School of Public Health, University of Haifa, Haifa, Israel.
School of Public Health, University of Haifa, Haifa, Israel; Leumit Health Services, Karmiel, Israel.
J Cardiol. 2019 Apr;73(4):280-291. doi: 10.1016/j.jjcc.2018.10.009. Epub 2018 Dec 23.
The current investigation examined the association between chemotherapy and/or radiotherapy and subsequent risk of cardiovascular disease (CVD) in breast cancer survivors.
A case-cohort study was conducted, based on 2165 female breast cancer survivors recruited from "Leumit" healthcare fund, who were diagnosed with primary nonmetastatic invasive breast cancer between 2002 and 2012. A 20% random subcohort was sampled at baseline, and all CVD cases were identified. Adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were estimated by weighted Cox proportional hazards models.
Of 2165 breast cancer survivors, 466 developed CVD over a mean follow-up of 5.7 years. The crude cumulative incidence of CVD accounting for death as a competing risk was 33.6% (95% CI, 29.6-37.6%) at 13 years of follow-up. Lifestyle components, collected post-CVD incidence, indicated a higher prevalence of poor nutrition and physical inactivity in CVD patients. In multivariable analyses, CVD was positively associated with radiotherapy without chemotherapy compared to no radiotherapy or chemotherapy (HR, 2.94; 95% CI, 1.17-7.38; p=.022), outpatient visits (HR per average 10-annual visits, 1.86; 95% CI, 1.50-2.31; p<.001), employment transition between breast cancer diagnosis and treatment: job loss versus no change (HR, 29.62; 95% CI, 12.72-68.97; p<.001), and inversely associated with education (HR per 1-year increment, 0.84; 95% CI, 0.75-0.94; p=.003).
Radiotherapy administered as an adjuvant treatment for breast cancer elevates the risk of CVD. Preventive strategies should be directed to surveillance for radiotherapy-related CVD dysfunction. Efforts should also address lifestyle modifications and occupational rehabilitation in patients at a high risk of CVD.
本研究旨在探讨乳腺癌幸存者接受化疗和/或放疗与心血管疾病（CVD）风险之间的关联。
本研究基于 2002 年至 2012 年间在“Leumit”医疗保健基金中确诊为原发性非转移性浸润性乳腺癌的 2165 名女性乳腺癌幸存者，开展了一项病例-队列研究。在基线时抽取了 20%的随机亚队列，并确定了所有 CVD 病例。通过加权 Cox 比例风险模型估计了调整后的风险比（HR）及其 95%置信区间（CI）。
在 2165 名乳腺癌幸存者中，466 人在平均 5.7 年的随访期间发生 CVD。考虑到死亡作为竞争风险，13 年随访时 CVD 的累积发生率为 33.6%（95%CI，29.6-37.6%）。在 CVD 发病后收集的生活方式成分表明，CVD 患者的营养状况较差和身体活动不足更为普遍。多变量分析显示，与未接受放疗或化疗相比，单纯放疗（HR，2.94；95%CI，1.17-7.38；p=.022）、门诊就诊次数（每增加 10 次就诊 HR，1.86；95%CI，1.50-2.31；p<.001）、乳腺癌诊断和治疗期间就业状况的变化（从工作到失业 HR，29.62；95%CI，12.72-68.97；p<.001）与 CVD 呈正相关，而与教育程度呈负相关（每增加 1 年教育程度 HR，0.84；95%CI，0.75-0.94；p=.003）。
乳腺癌辅助放疗会增加 CVD 的风险。应针对放疗相关 CVD 功能障碍进行监测，制定预防策略。还应努力改善生活方式和职业康复，以降低 CVD 高危患者的风险。
