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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.

Sec. Cardio-Oncology

Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1615793

This article is part of the Research TopicCardiomyopathy and Heart Failure in OncologyView all 7 articles

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

Provisionally accepted
Daniela  TrabattoniDaniela Trabattoni1*Maria  Cristina leonardiMaria Cristina leonardi2Maria  Elisabetta ManciniMaria Elisabetta Mancini1Barbara  Alicja Jereczek-FossaBarbara Alicja Jereczek-Fossa2Federica  CattaniFederica Cattani2Giulia  Santagostino BaldiGiulia Santagostino Baldi1Alice  BonomiAlice Bonomi1Arianna  GalottaArianna Galotta1Saima  MushtaqSaima Mushtaq1Andrea  Daniele AnnoniAndrea Daniele Annoni1Davide  AlioDavide Alio2Davide  AlioDavide Alio2Cristiana  Iuliana FodorCristiana Iuliana Fodor2Ludovico  La GruttaLudovico La Grutta3Piero  MontorsiPiero Montorsi1Gianluca  PontoneGianluca Pontone1
  • 1Monzino Cardiology Center (IRCCS), Milan, Lombardy, Italy
  • 2European Institute of Oncology, IRCCS, Milan, Italy
  • 3University of Palermo, Palermo, Sicily, Italy

The final, formatted version of the article will be published soon.

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

Keywords: breast cancer, radiation therapy, CV risks, Coronary artery calcium, Coronary Disease, prevention

Received: 21 Apr 2025; Accepted: 04 Jul 2025.

Copyright: © 2025 Trabattoni, leonardi, Mancini, Jereczek-Fossa, Cattani, Santagostino Baldi, Bonomi, Galotta, Mushtaq, Annoni, Alio, Alio, Fodor, La Grutta, Montorsi and Pontone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Daniela Trabattoni, Monzino Cardiology Center (IRCCS), Milan, 20138, Lombardy, Italy

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