Coronary Artery Calcium and cardiovascular risk factors analysis after Radiotherapy for breast cancer (the CLARIFIER: A gender-based preventive medicine study)

Daniela Trabattoni^1*Maria Cristina leonardi²Maria Elisabetta Mancini¹Barbara Alicja Jereczek-Fossa²Federica Cattani²Giulia Santagostino Baldi¹Alice Bonomi¹Arianna Galotta¹Saima Mushtaq¹Andrea Daniele Annoni¹Davide Alio²Davide Alio²Cristiana Iuliana Fodor²Ludovico La Grutta³Piero Montorsi¹Gianluca Pontone¹

• ¹Monzino Cardiology Center (IRCCS), Milan, Lombardy, Italy
• ²European Institute of Oncology, IRCCS, Milan, Italy
• ³University of Palermo, Palermo, Sicily, Italy

Patients receiving thoracic radiation (RT) are at increased risk for heart disease. Coronary artery calcium (CAC) is an independent risk factor for cardiac events. The aim of this prospective, jointinstitution, study was to analyze the relationship between cardiovascular risk factors (CVRF) known before breast cancer diagnosis and treatment, and the risk of developing coronary events in women undergoing adjuvant breast radiotherapy by measuring CAC.Results: Women (n=92) diagnosed with early-stage breast cancer between 2010 and 2016 were enrolled and underwent cardiologic clinical assessment and coronary CT-scan for CAC score analysis, at least 5-years after RT. Data obtained from 91/92 pts, showed a 36.2% incidence of pathologic Agatston CAC score, independent of the irradiated breast side. After grouping patients according to the total number of CVRF [group 1, n=55 (60.4%): 0-2 CV risk factors; group 2, n=36 (39.6%): 3-5 CV risk factors] significant differences were observed in CAC -scores.Normal CAC-scores (Agatston 0) were recorded in 70.9% in group 1 vs 41.7% in group 2 (p=0.005), while CAC-3 (Agatston > 300) in 11.1% of group 2 only (p=0.02), corresponding to clinical evidence of coronary disease. The risk of cardiac events was associated with increased age, early menopause, hypertension, high cholesterol levels, and smoking habits at the time of RT.This study helps to identify women at high-risk for cardiovascular events before RT and implement the best possible prevention of late post cancer treatment eventsCardiovascular risk factors well known at the time of RT treatment may be markers of a strong negative synergistic effect between modifiable risk factors and radiation exposure, predicting future coronary artery calcifications and cardiovascular events.• The presence of > 3-5 risk factors is independently associated with a high CAC-DRS score and worse cardiovascular clinical outcomes • The risk of higher CAC-scores was associated with increased age (p<0.0001), early menopause (p=0.01), prolonged follow-up underlying hypertension (p=0.01), high cholesterol (p=0.007), and smoking (p=0.04) at the time of RT • This study helps to identify women at high risk for CV events before RT and implement the best possible prevention of late post cancer treatment events, including modification of patient-and treatment related factors