Matthews Anthony A, Peacock Hinton Sharon, Stanway Susannah, Lyon Alexander R, Smeeth Liam, Bhaskaran Krishnan, Lund Jennifer L
1Department of Non-Communicable Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
2Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
J Natl Compr Canc Netw. 2021 Jan 5;19(3):275-284. doi: 10.6004/jnccn.2020.7629.
It has been suggested that cardiovascular risks are increased in breast cancer survivors, but few studies have quantified the risks of a range of specific clinically important cardiovascular outcomes in detail.
Women aged >65 years with incident breast cancer from 2004 to 2013 in the SEER-Medicare linked database were matched with 5 cancer-free female counterparts (5:1 ratio). Prevalence of specific cardiovascular outcomes at baseline was measured, then Cox regression was used to calculate hazard ratios (HRs) and 95% confidence intervals for the risk of individual cardiovascular outcomes during follow-up. Modification of the effect was investigated by time since diagnosis, race/ethnicity, prior cardiovascular disease (CVD), and age.
In all, 91,473 women with breast cancer and 454,197 without breast cancer were included. Women with breast cancer had lower baseline prevalence of all CVDs. Compared with cancer-free controls, breast cancer survivors had substantially increased risks of deep vein thrombosis (adjusted HR, 1.67; 95% CI, 1.62-1.73; 386,484 person-years of follow-up) and pericarditis (HR, 1.43; 95% CI, 1.38-1.49; 390,776 person-years of follow-up); evidence of smaller increased risks of sudden cardiac arrest, arrhythmia, heart failure, and valvular heart disease (adjusted HRs ranging from 1.05-1.09, lower CI limits all ≥1); and evidence of lower risk of incident angina, myocardial infarction, revascularization, peripheral vascular disease, and stroke (adjusted HRs ranging from 0.89-0.98, upper CI limits all ≤1). Increased risks of arrhythmia, heart failure, pericarditis, and deep vein thrombosis persisted >5 years after cancer diagnosis.
Women with a history of breast cancer were at increased risk of several CVDs, persisting into survivorship. Monitoring and managing cardiovascular risk throughout the long-term follow-up of women diagnosed with breast cancer should be a priority.
有研究表明乳腺癌幸存者患心血管疾病的风险会增加，但很少有研究详细量化一系列特定的具有临床重要性的心血管疾病结局的风险。
在2004年至2013年期间，从监测、流行病学和最终结果（SEER）医保关联数据库中选取年龄大于65岁的新发乳腺癌女性患者，并与5名无癌症的女性对照者（比例为5:1）进行匹配。测量基线时特定心血管疾病结局的患病率，然后使用Cox回归计算随访期间个体心血管疾病结局风险的风险比（HR）和95%置信区间。通过诊断后的时间、种族/民族、既往心血管疾病（CVD）和年龄来研究效应的修正情况。
总共纳入了91473名乳腺癌女性患者和454197名无乳腺癌女性患者。乳腺癌女性患者所有心血管疾病的基线患病率较低。与无癌症对照组相比，乳腺癌幸存者发生深静脉血栓形成的风险大幅增加（调整后HR为1.67；95%置信区间为1.62 - 1.73；随访386484人年）和心包炎（HR为1.43；95%置信区间为1.38 - 1.49；随访390776人年）；有证据表明心脏骤停、心律失常、心力衰竭和心脏瓣膜病的风险增加幅度较小（调整后HR范围为1.05 - 1.09，下限均≥1）；有证据表明新发心绞痛、心肌梗死、血运重建、外周血管疾病和中风的风险较低（调整后HR范围为0.89 - 0.98，上限均≤1）。心律失常、心力衰竭、心包炎和深静脉血栓形成的风险增加在癌症诊断后持续超过5年。
有乳腺癌病史的女性患几种心血管疾病的风险增加，这种情况会持续到生存阶段。在对乳腺癌确诊女性进行长期随访过程中，监测和管理心血管疾病风险应成为首要任务。
