Krediet, Jan (2025) Long-term risk of Major Adverse Cardiovascular Events after curative radiotherapy for women with breast cancer. thesis, Medicine.
Full text available on request.Abstract
Background: Breast cancer (BC) is the most common malignancy among women in the Netherlands, and advances in treatment have led to a growing population of long-term survivors. Radiotherapy, a cornerstone of BC treatment, has been associated with increased cardiovascular risk, but the long-term risk of major adverse cardiovascular events (MACE) in BC survivors treated solely with radiotherapy remains unclear. Objective: To evaluate the long-term risk (>5 years post-diagnosis) of MACE—defined as myocardial infarction (MI), cerebrovascular accident (CVA), or cardiovascular mortality—in women treated with radiotherapy alone for BC compared to women without a history of cancer. Methods: A longitudinal cohort study was conducted using data from the BLOC-I and BLOC-II studies, including 126 BC survivors treated exclusively with radiotherapy and 255 initially matched controls without cancer. Baseline and follow-up data were collected via medical records, echocardiography, and questionnaires, with a median follow-up of 9 years after initial inclusion. Logistic regression analyses, adjusted for age, pre-existing cardiovascular disease, smoking, diabetes, and hypertension, were used to estimate the odds of MACE. Results: The incidence of MACE was low in both groups: 3.2% in BC survivors and 4.3% in controls. The odds of MACE were not significantly higher in BC survivors (OR 0.48 [95% CI 0.14–1.69]). No cases of MI occurred in BC survivors, and the odds of CVA were similar between groups (OR 0.93 [95% CI 0.23–3.73]). Cardiovascular mortality was not observed in either group. Left-sided radiotherapy did not confer a higher risk of MACE compared to right-sided treatment. However, BC survivors showed a significantly higher incidence of decompensatio cordis (6.3% vs. 1.2%, p = 0.005) and a non-significant trend towards more atrial fibrillation. Conclusion: Long-term BC survivors treated solely with radiotherapy do not exhibit an increased risk of MACE compared to women without cancer, suggesting that routine additional long-term cardiovascular monitoring is not warranted in this population. Nonetheless, the elevated incidence of decompensatio cordis and atrial fibrillation highlights the need for targeted vigilance for these specific cardiac complications in primary care.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Wal, Laurine van der and Brandenbarg, Daan |
| Faculty: | Medical Sciences |
| Date Deposited: | 03 Apr 2026 13:24 |
| Last Modified: | 03 Apr 2026 13:24 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3914 |
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