Baseline Cardiovascular and cardiotoxicity Risk in newly diagnosed Breast Cancer: insights from a nationwide Turkish registry (CARPE DIEM-TR)

Abstract

Cardiovascular disease and cancer share common risk factors, and recent ESC cardio-oncology guidelines recommend HFA-ICOS risk stratification to define treatment-related cardiotoxicity risk. Beyond cardiotoxicity, assessment of individual baseline cardiovascular event risk is essential to guide appropriate preventive strategies. Aim: This study aimed to assess baseline estimated 10-year cardiovascular disease risk, anthracycline-related cardiotoxicity risk, and variations in these risk profiles according to disease stage and pathological subgroups in women with newly diagnosed breast cancer enrolled in the CARPE DIEM-TR registry. Methods: The Cardiovascular Risk Profile and Events During Treatment of Breast Cancer Patients in Türkiye (CARPE DIEM-TR) registry was initiated in 2024 to evaluate baseline cardiovascular risk factors and subsequent cardiovascular events in women with newly diagnosed BC. Patients with available data enrolled up to 15 January 2026 were included. Anthracycline (AC) cardiotoxicity risk was assessed using the HFA-ICOS risk calculator, while 10-year cardiovascular disease risk was estimated using SCORE2 and its derivatives (SCORE2-Diabetes and SCORE2-OP), as appropriate. Results: The study included 333 women with BC and available SCORE2 data. Mean age was 53.2±12.8 years and mean BMI was 28.5±5.4 kg/m²; 29.4% had a smoking history. Hypertension was present in 30.9%, diabetes in 18.6%, and coronary artery disease in 2.7%. The median 10-year CVD risk was 3.3% (0–60.9%), with 54.4% classified as low risk, 6.3% moderate, 30.6% high, and 8.4% very high risk. No patients were at very high AC cardiotoxicity risk, while 58.6% were at low risk for AC cardiotoxicity. Concordance between AC cardiotoxicity risk and SCORE2 categories is shown in the Sankey plot (Figure 1). Patients with available data on cancer stage, hormone receptor status, and HER2 status were further analyzed. Patients with locally advanced disease had higher non-HDL cholesterol (144.5±42.1 vs. 160.2±44.0; p=0.021), LDL cholesterol (120.3±34.7 vs. 137.3±39.4; p=0.004), and 10-year CVD risk (2.1% vs. 4.9%; p=0.032) compared with those with early-stage disease. Body mass index was significantly higher in HER2-positive patients than in HER2-negative patients (29.8±6.2 vs. 27.8 ± 5.3; p=0.045), while all other variables were comparable. No significant differences were observed between hormone receptor–positive and –negative patients (Table 1). Conclusions: HFA-ICOS cardiotoxicity risk and SCORE2 cardiovascular risk showed modest concordance, with many low cardiotoxicity–risk patients having high or very high baseline cardiovascular risk. Cardiovascular risk varied by tumor characteristics, with higher lipid levels and 10-year CVD risk in locally advanced disease and higher BMI in HER2-positive patients. These findings highlight the need for early, systematic cardiovascular risk assessment and individualized cardio-oncology strategies.