | 0.01 | <0.01 | ||||||||||||
| Never smoker | 8,128 | 55% | 84 | 46% | 37 | 41% | 39,961 | 54% | 335 | 46% | 102 | 40% | |||
| Current smoker | 1,320 | 9% | 21 | 12% | 6 | 7% | 6,804 | 9% | 79 | 11% | 49 | 19% | |||
| Former smoker | 4,223 | 29% | 63 | 35% | 39 | 43% | 16,243 | 22% | 212 | 29% | 71 | 28% | |||
| Unknown | 1,133 | 8% | 14 | 8% | 8 | 9% | 11,026 | 15% | 106 | 14% | 36 | 14% | |||
| Post-menopausal | 11,087 | 75% | 173 | 95% | 78 | 87% | 0.03 | 56,010 | 76% | 709 | 97% | 250 | 97% | 1.00 | 0.05 |
| History of diabetes before breast cancer d | 1,977 | 13% | 58 | 32% | 25 | 28% | 0.58 | 9,536 | 13% | 269 | 37% | 80 | 31% | 0.11 | 0.12 |
| History of dyslipidemia before breast cancer e | 6,434 | 43% | 127 | 70% | 46 | 51% | <0.01 | 30,670 | 41% | 518 | 71% | 174 | 67% | 0.36 | 0.42 |
| History of hypertension before breast cancer f | 6,240 | 42% | 149 | 82% | 59 | 66% | <0.01 | 30,937 | 42% | 593 | 81% | 190 | 74% | 0.02 | <0.01 |
| History of chronic kidney disease before breast cancer | 2,378 | 21% | 84 | 50% | 24 | 33% | 0.02 | 11,610 | 21% | 348 | 51% | 117 | 52% | 0.91 | 0.71 |
| Prevalent CVD at baseline | |||||||||||||||
| Arrhythmia | 143 | 1% | 4 | 2% | 2 | 2% | 1.00 | 697 | 1% | 29 | 4% | 8 | 3% | 0.66 | 0.81 |
| Cardiac arrest | 2 | 0% | 0 | 0% | 0 | 0% | NC | 8 | 0% | 0 | 0% | 0 | 0% | NC | 1.00 |
| Cardiomyopathy | 0 | 0% | 0 | 0% | 0 | 0% | NC | 10 | 0% | 1 | 0% | 1 | 0% | 1.00 | 0.32 |
| Heart failure | 0 | 0% | 0 | 0% | 0 | 0% | NC | 0 | 0% | 0 | 0% | 0 | 0% | NC | NC |
| Carotid disease | 0 | 0% | 0 | 0% | 0 | 0% | NC | 0 | 0% | 0 | 0% | 0 | 0% | NC | NC |
| Ischemic heart disease | 83 | 1% | 5 | 3% | 2 | 2% | 1.00 | 516 | 1% | 26 | 4% | 9 | 3% | 1.00 | 0.07 |
| Myocarditis pericarditis | 4 | 0% | 0 | 0% | 0 | 0% | NC | 7 | 0% | 0 | 0% | 0 | 0% | NC | 0.18 |
| Stroke | 107 | 1% | 4 | 2% | 0 | 0% | 0.38 | 552 | 1% | 21 | 3% | 5 | 2% | 0.56 | 0.81 |
| Transient Ischemic Attack (TIA) | 5 | 0% | 0 | 0% | 0 | 0% | NC | 63 | 0% | 4 | 1% | 0 | 0% | 0.54 | 0.06 |
| Valvular disease | 11 | 0% | 0 | 0% | 0 | 0% | NC | 69 | 0% | 2 | 0% | 2 | 1% | 0.60 | 0.58 |
| Venous thromboembolic disease | 28 | 0% | 0 | 0% | 0 | 0% | NC | 163 | 0% | 2 | 0% | 0 | 0% | 0.97 | 0.52 |
| Received chemotherapy (case only) | 6,229 | 42% | 51 | 28% | 50 | 56% | <0.01 | NA | NA | NA | NA | NA | NA | NA | NA |
| Anthracycline | 4,112 | 28% | 35 | 19% | 43 | 48% | <0.01 | NA | NA | NA | NA | NA | NA | NA | NA |
| Trastuzumab or pertuzumab | 1,521 | 10% | 11 | 6% | 11 | 12% | 0.13 | NA | NA | NA | NA | NA | NA | NA | NA |
| Received left-sided radiation therapy (case only) | 4,813 | 33% | 62 | 34% | 31 | 34% | 1.00 | NA | NA | NA | NA | NA | NA | NA | NA |
| Received endocrine therapy (case only) | 7,874 | 53% | 104 | 57% | 42 | 47% | 0.13 | NA | NA | NA | NA | NA | NA | NA | NA |
NA = not applicable, NC = not calculable
Breast cancer cases matched 1:5 to non-breast cancer controls on birth year and race/ethnicity.
Chi-square or Fisher exact test for categorical variables, one-way ANOVA for continuous variables across two HF groups within case/control group
Chi-square or Fisher exact test for categorical variables, one-way ANOVA for continuous variables across case/control groups
Diabetes status was determined by the KPNC diabetes registry which uses a combination of inpatient and outpatient diagnosis codes, pharmacy, and blood test results to identify diabetic patients.
Dyslipidemia was determined by a combination of diagnosis codes, pharmacy records, and blood lipid test.
Hypertension was determined by a combination of diagnosis codes, blood pressure values, and number of clinical encounters.