Bradshaw Patrick T, Stevens June, Khankari Nikhil, Teitelbaum Susan L, Neugut Alfred I, Gammon Marilie D
From the Departments of aNutrition and bEpidemiology, University of North Carolina, Chapel Hill, NC; cDepartment of Preventive Medicine, Mount Sinai School of Medicine, New York, NY; and dDepartments of Medicine and Epidemiology, Columbia University, New York, NY.
Epidemiology. 2016 Jan;27(1):6-13. doi: 10.1097/EDE.0000000000000394.
Cardiovascular disease (CVD) is of increasing concern among breast cancer survivors. However, the burden of this comorbidity in this group relative to the general population, and its temporal pattern, remains unknown.
We compared deaths due to CVD in a population-based sample of 1,413 women with incident breast cancer diagnosed in 1996-1997, and 1,411 age-matched women without breast cancer. Date and cause of death through December 31, 2009 were assessed through the national death index and covariate data was gathered through structured interviews and medical record abstraction. Hazard ratios (HR) and 95% confidence intervals were calculated using Cox regression for overall mortality (HR) and CVD-specific death (cause-specific HR). Subdistribution HRs for CVD death were estimated from the Fine-Gray model.
Risk of death was greater among breast cancer survivors compared with women without breast cancer (HR: 1.8 [1.5, 2.1]). An increase in CVD-related death among breast cancer survivors was evident only 7 years after diagnosis (years 0-7, cause-specific HR: 0.80 [0.53, 1.2], subdistribution HR: 0.59 [0.40, 0.87]); years 7+, cause-specific HR: 1.8 [1.3, 2.5], subdistribution HR: 1.9 [1.4, 2.7]; P interaction: 0.001). An increase in CVD-related mortality was observed among breast cancer survivors receiving chemotherapy.
Breast cancer survivors are at greater risk for CVD-related mortality compared with women without breast cancer and this increase in risk is manifested approximately 7 years after diagnosis. Efforts should be made to identify risk factors and interventions that can be employed during this brief window to reduce the excess burden of CVD in this vulnerable population.
心血管疾病（CVD）在乳腺癌幸存者中越来越受到关注。然而，相对于普通人群，该合并症在这一群体中的负担及其时间模式仍不清楚。
我们比较了1996 - 1997年确诊的1413例新发乳腺癌女性患者以及1411例年龄匹配的无乳腺癌女性的CVD死亡情况。通过国家死亡指数评估截至2009年12月31日的死亡日期和原因，并通过结构化访谈和病历摘要收集协变量数据。使用Cox回归计算全因死亡率（HR）和CVD特异性死亡（病因特异性HR）的风险比（HR）和95%置信区间。CVD死亡的亚分布HR由Fine-Gray模型估计。
与无乳腺癌女性相比，乳腺癌幸存者的死亡风险更高（HR：1.8 [1.5, 2.1]）。乳腺癌幸存者中与CVD相关的死亡仅在诊断后7年才明显增加（0 - 7年，病因特异性HR：0.80 [0.53, 1.2]，亚分布HR：0.59 [0.40, 0.87]）；7年以上，病因特异性HR：1.8 [1.3, 2.5]，亚分布HR：1.9 [1.4, 2.7]；P交互作用：0.001）。接受化疗的乳腺癌幸存者中观察到与CVD相关的死亡率增加。
与无乳腺癌女性相比，乳腺癌幸存者患CVD相关死亡率的风险更高，且这种风险增加在诊断后约7年显现。应努力识别可在这一短暂窗口期采用的风险因素和干预措施，以减轻这一脆弱人群中CVD的额外负担。
