Risk of heart disease following treatment for breast cancer - results from a population-based cohort study

被引:17
|
作者
Yang, Haomin [1 ,2 ]
Bhoo-Pathy, Nirmala [3 ]
Brand, Judith S. [4 ]
Hedayati, Elham [5 ]
Grassmann, Felix [2 ,6 ]
Zeng, Erwei [2 ]
Bergh, Jonas [7 ,8 ]
Bian, Weiwei [2 ]
Ludvigsson, Jonas F. [2 ,9 ]
Hall, Per [2 ,10 ]
Czene, Kamila [2 ]
机构
[1] Fujian Med Univ, Sch Publ Hlth, Dept Epidemiol & Hlth Stat, Fuzhou, Peoples R China
[2] Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden
[3] Univ Malaya, Fac Med, Ctr Epidemiol & Evidence Based Practice, Kuala Lumpur, Malaysia
[4] Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, Orebro, Sweden
[5] Karolinska Inst, Dept Oncol Pathol, Stockholm, Sweden
[6] Hlth & Med Univ, Potsdam, Germany
[7] Karolinska Univ Hosp, Breast Canc Ctr, Stockholm, Sweden
[8] Karolinska Comprehens Canc Ctr, Stockholm, Sweden
[9] Orebro Univ Hosp, Dept Pediat, Orebro, Sweden
[10] Soder Sjukhuset, Dept Oncol, Stockholm, Sweden
来源
ELIFE | 2022年 / 11卷
基金
瑞典研究理事会;
关键词
breast cancer; arrhythmia; heart failure; ischemic heart disease; Human; AROMATASE INHIBITORS; CARDIAC TOXICITY; ANTHRACYCLINE CHEMOTHERAPY; ARTERIAL THROMBOEMBOLISM; ADJUVANT CHEMOTHERAPY; MYOCARDIAL-INFARCTION; RANDOMIZED-TRIAL; OLDER WOMEN; TRASTUZUMAB; TAMOXIFEN;
D O I
10.7554/eLife.71562
中图分类号
Q [生物科学];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices.
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页数:17
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