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. 2017 May 13;164(3):537–555. doi: 10.1007/s10549-017-4282-9

Table 3.

Risk factors of death from cardiovascular disease in women diagnosed with breast cancer

First author, year of publication Statistical analysis Categories Cause of death (outcome) Risk of death HR (95% CI) Covariates
CVD mortality in breast cancer patients compared with the general population
Bradshaw, 2016 Competing risk General population CVD 1.0 (ref) Age, menopausal status, CVD risk factors
Breast cancer patients diagnosed 0–7 years ago 0.59 (0.4–0.9)
General population CVD 1.00 (ref)
Breast cancer patients diagnosed >7 years ago 1.9 (1.4–2.7)
General population CVD 1.0 (ref)
Breast cancer patients treated with RT 1.1 (0.8–1.6)
General population CVD 1.0 (ref)
Breast cancer patients treated without RT 1.3 (0.9–2.0)
General population CVD 1.0 (ref)
Breast cancer patients treated with CT 1.4 (1.0–2.2)
General population CVD 1.0 (ref)
Breast cancer patients treated without CT 1.1 (0.8–1.5)
General population CVD 1.0 (ref)
Breast cancer patients treated with HT 1.2 (0.9–1.7)
General population CVD 1.0 (ref)
Breast cancer patients treated without HT 1.2 (0.8–1.8)
Riihimäki, 2012 Cox proportional hazard General population CVA 1.00 (ref) Age, socioeconomic index, geographical region of residence
Breast cancer patients 1.03 (1.00–1.07)
General population AMI 1.00 (ref)
Breast cancer patients 1.01 (0.98–1.0)
General population Other CHD 1.00 (ref)
Breast cancer patients 1.14 (1.10–1.19)
General population Heart failure 1.00 (ref)
Breast cancer patients 1.29 (1.22–1.37)
General population Other heart disease 1.00 (ref)
Breast cancer patients 1.24 (1.17–1.32)
General population Arterial disease 1.00 (ref)
Breast cancer patients 0.95 (0.89–1.02)
General population Complications of CVD 1.00 (ref)
Breast cancer patients 1.12 (0.99–1.2)
CVD mortality in breast cancer patients by patient, tumor, and treatment characteristics
Colzani, 2011 Flexible parametric survival models Age at diagnosis <45 CVD 0.3 (0.0–2.5) Clinical, tumor, treatment characteristics
45–54 1.00 (ref)
55–64 6.5 (2.8–14.6)
65–74 17.9 (8.0–39.7)
Calendar time at diagnosis 1990–1994 CVD 2.1 (1.2–3.6)
1995–1999 1.6 (0.9–2.9)
2000–2006 1.00 (ref)
Treatment Surgery CVD 2.1 (1.2–3.8)
Surgery + RT + HT 1.00 (ref)
Surgery + RT 1.4 (0.7–2.5)
Surgery + RT + CT 0.6 (0.1–2.5)
Surgery + CT 2.0 (0.6–6.8)
Surgery + RT + CT + HT 0.7 (0.3–1.9)
Surgery + HT 2.2 (1.5–3.2)
Surgery + CT + HT 1.0 (0.2–4.5)
No. of positive lymph nodes 0 CVD 1.00 (ref)
1–3 2.0 (1.4–2.9)
≥4 (1.0-3.4)
Estrogen receptor Negative CVD 1.00 (ref)
Status Positive 0.8 (0.5–1.3)
Tumor size in mm 1–20 CVD 1.00 (ref)
>20 1.5 (1.1–2.1)
Hooning, 2006 Cox proportional hazard Total study population Clinical, tumor, treatment, characteristics
Age at diagnosis (continuous) CVD 1.12 (1.10–1.14)
Treatment Surgery CVD 1.00 (ref)
Surgery + RT 2.03 (1.33–3.10)
Surgery + RT + CT 1.47 (0.81–2.67)
Surgery + RT + HT 1.70 (0.99–2.93)
Calendar time at diagnosis 1970–1975 CVD 1.34 (0.93–1.92)
1976–1980 1.54 (1.11–2.14)
1981–86 1.00 (ref)
10-year survivors
Age at diagnosis (continuous) CVD 1.11 (1.09–1.13)
Treatment Surgery CVD 1.00 (ref)
Surgery + RT 2.08 (1.25–3.47)
Surgery + RT + CT 2.38 (1.18–4.77)
Surgery + RT + HT 2.42 (1.27–4.61)
Calendar time at diagnosis 1970–1975 CVD 1.38 (0.89–2.14)
1976–1980 1.62 (1.07–2.46)
1981–1986 1.00 (ref)
CVD mortality in breast cancer patients by laterality of the tumor
Bouchardy, 2016 Cox proportional hazard RT and right-sided tumor CVD 1.00 (ref) Clinical, tumor, and treatment characteristics
RT and left-sided tumor 0.52 (0.24–1.12)
RT and outer quadrant CVD 1.00 (ref)
RT and inner quadrant 2.46 (1.13–5.37)
RT and right-sided tumor and outer quadrant CVD 1.00 (ref)
RT and right-sided tumor and inner quadrant 2.51 (0.88–7.18)
RT and left-sided tumor and outer quadrant CVD 1.00 (ref)
RT and left-sided tumor and inner quadrant 2.17 (0.65–7.25)
RT and outer quadrant and right-sided tumor CVD 1.00 (ref)
RT and outer quadrant and left-sided tumor 0.70 (0.21–2.32)
RT and inner quadrant and right-sided tumor CVD 1.00 (ref)
RT and inner quadrant and left-sided tumor 0.52 (0.18-1.48)
Darby, 2005 Poisson regression for mortality rates RT on right-sided tumor CVD 1.00 (ref) No covariates
RT on left-sided tumor 1.44 (1.26–1.65)
RT on right-sided tumor AMI 1.00 (ref)
RT on left-sided tumor 1.43 (1.10–1.87)
RT on right-sided tumor Other 1.00 (ref)
Ischemic
CVD
RT on left-sided tumor 1.60 (1.26–2.02)
RT on right-sided tumor and aged 20–49 years at diagnosis CVD 1.00 (ref)
RT on left-sided tumor and aged 20–49 years at diagnosis 1.54 (1.08–2.19)
RT on right-sided tumor and aged 50–59 years at diagnosis CVD 1.00 (ref)
RT on left-sided tumor and aged 50–59 years at diagnosis 1.53 (1.19–1.98)
RT on right-sided tumor and aged 60–69 years at diagnosis CVD 1.00 (ref)
RT on left-sided tumor and aged 60–69 years at diagnosis 1.40 (1.15–1.70)
RT on right-sided tumor and aged 70–79 years at diagnosis CVD 1.00 (ref)
RT on left-sided tumor and aged 70–79 years at diagnosis 1.28 (0.87–1.90)
RT on right-sided tumor and white ethnic origin CVD 1.00 (ref)
RT on left-sided tumor and white ethnic origin 1.39 (1.21–1.61)
RT on right-sided tumor and black ethnic origin CVD 1.00 (ref)
RT on left-sided tumor and black ethnic origin 2.25 (1.36–3.72)
RT on right-sided tumor and other/ unknown ethnic origin CVD 1.00 (ref)
RT on left-sided tumor and other/ unknown ethnic origin 1.30 (0.71–2.39)
Giordano, 2005 Cox proportional hazard Right-sided tumor and diagnosed in 1979 CVD 1.00 (ref) No covariates
Left-sided tumor and diagnosed in 1979 1.50 (1.19–1.87)
Right-sided tumor and diagnosed in 1988 CVD 1.00 (ref)
Left-sided tumor and diagnosed in 1988 0.79 (0.52–1.18)
Haque, 2016 Cox proportional hazard Diagnosed 1973–1982 Clinical, tumor, treatment characteristics
Right-sided tumor CVD 1.00 (ref)
Left-sided tumor 1.30 (1.18–1.42)
Race White CVD 1.00 (ref)
African American 1.14 (0.94–1.36)
American Indian/ 0.83 (0.66–1.02)
Asian/ Pacific
Islander
Unspecified 0.47 (0.03–2.06)
Age at diagnosis ≤60 CVD 1.00 (ref)
>60 5.87 (5.30–6.50)
Marital status Married CVD 1.00 (ref)
Unmarried 1.87 (1.70–2.05)
Unknown 1.77 (1.29–2.37)
Right-sided tumor and <10 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and <10 years since diagnosis 1.14 (0.99–1.32)
Right-sided tumor and 10–19 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and 10–19 years since diagnosis 1.32 (1.12–1.57)
Right-sided tumor and ≥20 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and ≥20 years since diagnosis 1.30 (1.10–1.54)
Region Pacific CVD 1.00 (ref)
Alaska –
East 0.97 (0.86-1.09)
Northern Plains 1.35 (1.21-1.51)
Southwest 1.51 (0.98-1.34)
Diagnosed 1983–1992
Right-sided tumor CVD 1.00 (ref)
Left-sided tumor 1.02 (0.95–1.10)
Race White CVD 1.00 (ref)
African American 1.14 (0.98–1.32)
American Indian/ 0.68 (0.56–0.82)
Asian/ Pacific
Islander
Unspecified 0.39 (0.02–1.74)
Age at diagnosis ≤60 CVD 1.00 (ref)
>60 10.16 (9.62–11.30)
Marital status Married CVD 1.00 (ref)
Unmarried 2.25 (2.08–2.42)
Unknown 1.65 (1.28–2.08)
Right-sided tumor and <10 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and <10 years since diagnosis 1.01 (0.90–1.13)
Right-sided tumor and 10–19 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and 10–19 years since diagnosis 0.98 (0.88–1.10)
Right-sided tumor and ≥ 20 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and ≥20 years since diagnosis 0.94 (0.77–1.15)
Region Pacific CVD 1.00 (ref)
Alaska 0.00 (0.00–14.13)
East 1.09 (0.99–1.20)
Northern Plains 1.42 (1.30–1.56)
Southwest 1.13 (0.97–1.30)
Diagnosed 1993–1902
Right-sided tumor CVD 1.00 (ref)
Left-sided tumor 0.99 (0.93–1.05)
Race White CVD 1.00 (ref)
African American 1.32 (1.20–1.45)
American Indian/ 0.53 (0.46–0.61)
Asian/ Pacific
Islander
Unspecified 0.11 (0.01–0.47)
Age at diagnosis ≤60 CVD 1.00 (ref)
>60 10.73 (9.86–11.70)
Marital status Married CVD 1.00 (ref)
Unmarried 2.21 (2.28–2.55)
Unknown 1.90 (1.60–2.24)
Right-sided tumor and <10 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and <10 years since diagnosis 1.00 (0.98–1.03)
Right-sided tumor and ≥20 years since diagnosis CVD 1.00 (ref)
Left-sided tumor and ≥20 years since diagnosis 1.01 (0.91–1.11)
Region Pacific CVD 1.00 (ref)
Alaska 0.24 (0.01–1.07)
East 1.06 (0.99–1.13)
Northern Plains 1.25 (1.16–1.35)
Southwest 0.87 (0.76–0.99)
Merzenich, 2016 Cox proportional hazard RT and right-sided tumor CVD 1.0 (ref) Clinical, tumor, treatment characteristics
RT and left-sided tumor 0.94 (0.64–1.38)
No RT and right-sided tumor CVD 1.0 (ref)
No RT and left-sided tumor 1.07 (0.79–1.46)
RT without a history of cardiac disease CVD 1.0 (ref)
RT with a history of cardiac disease 1.73 (1.11–2.68)
RT without chemotherapy CVD 1.0 (ref)
RT with chemotherapy 0.66 (0.37–1.19)
CVD mortality in breast cancer patients with different ethnic origins
Berkman, 2014 Kaplan– Meier
with log-rank statistics		 White and diagnosed between 1990 and 2010 CVD 1.00 (ref) No covariates
Black and diagnosed between 1990 and 2010 6.43 (3.61–11.45)
White and age at diagnosis 40–49 years CVD 1.00 (ref)
Black and age at diagnosis 40–49 years 9.83 (4.56–21.17)
White and age at diagnosis 50–59 years CVD 1.00 (ref)
Black and age at diagnosis 50–59 years 3.35 (2.14–5.24)
White and age at diagnosis 60–69 years CVD 1.00 (ref)
Black and age at diagnosis 60–69 years 2.13 (1.65–2.74)
White and age at diagnosis ≥70 years CVD 1.00 (ref)
Black and age at diagnosis ≥70 years 1.07 (0.93–1.23)
Solanki, 2016 Cox proportional hazard Non-Hispanic white CVD 1.00 (ref) Age, birthplace, SEER registry, AJCC stage
Asian and Pacific islander 0.77 (0.71–0.83)
Non-Hispanic white CVD 1.00 (ref)
Chinese 0.66 (0.56–0.78)
Non-Hispanic white CVD 1.00 (ref)
Japanese 0.71 (0.62–0.81)
Non-Hispanic white CVD 1.00 (ref)
Filipino 0.90 (0.78–1.03)
Non-Hispanic white CVD 1.00 (ref)
Hawaiian 1.43 (1.17–1.75)
Non-Hispanic white CVD 1.00 (ref)
Korean 0.68 (0.46–0.99)
Non-Hispanic white CVD 1.00 (ref)
Vietnamese 0.46 (0.28–0.76)
Non-Hispanic white CVD 1.00 (ref)
Asian Indian and Pakistani 0.98 (0.70–1.37)
Non-Hispanic white CVD 1.00 (ref)
Pacific Islander 1.33 (0.83–2.15)
Non-Hispanic white CVD 1.00 (ref)
Other Asian 0.61 (0.45–0.83)
Non-U.S. born Asian and Pacific Islander CVD 1.00 (ref)
U.S. born Asian and Pacific Islander 1.29 (1.08–1.54)
Non-U.S. born Chinese CVD 1.00 (ref)
U.S. born Chinese 1.33 (0.81–2.20)
Non-U.S. born Japanese CVD 1.00 (ref)
U.S. born Japanese 1.04 (0.74–1.48)
Non-U.S. born Filipino CVD 1.00 (ref)
U.S. born Filipino 0.99 (0.57–1.72)
Non-U.S. born Hawaiian CVD 1.00 (ref)
U.S. born Hawaiian 0.97 (0.13–7.38)
Non-U.S. born Korean CVD 1.00 (ref)
U.S. born Korean 0.17 (0.02–1.69)
Non-U.S. born Asian Indian and Pakistani CVD 1.00 (ref)
U.S. born Asian Indian and Pakistani 0.94 (0.11–8.13)
Non-U.S. born Pacific Islander CVD 1.00 (ref)
U.S. born Pacific Islander 4.27 (0.68–26.7)
Non-U.S. born Other Asian CVD 1.00 (ref)
U.S. born Other Asian 2.06 (0.84–5.10)
CVD mortality in breast cancer patients by diet, body weight, and health behaviors
McCullough, 2016 Cox proportional hazard Pre-diagnostic diet score (continuous) CVD 0.96 (0.84–1.10) Clinical, tumor, and treatment characteristics, CVD risk factors
Pre-diagnostic diet score 0–2 CVD 1.00 (ref)
Pre-diagnostic diet score 3–5 0.95 (0.68–1.32)
Pre-diagnostic diet score 6–9 0.94 (0.63–1.39)
Post-diagnostic diet score (continuous) CVD 0.95 (0.79–1.14)
Post-diagnostic diet score 0–2 CVD 1.00 (ref)
Post-diagnostic diet score 3–5 0.96 (0.60–1.54)
Post-diagnostic diet score 6–9 0.81 (0.47–1.39)
Nichols, 2009 Cox proportional hazard One to 5 year before diagnosis a BMI <18.5 CVD 4.15 (1.44–12.0) Age, menopausal status, and other CVD risk factors
One to 5 year before diagnosis a BMI 18.5−24.9 1.00 (ref)
One to 5 year before diagnosis a BMI 25.0−29.9 1.05 (0.63–1.74)
One to 5 year before diagnosis a BMI ≥30 2.45 (1.46–4.11)
BMI after diagnosis <18.5 CVD 0.58 (0.08–4.34)
BMI after diagnosis 18.5−24.9 1.00 (ref)
BMI after diagnosis 25.0−29.9 0.99 (0.59–1.66)
BMI after diagnosis ≥30 1.65 (0.97–2.83)
Weight (kg) change −50.0 to −10.1 CVD 1.08 (0.42–2.78)
Weight (kg) change −10.0 to −2.1 1.02 (0.58–1.80)
Weight (kg) change −2.0 to 2.0 1.00 (ref)
Weight (kg) change 2.1–6.0 0.79 (0.43–1.44)
Weight (kg) change 6.1–10.0 0.64 (0.29–1.44)
Weight (kg) change 10.1 1.73 (0.83–3.62)
Veal, 2017 Cox proportional hazard Pre-diagnosis behaviors Demographic, clinical, tumor, and treatment characteristics
BMI Continuous CVD 1.01 (0.95–1.07)
18.5–24.9 CVD 1.0 (ref)
25.0–29.9 0.88 (0.37–2.07)
30.0–34.9 1.21 (0.45–3.24)
≥35.0 1.85 (0.59–5.85)
Physical activity (hours per week) Continuous CVD 0.83 (0.70–0.98)
No activity CVD 1.0 (ref)
0–1.9 0.52 (0.22–1.23)
2.0–4.9 0.38 (0.15–1.00)
≥5.0 0.29 (0.08–1.04)
Alcohol (drinks per week) Continuous CVD 1.01 (0.94–1.08)
Non-drinker CVD 1.0 (ref)
0–1.9 0.68 (0.29–1.60)
2.0–6.9 1.22 (0.47–3.14)
≥7.0 0.49 (0.13–1.86)
Smoking Non-smoker CVD 1.0 (ref)
Former smoker 0.96 (0.43–2.15)
Current smoker 2.07 (0.84–5.11)
Post-diagnosis behaviors Pre-diagnosis health behavior and demographic, clinical, tumor, and treatment characteristics
BMI Continuous CVD 0.96 (0.85–1.08)
18.5–24.9 CVD 1.0 (ref)
25.0–29.9 0.90 (0.32–2.51)
30.0–34.9 0.63 (0.15–2.70)
≥35.0 0.36 (0.05–2.74)
Physical activity (hours per week) Continuous CVD 1.04 (0.91–1.18)
No activity CVD 1.0 (ref)
0–1.9 0.35 (0.04–2.97)
2.0–4.9 0.42 (0.05–3.60)
≥5.0 2.27 (0.40–12.76)
Alcohol (drinks per week) Continuous CVD 0.90 (0.67–1.22)
Non-drinker CVD 1.0 (ref)
0–1.9 1.43 (0.37–5.62)
2.0–6.9 1.53 (0.24–9.89)
≥7.0 0.57 (0.04–8.52)
Smoking Non-smoker CVD 1.0 (ref)
Former smoker 0.92 (0.41–2.08)
Current smoker 1.27 (0.22–6.86)

AJCC American Joint Committee on Cancer, AMI acute myocardial infarction, BMI body mass index; kg/m2, CHD Coronary heart disease, CI confidence interval, CT chemotherapy, CVA cerebrovascular accident, CVD cardiovascular disease, DCIS ductal carcinoma in situ, HR hazard ratio, HT hormonal therapy, MR mortality ratio, ref reference category, RT radiotherapy, SD standard deviation, SEER Surveillance, Epidemiology, and End Results, US United States