Grant to Help Researchers Uncover Signs of Heart Damage

07.06.2022 Atrium Health News | Levine Cancer Institute

Multi-Site Study Aims to Prevent Heart Disease in Young Breast Cancer Patients

WINSTON-SALEM, N.C., July 6, 2022 – A 5-year, $3.1 million grant from the National Heart, Lung and Blood Institute (NHLBI), part of the National Institutes of Health (NIH), will enable researchers from Atrium Health Wake Forest Baptist’s NCI-designated Comprehensive Cancer Center, Virginia Commonwealth University Massey Cancer Center and Duke Cancer Institute to collaborate in a first-of-its-kind prospective study to look for the earliest signs of heart vessel damage in young, pre-menopausal breast cancer survivors.

Over the past two decades, the rates of women with hormone receptor-positive breast cancer have increased. However, survival rates for women with this type of breast cancer have improved when the treatment involves estrogen depletion to stop cancer cells from growing. Estrogen keeps blood vessels healthy and protects women from heart disease, but the long-term effect of estrogen depletion in young breast cancer survivors puts them at increased risk of heart disease, including heart failure and heart attacks.

“Our patients with hormone-receptor breast cancer are living longer due to aggressive treatment which includes turning off estrogen production that induces early menopause,” said Dr. Alexandra Thomas, Williams Family Chair in breast oncology, professor of hematology and oncology at Wake Forest University School of Medicine and the study’s co-principal investigator. “These patients have decades of life ahead of them and we hope that, by identifying early changes in coronary arteries, we may find ways to lower their risk of irreversible heart disease.”

The study is called “Cardiac Outcomes With Near Complete Estrogen Deprivation” (CROWN) and will include 90 women, age 55 and under, who have been diagnosed with breast cancer. Sixty-five of the study participants will receive standard estrogen-depletion therapy, while 25 participants with hormone receptor negative breast cancer will serve as a control group for the study.

The CROWN study will be conducted at all three centers and the researchers also hope to recruit a diverse group of women, especially Black women, who have higher rates of both breast cancer and heart disease. 

All study participants will receive sophisticated imaging tests at different intervals to look for small changes in the blood vessels that supply blood to the heart. Those include a cardiac MRI stress test at the beginning of the study, and at 1-year and 2-year intervals. They also will receive CT imaging of their cardiac arteries at baseline and after two years, along with blood tests to look for biomarkers that correlate with the risk of cardiovascular disease. The participants will be followed for five years.

“The state-of-the-art cardiovascular imaging will allow us to study cardiovascular health in young breast cancer survivors who have decades of survivorship health to protect,” said Jennifer JordanPh.D., assistant professor in the Virginia Commonwealth University Department of Biomedical Engineering and Pauley Heart Center and who also serves as co-principal investigator of the study. “Our collaboration is a great demonstration of team science that integrates the unique expertise of multiple investigators to address a major, unanswered question in cardio-oncology. It has been very exciting to build this team across our institutions, each of which has top-rated cancer centers in addition to cardiovascular imaging centers of excellence.”

“We have made great strides in the treatment of breast cancer,” said Dr. Susan Dent, professor of medicine at Duke University and lead investigator for patients enrolled at the Duke Cancer Institute. “We need a better understanding of the cardiovascular consequences of breast cancer treatments so that we don’t offset the gains we have made in breast cancer survival with early onset cardiovascular disease.” 

About Atrium Health 
Atrium Health is a nationally recognized leader in shaping health outcomes through innovative research, education and compassionate patient care. Based in Charlotte, North Carolina, Atrium Health is an integrated, nonprofit health system with more than 70,000 teammates serving patients at 40 hospitals and more than 1,400 care locations. It provides care under the Atrium Health Wake Forest Baptist name in the Winston-Salem, North Carolina, region, as well as Atrium Health Navicent and Atrium Health Floyd in Georgia and Alabama. Atrium Health is renowned for its top-ranked pediatric, cancer and heart care, as well as organ transplants, burn treatments and specialized musculoskeletal programs. A recognized leader in experiential medical education and groundbreaking researchWake Forest University School of Medicine is the academic core of the enterprise, including Wake Forest Innovations, which is advancing new medical technologies and biomedical discoveries. Atrium Health is also a leading-edge innovator in virtual care and mobile medicine, providing care close to home and in the home. Ranked nationally among U.S. News & World Report’s Best Hospitals in eight pediatric specialties and for rehabilitation, Atrium Health has also received the American Hospital Association’s Quest for Quality Prize and its 2021 Carolyn Boone Lewis Equity of Care Award, as well as the 2020 Centers for Medicare & Medicaid Services Health Equity Award for its efforts to reduce racial and ethnic disparities in care. With a commitment to every community it serves, Atrium Health seeks to improve health, elevate hope and advance healing – for all, providing $2.46 billion last year in free and uncompensated care and other community benefits.

About VCU and VCU Health 
Virginia Commonwealth University is a major, urban public research university with national and international rankings in sponsored research. Located in downtown Richmond, VCU enrolls nearly 30,000 students in 238 degree and certificate programs in the arts, sciences and humanities. Twenty-three of the programs are unique in Virginia, many of them crossing the disciplines of VCU’s 11 schools and three colleges. The VCU Health brand represents the VCU health sciences academic programs, the VCU Massey Cancer Center and the VCU Health System, which comprises VCU Medical Center (the only academic medical center in the region), Community Memorial Hospital, Tappahannock Hospital, Children’s Hospital of Richmond at VCU, and MCV Physicians. The clinical enterprise includes a collaboration with Sheltering Arms Institute for physical rehabilitation services. For more, please visit and

About Duke Cancer Institute 
Duke Cancer Institute brings together the world-class resources of Duke University, Duke Health and the Duke Comprehensive Cancer Center into a single collaborative powerhouse. We've organized our flagship cancer center to assemble each patient's clinical team and treatment resources in a single building. With centers in North Durham and Wake County, we also provide Duke quality cancer care closer to home. To learn more, visit Duke Health.