Abstract The risk factors and clinical prediction of cardiovascular disease comorbidities in patients with breast cancer have not been fully clarified. We conducted this retrospective case-control study. The univariable and multivariable cox regression was used to screen the risk factors of cardiovascular comorbidities in breast cancer patients, and construct a clinical prediction model, followed by prediction efficacy test and internal validation. A total of 144 cases were included and divided into two groups based on the low and high expression levels of apoB (n=46 in apoBlow and n=98 in apoBhigh group). Univariable and multivariable cox regression found that apoB, age and HER2 were the key factors responsible for the myocardial ischemia occurrence in breast cancer patients. These factors were used to constructed the clinical prediction model with combination area under curve (AUC) of 0.583, and the decision curve analysis (DCA) suggested that there would be therapeutically clinical net benefit in the model-predicted population in the predicted threshold interval between 0.35 to 0.70. Finally, Kaplan-meier plot indicated HER2(+) category and apoBhigh lead to the most occurrence of myocardial ischemia in breast cancer patients. Moreover, the 3-year disease-free survival (DFS) was not found difference between the apoBlow and apoBhigh subgroups. The clinical prediction model was constructed using three key factors, and it was indicated HER2(+) and apoBhigh lead to the most occurrence of myocardial ischemia in breast cancer patients. This study may be helpful in providing clinical evidence for the early prediction of cardiovascular comorbidities in breast cancer patients.