Arterial stiffness in long-term breast cancer survivors: a propensity score–matched analysis in primary prevention

Breast cancer treatment may be associated with adverse cardiovascular effects. Pulse wave velocity (PWV) is a marker of arterial stiffness and a validated predictor of cardiovascular events. The aim of this study was to evaluate whether a history of breast cancer (HBC), beyond the first year after diagnosis, is associated with higher PWV in middle-aged women in a primary prevention setting. Women aged 35 to 65 years evaluated at a cardiometabolic unit between September 2021 and March 2024 were included if valid PWV measurements obtained by automated oscillometry were available. Exclusion criteria comprised previous cardiovascular disease, chronic kidney disease stage > II, and inflammatory conditions. Participants were categorized according to HBC, defined as a diagnosis made at least one year prior to evaluation. A propensity score adjusted for age, hypertension, dyslipidemia, smoking status, physical inactivity, diabetes, obesity and use of statins was constructed, and 1:1 matching was performed. PWV (m/s) was the primary outcome. In addition, inverse probability weighting (IPW) analysis was conducted. A total of 2,318 women were analyzed (mean age 51.0 ± 7.3 years); 53 (2.3%) had HBC, with a median time of 67 months since diagnosis. PWV was significantly higher in women with HBC compared with those without cancer (7.85 ± 0.99 vs. 7.34 ± 1.09 m/s; p = 0.0008), with no significant differences in traditional cardiovascular risk factors. After matching, HBC was associated with a 0.34 m/s increase in PWV (95% CI: 0.24–0.45; p < 0.001). IPW analysis confirmed these findings. A history of breast cancer is associated with increased arterial stiffness independently of traditional risk factors, underscoring the relevance of vascular surveillance in breast cancer survivors.