Haque Reina, Prout Marianne, Geiger Ann M, Kamineni Aruna, Thwin Soe Soe, Avila Chantal, Silliman Rebecca A, Quinn Virginia, Yood Marianne Ulcickas
Kaiser Permanente Southern California, Department of Research and Evaluation, 100 South Los Robles Ave, 2nd Floor, Pasadena, CA 91101. E-mail:
Am J Manag Care. 2014;20(1):86-92.
To evaluate cardiovascular disease (CVD) risk factors in older breast cancer survivors compared with a group of women without breast cancer.
The retrospective study included (1) women aged 65 or more years who were initially diagnosed with stage I or II breast cancer from 1990 to 1994 in 6 US health plans and who survived at least 5 years post-diagnosis (cases) and (2) a matched comparison group. They were followed for a maximum of 15 years.
Data sources included medical charts and electronic health records. Cases (n = 1361) were matched on age, health plan site, and enrollment year to women in the comparison group (n = 1361). Subjects were followed to the first CVD outcome, health plan disenrollment, death, or study end. We compared rates of CVD in these 2 groups and used Cox proportional hazard models to estimate the hazard ratio (HR), considering body mass index, smoking history, diabetes, and hypertension.
The strongest predictors of CVD were smoking history (HR = 1.29; 95% confidence interval [CI], 1.15-1.46), diabetes (HR = 1.72; 95% CI, 1.48-1.99), and hypertension (HR = 1.48; 95% CI, 1.31-1.67) rather than breast cancer case-comparison status (HR = 0.97; 95% CI, 0.87-1.09).
Results suggest that long-term prognosis in breast cancer patients is affected by management of preexisting conditions. Assessment of comorbid conditions and effective management of diabetes and hypertension in older breast cancer survivors may lead to longer overall survival.
评估老年乳腺癌幸存者与一组无乳腺癌女性相比的心血管疾病（CVD）风险因素。
这项回顾性研究纳入了（1）1990年至1994年在美国6个健康计划中最初被诊断为I期或II期乳腺癌且诊断后存活至少5年的65岁及以上女性（病例组），以及（2）一个匹配的对照组。对她们进行了最长15年的随访。
数据来源包括病历和电子健康记录。病例组（n = 1361）在年龄、健康计划地点和入组年份方面与对照组女性（n = 1361）进行匹配。对受试者进行随访，直至出现首个心血管疾病结局、退出健康计划、死亡或研究结束。我们比较了这两组的心血管疾病发生率，并使用Cox比例风险模型估计风险比（HR），同时考虑体重指数、吸烟史、糖尿病和高血压。
心血管疾病的最强预测因素是吸烟史（HR = 1.29；95%置信区间[CI]，1.15 - 1.46）、糖尿病（HR = 1.72；95% CI，1.48 - 1.99）和高血压（HR = 1.48；95% CI，1.31 - 1.67），而非乳腺癌病例 - 对照状态（HR = 0.97；95% CI，0.87 - 1.09）。
结果表明，乳腺癌患者的长期预后受既有疾病管理的影响。对老年乳腺癌幸存者的合并症进行评估并有效管理糖尿病和高血压可能会延长总体生存期。
