European Primary Care Cardiovascular Society

Increased risk of CV death, HF and AF in breast cancer survivors

Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis

Literature - Galimzhanov A, Istanbuly S, Tun HN, et al. - Eur J Prev Cardiol. 2023 Jul 27;zwad243. [Online ahead of print]. doi: 10.1093/eurjpc/zwad243.

Introduction and methods


CVD has been recognized as an important cause of morbidity and mortality in breast cancer survivors [1-2]. CVD and breast cancer share risk factors, have common pathophysiological pathways, and many therapies that are used to treat breast cancer have toxic effects on the cardiovascular system [3-7]. There is increased literature that reports on cardiovascular outcomes in breast cancer survivors compared with the general cancer-free population. The relationship between breast cancer and cause-specific CVD is complex and remains incompletely understood. There is a need to quantify the future risk of CVD in breast cancer survivors for appropriate risk stratification.

Aim of the study

The aim of this meta-analysis was to determine the relative risk of cause-specific CVD in breast cancer patients compared with the general matched cancer-free population. Moreover, this meta-analysis also aimed to determine the absolute risk of cardiovascular outcomes in breast cancer survivors.


This was a systematic review and meta-analysis of studies published in PubMed, Web of Science, and Scopus before 23 March, 2023. In addition, studies were also retrieved from registries, journal websites, Biomed Explorer, Dimensions, and international meeting proceedings. In order to compare the risk of CV outcomes in breast cancer survivors and in the general population, 26 articles (n=836,301 patients) were included that reported on CV outcomes in patients with breast cancer at different stages as compared to those in the general matched cancer-free population. In order to estimate the incidence rate of CV outcomes in patients with breast cancer, 116 articles (n=2,111,882 patients) were included that provided original data on the incidence of CV outcome in breast cancer patients. Treatment strategy for breast cancer patients has been changed considerably after 1990. Therefore, studies before 1990 were excluded in this analysis. Follow-up time ranged from 1 to 11.8 years. The matching criteria varied considerably between studies, but all studies were matched for age, and in most reports the study arms were matched or statistical analyses were adjusted for race, socioeconomic status, comorbidities, and common CV risk factors.


The outcomes were CV death, HF, CAD, MI, any stroke, ischemic or hemorrhagic stroke, and AF. The same outcome definitions of the primary studies were used.

Main results

Risk of CV outcomes

Incidence of CV outcomes


This meta-analysis showed that breast cancer was associated with an increased risk of cardiovascular death, HF, and AF, but not CAD, MI, or (ischemic) stroke. The increased risk for HF in breast cancer survivors persisted to 10 years after breast cancer diagnosis. Moreover, there was a time-dependent increase in the risk of AF in breast cancer survivors, with a relative higher risk in the first 3 months after diagnosis. These data highlight the importance to carefully asses breast cancer survivors for their cardiovascular risk factor profile and future CV risk, and to monitor the cardiovascular function long-term in these patients.


Show references

Find this article online at Eur J Prev Cardiol.

Share this page with your colleagues and friends: