Abstract Body: Background: Cardiovascular disease (CVD) remains a significant concern among breast cancer (BC) survivors, particularly following potentially cardiotoxic treatments, such as anthracyclines and anti-HER2 drugs, which increase the risk of major adverse cardiovascular events (MACE). Social determinants of health (SDOH) and environmental factors influence health outcomes, including those related to CVD. Greenspace has been associated with cardiovascular and cancer-related health benefits, yet its specific impact on MACE among BC survivors remains unknown.
Objective: This study aims to investigate the association between urban greenspace and time to first MACE incidence among individuals with BC after being treated with cardiotoxic therapies in the greater Milwaukee, WI area.
Methods: A retrospective cohort study was conducted using electronic medical records from the Froedtert Health System, linked to the National Death Index. Cox proportional hazards regression models were used to assess the association between percent tree canopy cover and MACE-specific hazards, adjusting for sociodemographic, clinical, and neighborhood-level factors.
Results: Among the 849 women included, 44.6% experienced a MACE. Non-Hispanic Black (NHB) women had a higher proportion of MACE incidence. Adjusted models indicated a 18% and 20% lower MACE-specific hazard for women in the second and third quartiles of percent tree canopy cover, as compared to the women in the first (lowest) quartile, respectively. Racial/ethnic disparities in MACE incidence were evident, with the NHB group having a higher proportion of MACE (61.9%) compared to NHW women (41.6%).
Discussion: Our findings suggest a protective effect of urban tree canopy on time to incident MACE among BC survivors receiving cardiotoxic treatments. These results underscore the importance of considering environmental factors in Cardio-Oncology care and highlight the benefits of greenspace in mitigating cardiovascular complications among individuals with BC. Future research should delve into environmental factors, behavioral factors, and biological mechanisms that underlie these associations. Additionally, longitudinal studies should be conducted to evaluate greenspace-based interventions for BC survivors, aiming to advance precision Cardio-Oncology interventions. Observed racial/ethnic disparities in MACE incidence underscore the urgent need for equity-focused interventions addressing greenspace access and MACE-related disparities.