Racial and Ethnic Disparities in Cardiovascular and All-Cause Mortality Among U.S. Women with Breast Cancer: a National NHANES Analysis

BACKGROUND: Cardiovascular complications are an important and increasingly recognized concern among women with breast cancer. Racial and ethnic differences in cardiovascular disease burden suggest that certain populations may be at heightened risk of adverse cardiovascular outcomes. This study examined racial differences in cardiovascular outcomes and mortality among women with breast cancer using data from the National Health and Nutrition Examination Survey (NHANES). METHODS: We conducted a retrospective observational analysis of 669 women with self-reported breast cancer identified in NHANES and linked to the National Death Index. Participants were categorized by race and ethnicity as Non-Hispanic White, Non-Hispanic Black, Mexican American, Other Hispanic, or Other Race. Heart failure prevalence was evaluated as a clinically relevant cardiovascular outcome. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular-specific mortality, adjusting for demographic, socioeconomic, and clinical factors. Kaplan-Meier survival curves and forest plots were generated to visualize differences across groups. RESULTS: Non-Hispanic Black women demonstrated the highest prevalence of cardiovascular disease, including heart failure (8.2%), compared with Non-Hispanic White (7.4%), Other Race (6.1%), Other Hispanic (2.2%), and Mexican American women (1.7%). Non-Hispanic Black women showed a trend toward poorer survival outcomes, with an elevated risk of all-cause mortality (HR 1.80; 95% CI: 0.96-3.36) compared with Mexican American women. After multivariable adjustment, this association persisted (HR 1.81; 95% CI: 0.96-3.41). Cardiovascular-specific mortality was higher among Non-Hispanic Black women, reaching statistical significance in the fully adjusted model (adjusted HR 3.46; 95% CI: 1.66-7.24). CONCLUSION: Racial differences in cardiovascular outcomes and mortality were observed among women with breast cancer, with Non-Hispanic Black women experiencing a higher burden. These findings highlight the need for targeted, evidence-based strategies to address cardiovascular risk and improve equitable outcomes in this population.