Grant Details
Grant Number: |
5R01CA214057-04 Interpret this number |
Primary Investigator: |
Kwan, Marilyn |
Organization: |
Kaiser Foundation Research Institute |
Project Title: |
Predictors of Cvd Among Breast Cancer Survivors in an Integrated Health System |
Fiscal Year: |
2020 |
Abstract
PROJECT SUMMARY / ABSTRACT
Breast cancer survivors are at high risk of developing and dying from cardiovascular disease (CVD) following
breast cancer diagnosis, but subpopulations at increased risk and targets for intervention have not been well-
characterized. A growing body of literature links CVD with specific cardiotoxic cancer treatments. CVD risk
among breast cancer survivors might vary by concomitant non-adherence to CVD medications and presence
of CVD risk factors. However, most of the studies on CVD risk among breast cancer patient populations have
had significant limitations, including poorly characterized CVD outcomes, lack of CVD medication adherence
data and risk factors, and poorly matched cancer-free control groups. Well-designed studies are needed to
identify subpopulations of breast cancer survivors at high risk for CVD events and modifiable targets for
intervention while accounting for specific breast cancer treatments received, CVD medications, and CVD risk
factors. We propose to conduct an ancillary study within an ongoing study of breast cancer survivors which will
overcome limitations of prior studies. The proposed study will comprehensively examine clinical and behavioral
predictors of CVD outcomes among breast cancer survivors, and will maximize unique patient and data
resources available at Kaiser Permanente Northern California (KPNC). We will compare CVD events in the
Pathways Study, a cohort of female KPNC members age ≥21 years diagnosed with invasive breast cancer
(n=4,453, R01CA105274) with CVD events in a new age, race/ethnicity, history of comorbidity, and length of
KPNC membership matched cohort of healthy KPNC female members (n=22,265). Specific aims are: Aim 1)
To examine the absolute risk and relative risk of incident CVD events (ischemic heart disease, stroke/transient
ischemic attack, and cardiomyopathy/heart failure, and others) and new onset CVD risk factors (hypertension,
diabetes, dyslipidemia) in women with breast cancer (Pathways) and a cancer-free comparison group (KPNC
matched cohort); Aim 2) In women with a history of breast cancer (Pathways), to examine the relative risk of
incident CVD events and new onset of CVD risk factors, by type of cardiotoxic breast cancer treatment
received, including chemotherapy/biologic therapy (anthracyclines, trastuzamab), hormonal therapy
(Tamoxifen, aromatase inhibitors), and radiation therapy, controlling for confounders related to baseline CVD
medication adherence, clinical and behavioral risk factors, medical care and health care system factors, and
socioeconomic status (SES); Aim 3) To assess adherence to CVD medications in women with a history of
breast cancer (Pathways) using 14 years of follow-up data, and to examine the association of adherence with
risk of CVD events controlling for cardiotoxic cancer treatment received, baseline CVD clinical and behavioral
risk factors, medical care and health care system factors, and SES. Impact: Results from this study will have
important implications for identifying breast cancer subgroups at high risk of CVD and identifying potential
targets for intervention, such as medication adherence and control of CVD risk factors.
Publications
Diet quality and cardiometabolic health in breast cancer survivors: the Pathways Study.
Authors: Ergas I.J.
, Cheng R.K.
, Roh J.M.
, Kresovich J.K.
, Iribarren C.
, Nguyen-Huynh M.
, Rana J.S.
, Rillamas-Sun E.
, Laurent C.A.
, Lee V.S.
, et al.
.
Source: Breast Cancer Research And Treatment, 2025-02-01 00:00:00.0; , .
EPub date: 2025-02-01 00:00:00.0.
PMID: 39890673
Related Citations
Physical activity and incident cardiovascular disease in breast cancer survivors: the Pathways Study.
Authors: Kresovich J.K.
, Richards A.R.
, Ergas I.J.
, Cannioto R.
, Thomsen C.
, Laurent C.A.
, Shariff-Marco S.
, Rillamas-Sun E.
, Kolevska T.
, Yao S.
, et al.
.
Source: Jnci Cancer Spectrum, 2025-01-03 00:00:00.0; 9(1), .
PMID: 39693117
Related Citations
Diet quality and cardiovascular disease risk among breast cancer survivors in the Pathways Study.
Authors: Ergas I.J.
, Cheng R.K.
, Roh J.M.
, Kushi L.H.
, Kresovich J.K.
, Iribarren C.
, Nguyen-Huynh M.
, Rana J.S.
, Rillamas-Sun E.
, Laurent C.A.
, et al.
.
Source: Jnci Cancer Spectrum, 2024-02-29 00:00:00.0; 8(2), .
PMID: 38627946
Related Citations
Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer.
Authors: Rillamas-Sun E.
, Kwan M.L.
, Iribarren C.
, Cheng R.
, Neugebauer R.
, Rana J.S.
, Nguyen-Huynh M.
, Shi Z.
, Laurent C.A.
, Lee V.S.
, et al.
.
Source: Breast Cancer Research And Treatment, 2023-06-16 00:00:00.0; , .
EPub date: 2023-06-16 00:00:00.0.
PMID: 37326764
Related Citations
Neighborhood attributes and cardiovascular disease risk in breast cancer survivors: The Pathways Study.
Authors: Conroy S.M.
, Von Behren J.
, Kwan M.L.
, Kushi L.H.
, Kim M.O.
, Iribarren C.
, Roh J.M.
, Laurent C.A.
, Thomsen C.
, Chu J.N.
, et al.
.
Source: Cancer, 2023-04-25 00:00:00.0; , .
EPub date: 2023-04-25 00:00:00.0.
PMID: 37096827
Related Citations
Development of cardiometabolic risk factors following endocrine therapy in women with breast cancer.
Authors: Rillamas-Sun E.
, Kwan M.L.
, Carlos C.
, Cheng R.
, Neugebauer R.
, Rana J.S.
, Nguyen-Huynh M.
, Shi Z.
, Laurent C.A.
, Lee V.S.
, et al.
.
Source: Research Square, 2023-03-22 00:00:00.0; , .
EPub date: 2023-03-22 00:00:00.0.
PMID: 36993531
Related Citations
Reply to M.S. Ewer et al.
Authors: Greenlee H.
, Rillamas-Sun E.
, Cheng R.
, Iribarren C.
, Rana J.S.
, Nguyen-Huynh M.
, Kushi L.H.
, Kwan M.L.
.
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2022-07-25 00:00:00.0; , p. JCO2201353.
EPub date: 2022-07-25 00:00:00.0.
PMID: 35878101
Related Citations
Risk of Cardiovascular Disease in Women With and Without Breast Cancer: The Pathways Heart Study.
Authors: Greenlee H.
, Iribarren C.
, Rana J.S.
, Cheng R.
, Nguyen-Huynh M.
, Rillamas-Sun E.
, Shi Z.
, Laurent C.A.
, Lee V.S.
, Roh J.M.
, et al.
.
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2022-05-20 00:00:00.0; 40(15), p. 1647-1658.
EPub date: 2022-04-06 00:00:00.0.
PMID: 35385342
Related Citations
Risk of heart failure with preserved versus reduced ejection fraction in women with breast cancer.
Authors: Kwan M.L.
, Cheng R.K.
, Iribarren C.
, Shen H.
, Laurent C.A.
, Roh J.M.
, Hershman D.L.
, Kushi L.H.
, Greenlee H.
, Rana J.S.
.
Source: Breast Cancer Research And Treatment, 2022-04-16 00:00:00.0; , .
EPub date: 2022-04-16 00:00:00.0.
PMID: 35429322
Related Citations
Risk of Cardiometabolic Risk Factors in Women With and Without a History of Breast Cancer: The Pathways Heart Study.
Authors: Kwan M.L.
, Cheng R.K.
, Iribarren C.
, Neugebauer R.
, Rana J.S.
, Nguyen-Huynh M.
, Shi Z.
, Laurent C.A.
, Lee V.S.
, Roh J.M.
, et al.
.
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2022-01-13 00:00:00.0; , p. JCO2101738.
EPub date: 2022-01-13 00:00:00.0.
PMID: 35025627
Related Citations