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Research ArticleOriginal Research

Cardiovascular Screening and Lipid Management in Breast Cancer Survivors

S. Tucker Price, Lisa D. Mims, Marty S. Player, Carole Berini, Suzanne Perkins, Chanita Hughes Halbert and Vanessa A. Diaz
The Journal of the American Board of Family Medicine November 2020, 33 (6) 894-902; DOI: https://doi.org/10.3122/jabfm.2020.06.190459
S. Tucker Price
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Lisa D. Mims
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Marty S. Player
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Carole Berini
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Suzanne Perkins
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Chanita Hughes Halbert
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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Vanessa A. Diaz
the Department of Family Medicine, Medical University of South Carolina, Charleston, SC (STP, LDM, MSP, CB, SP, VAD); Medical University of South Carolina Department of Psychiatry and Behavioral Sciences, Charleston, SC (CHH).
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    Figure 1.

    Cardiovascular screening and statin therapy in breast cancer (BC) survivors. A, BC survivors are more likely to have received cholesterol screening and statin therapy than matched controls. B, Subgroup analysis of BC survivors with a diagnosis of hypertension have no differences in blood pressure control compared with comorbidity matched peers. C, Subgroup analysis of BC survivors are more likely than matched controls to have an active statin prescription if indicated. Sample size is indicated in parentheses for each group. Abbreviation: BMI, body mass index. *P < .05, ** P < .01, ***P < .001.

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    Figure 2.

    Cardiovascular screening, management, and comorbidities in African American and White breast cancer (BC) survivors. A, No differences in cardiovascular screening and management were observed between White and African American BC survivors; however, African American BC survivors were found to have a decreased incidence of having a body mass index less than 25 kg/m2. B, African American BC survivors are more likely to have a diagnosis of hypertension. Sample size is indicated in parentheses for each group. Abbreviation: BMI, body mass index. *P < .05, ***P < .001.

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    Figure 3.

    Impact of age on cardiovascular screening breast cancer (BC) survivors. A, Cardiovascular screening and management of BC survivors stratified by age. Older individuals are more likely to have received cholesterol screening than younger counterparts. B, Incidence of comorbidities based on age in BC survivors. Older BC survivors have a higher incidence of hypertension. Sample size is indicated in parentheses for each group. *P < .05, **P < .01, ***P < .001.

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    Table 1.

    Demographic Data

    BC SurvivorsMatched Control
    Age, mean (SD)63 (8.5)63 (8.5)
    Individuals, n105210
    Ethnicity
     White48% (51)57% (120)
     African American44% (46)39% (82)
     Hispanic or Latino4% (4)1% (2)
     Asian4% (4)3% (6)
    Medical comorbidities
     Hypertension63% (66)63% (132)
     Hyperlipidemia32% (34)34% (73)
     Diabetes27% (28)29% (61)
    Cardiotoxic therapies received
     None25% (26)
     One or more77% (81)
     Two or more42% (44)
    Cancer therapy
     Radiation therapy38% (40)
     Chemotherapy38% (40)
     Endocrine therapy55% (58)
    Stage at diagnosis
     016% (17)
     136% (38)
     222% (23)
     34% (4)
     42% (2)
     Unknown20% (21)
    Cardiovascular metrics
     ASCVD risk10.9% (8.6)11.9% (8.1)
     Body mass index30.4 (7.6)30.9 (9.9)
     Major cardiovascular events6.7% (7)1.4% (3)
     Hemoglobin A1c <9% (n = 89)67.2% (20)71.4% (41)
     Lipid screening by primary care93.7% (90)88.3% (129)
     Statin therapy by primary care93.6% (44)87.7% (50)
    • ASCVD, atherosclerotic cardiovascular disease; BC, breast cancer, SD, standard deviation.

    • Cancer survivors seen within 3 months were matched with controls based on age and medical comorbidity of hypertension, hyperlipidemia, and diabetes mellitus.

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The Journal of the American Board of Family     Medicine: 33 (6)
The Journal of the American Board of Family Medicine
Vol. 33, Issue 6
November-December 2020
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Cardiovascular Screening and Lipid Management in Breast Cancer Survivors
S. Tucker Price, Lisa D. Mims, Marty S. Player, Carole Berini, Suzanne Perkins, Chanita Hughes Halbert, Vanessa A. Diaz
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 894-902; DOI: 10.3122/jabfm.2020.06.190459

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Cardiovascular Screening and Lipid Management in Breast Cancer Survivors
S. Tucker Price, Lisa D. Mims, Marty S. Player, Carole Berini, Suzanne Perkins, Chanita Hughes Halbert, Vanessa A. Diaz
The Journal of the American Board of Family Medicine Nov 2020, 33 (6) 894-902; DOI: 10.3122/jabfm.2020.06.190459
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Keywords

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