Relationship between incident cardiovascular disease and quality of life after a breast cancer diagnosis

Alexi Vasbinder; Elena Wadden; Richard K Cheng; Ana Barac; Christopher R Friese; Yangbo Sun; Aladdin H Shadyab; Longjian Liu; Lisa Warsinger Martin; Marcia Stefanick; Michael S Simon; Kerryn Reding

doi:10.1007/s11764-025-01757-w

Relationship between incident cardiovascular disease and quality of life after a breast cancer diagnosis

J Cancer Surviv. 2025 Feb 6. doi: 10.1007/s11764-025-01757-w. Online ahead of print.

Authors

Affiliations

¹ Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific St, Box 357266, Seattle, WA, 98195, USA. avasbind@uw.edu.
² Department of Medicine, University of Washington, Seattle, WA, USA.
³ Division of Cardiology, University of Washington, Seattle, WA, USA.
⁴ Inova Schar Heart and Vascular, Inova Schar Cancer, Fairfax, VA, USA.
⁵ Rogel Cancer Center, School of Nursing and Public Health, University of Michigan, Ann Arbor, MI, USA.
⁶ Department of Preventive Medicine, The University of Tennessee Health Science Center, Memphis, TN, USA.
⁷ Herbert Wertheim School of Public Health and Human Longevity Science and Division of Geriatrics, Gerontology, and Palliative Care, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
⁸ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
⁹ Division of Cardiology, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA.
¹⁰ Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
¹¹ Department of Oncology, Karmanos Cancer Institute at Wayne State University, Detroit, MI, USA.
¹² Department of Biobehavioral Nursing and Health Informatics, University of Washington School of Nursing, 1959 NE Pacific St, Box 357266, Seattle, WA, 98195, USA.

PMID: 39909978
DOI: 10.1007/s11764-025-01757-w

Abstract

Purpose: Breast cancer survivors are at risk for both poor quality of life (QoL) and cardiovascular disease (CVD). This study examines whether incident CVD after breast cancer independently predicts QoL.

Methods: Using data from the Women's Health Initiative, we included women who were diagnosed with invasive breast cancer during follow-up and free of prevalent CVD prior to breast cancer. CVD was defined as adjudicated coronary heart disease, heart failure, or stroke. Physical and mental QoL, measured by the SF-36 Physical and Mental Component Scores (PCS and MCS, respectively), were recorded after breast cancer. Poor PCS and MCS were defined as scores < 40. We used adjusted time-dependent Cox proportional hazards models, accounting for time to CVD.

Results: Among 2912 BC survivors (mean age at BC diagnosis = 67), 1094 (37.6%) and 313 (10.7%) women had a post-breast cancer PCS and MCS score < 40, respectively, at a median of 2.5 years. A higher proportion of women had poor PCS scores post-BC (37.5% vs. 19.2%, P < 0.001) but not MCS (10.4% vs. 8.2%, P = 0.10). After adjustment for key covariates, incident CVD was associated with a 1.95-fold (95% CI 1.42, 2.67) greater risk of poor PCS scores (P < 0.001), but was not associated with poor MCS (HR 1.23, 95% CI 0.57, 2.65, P = 0.59)).

Conclusions: Incident CVD after breast cancer was associated with poor physical QoL but not mental QoL.

Implications for cancer survivors: This study highlights the importance of regular assessments of QoL and need for strategies to improve physical QoL in breast cancer survivors with CVD.

Keywords: Breast cancer; Cardiovascular disease; Quality of life; Short-form 36; Survivor.