See the Notes section for the full list of authors' affiliations.
J Natl Cancer Inst. 2019 Aug 1;111(8):854-862. doi: 10.1093/jnci/djy218.
Data are limited regarding the risk of heart failure (HF) requiring hospital-based care after early stage breast cancer (EBC) and its relationship to other types of cardiovascular disease (CVD).
We conducted a population-based, retrospective cohort study of EBC patients (diagnosed April 1, 2005-March 31, 2015) matched 1:3 on birth-year to cancer-free control subjects. We identified hospitalizations and emergency department visits for CVD through March 31, 2017. We used cumulative incidence function curves to estimate CVD incidence and cause-specific regression models to compare CVD rates between cohorts. All statistical tests were two-sided.
We identified 78 318 EBC patients and 234 954 control subjects. The 10-year incidence of CVD hospitalization was 10.8% (95% confidence interval [CI] = 10.5% to 11.1%) after EBC and 9.1% (95% CI = 8.9% to 9.2%) in control subjects. Ischemic heart disease was the most common reason for CVD hospitalization after EBC. After regression adjustment, the relative rates compared with control subjects remained statistically significantly elevated for HF (hazard ratio [HR] = 1.21, 95% CI = 1.14 to 1.29, P < .001), arrhythmias (HR = 1.31, 95% CI = 1.23 to 1.39, P < .001), and cerebrovascular disease (HR 1.10, 95% CI = 1.04 to 1.17, P = .002) hospitalizations. It was rare for HF hospital presentations (2.9% of cases) to occur in EBC patients without recognized risk factors (age >60 years, hypertension, diabetes, prior CVD). Anthracycline and/or trastuzumab were used in 28 950 EBC patients; they were younger than the overall cohort with lower absolute rates of CVD, hypertension, and diabetes. However, they had higher relative rates of CVD in comparison with age-matched control subjects.
Atherosclerotic diagnoses, rather than HF, were the most common reasons for CVD hospitalization after EBC. HF hospital presentations were often preceded by risk factors other than chemotherapy, suggesting potential opportunities for prevention.
有关早期乳腺癌（EBC）后需要住院治疗的心力衰竭（HF）风险及其与其他类型心血管疾病（CVD）的关系的数据有限。
我们进行了一项基于人群的回顾性队列研究，纳入了 2005 年 4 月 1 日至 2015 年 3 月 31 日期间诊断为 EBC 的患者，并按出生年份与无癌症对照组进行了 1:3 的匹配。我们通过 2017 年 3 月 31 日确定了 CVD 的住院和急诊就诊情况。我们使用累积发病率函数曲线来估计 CVD 的发病率，并使用特定病因回归模型来比较队列之间的 CVD 发生率。所有统计检验均为双侧检验。
我们共确定了 78318 例 EBC 患者和 234954 例对照组。EBC 后 CVD 住院的 10 年发病率为 10.8%（95%置信区间[CI]为 10.5%至 11.1%），对照组为 9.1%（95%CI为 8.9%至 9.2%）。缺血性心脏病是 EBC 后 CVD 住院的最常见原因。在回归调整后，与对照组相比，HF（风险比[HR] = 1.21，95%CI = 1.14 至 1.29，P <.001）、心律失常（HR = 1.31，95%CI = 1.23 至 1.39，P <.001）和脑血管疾病（HR = 1.10，95%CI = 1.04 至 1.17，P =.002）的住院率仍有统计学意义的升高。在没有已知危险因素（年龄>60 岁、高血压、糖尿病、既往 CVD）的 EBC 患者中，HF 住院表现（占病例的 2.9%）很少见。28950 例 EBC 患者使用了蒽环类药物和/或曲妥珠单抗；他们比整个队列年轻，CVD、高血压和糖尿病的绝对发生率较低。然而，与年龄匹配的对照组相比，他们的 CVD 相对发生率更高。
与 EBC 后 CVD 住院最常见的原因是动脉粥样硬化诊断，而不是 HF。HF 住院表现通常先于化疗以外的其他危险因素，这表明有潜在的预防机会。
