The Influence of Breast Cancer Chemotherapy Treatment on Cardiovascular Disease Risk Factors in Premenopausal and Postmenopausal Women

Background: Cardiovascular disease (CVD) risk is higher in postmenopausal versus premenopausal women, described in part as an elevation in systolic blood pressure (SBP), which occurs largely as a result of menopause-related reductions in estrogen. Breast cancer (BC) chemotherapy treatment can increase CVD-related morbidity and mortality in women, which may be attributed to the estrogen suppressing effects of chemotherapy treatment. However, whether BC chemotherapy exacerbates the menopause-related elevation in CVD risk is unknown. Purpose: To determine the influence of BC chemotherapy treatment on traditional CVD risk factors in premenopausal women and postmenopausal women. Methods: We utilized TriNetx and Health Data Compass to access electronic health records (EHR) from the University of Colorado Health system. We gathered EHR from a total of 150 women, which equated to 4 groups of women: 1) premenopausal with no history of BC (n=50; mean age, 34±6 years); 2) premenopausal with history of BC and chemotherapy treatment (n=20; mean age, 43±5 years); 3) postmenopausal with no history BC (n=50; mean age, 64±5 years); and 4) postmenopausal with history BC and chemotherapy treatment (n=30; mean age, 64±5 years). Inclusionary criteria for the BC groups included concomitant radiation treatment. Exclusionary criteria for the BC groups included any neoplasms other than BC. Exclusionary criteria for all groups included the use of anti-hypertensive medications. Extracted data included SBP, diastolic BP, bodyweight, body mass index (BMI), resting heart rate (HR), respiratory rate (RR), and serum-based measures including low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), triglycerides, glucose, hemoglobin A1C, and triglycerides. Results: SBP tended to be higher in premenopausal women with history of BC and chemotherapy treatment relative to premenopausal women with no history of BC (113±8 vs. 108 ± 12 mmHg, P = 0.091). SBP was not different between postmenopausal women with history of BC and chemotherapy treatment relative to postmenopausal women with no history of BC (123 ± 14 vs. 126 ± 13 mmHg, P = 0.99). LDL was higher in premenopausal women with history of BC and chemotherapy treatment relative to premenopausal women with no history of BC (119 ± 42 vs. 95 ± 31 mg/dL, P = 0.010). LDL was not different between postmenopausal women with history of BC and chemotherapy treatment relative to postmenopausal women with no history of BC (118 ± 39 vs. 107 ± 38, P = 0.22). We did not observe an effect of BC chemotherapy in premenopausal or postmenopausal women on DBP, bodyweight, BMI, HR, RR, LDL, HDL, TC, triglycerides, glucose or hemoglobin A1C. Conclusion: Based on the results generated from these cohorts of women, BC chemotherapy treatment may promote premature CVD risk in premenopausal women but may not exacerbate CVD risk in postmenopausal women. Together, these data suggest that that presence of female sex hormones (e.g., estrogen) may regulate the influence of BC chemotherapy treatment on CV health in women but further mechanistic studies are warranted. Funding: T32 AG000279 (BLN); R00 HL151818 (ZSC) This abstract was presented at the American Physiology Summit 2025 and is only available in HTML format. There is no downloadable file or PDF version. The Physiology editorial board was not involved in the peer review process.