Abstract P2-10-07: Cardiovascular disease risk and statin use among women with breast cancer treated with adjuvant aromatase inhibitor therapy
Authors: Chen Monica F , Manger Morgan , Crew Katherine D 
Published: March 2020

Background: Patients with early-stage breast cancer are more likely to die from cardiovascular disease (CVD) than breast cancer. Aromatase inhibitors (AI) are used as adjuvant therapy in postmenopausal women with hormone receptor-positive breast cancer to improve survival rates, however, AI use has numerous adverse effects including increasing the risk of CVD due to negative effects on blood pressure and cholesterol levels. The American College of Cardiology/American Heart Association 2019 guidelines recommend that all patients at intermediate or high risk for CVD based on 10-year atherosclerotic cardiovascular disease (ASCVD) risk score be on a statin. We aimed to evaluate CVD risk and statin use among racially/ethnically diverse women with breast cancer on adjuvant AI therapy.

Methods: We evaluated postmenopausal women with stage I-III breast cancer treated with AIs between 2007 and 2018 at Columbia University Irving Medical Center in New York, NY. Ten-year ASCVD risk score was calculated at breast cancer diagnosis from age (20-79 years), gender (female only), race (white/black/other), serum total cholesterol (130-320 mg/dL) and HDL cholesterol (20-100 mg/dL), systolic blood pressure (90-200 mm Hg), hypertension treatment (yes/no), diabetes (yes/no), and smoking status (current/former/never). Individuals were categorized based upon their 10-year ASCVD risk as low (&lt;5%), borderline (5-7.5%), intermediate (7.5-20%), or high risk (&gt;20%). We used descriptive statistics and multivariable logistic regression to determine predictors of statin use among patients with intermediate or high risk ASCVD risk scores.

Results: Of 363 evaluable patients, median age at diagnosis was 64 years (range, 50-80) and 35.8% were non-Hispanic white, 32.5% Hispanic, 23.4% non-Hispanic black, and 8.3% other races. Overall, the proportion of women with low risk ASCVD risk was 25.6%, borderline risk was 8.0%, intermediate risk was 37.7%, and high risk was 28.7%. Mean 10-year ASCVD risk scores were 13.7% for black women, 11.5% Hispanics, and 11.0% for white women and other races (p=0.082). The percentage of patients on statins was 50% in the intermediate risk category and 77% in the high risk category. Among those with intermediate or high ASCVD risk scores (N=240), statin use was associated with higher ASCVD risk, higher total cholesterol and systolic blood pressure, and a diagnosis of hypercholesterolemia.

Conclusions: Among women with early-stage breast cancer starting adjuvant AI therapy, there is a high prevalence with intermediate and high ASCVD risk. Given the effects of AI therapy on CVD risk factors, these patients should be screened for ASCVD risk and started on statin therapy when indicated.

Citation Format: Monica F Chen, Morgan Manger, Katherine D Crew. Cardiovascular disease risk and statin use among women with breast cancer treated with adjuvant aromatase inhibitor therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-10-07.