SUNY Downstate Medical Center, Brooklyn, New York.
Yale Medical Center, New Haven, Connecticut.
Am J Cardiol. 2021 May 15;147:116-121. doi: 10.1016/j.amjcard.2021.02.013. Epub 2021 Feb 20.
Breast cancer and cardiovascular-specific mortality are higher among blacks compared with whites, but disparities in cancer therapy-related adverse cardiovascular outcomes have not been well studied. We assessed for the contribution of race and socioeconomic status on cardiotoxicity among women with HER2-positive breast cancer. This retrospective cohort analysis studied women diagnosed with stage I-III HER2-positive breast cancer from 2004-2013. All underwent left ventricular ejection fraction assessment at baseline and at least one follow-up after beginning trastuzumab. Multivariable logistic regression was used to assess the association between race and socioeconomic status (SES) on cardiotoxicity, defined by clinical heart failure (New York Heart Association class III or IV) or asymptomatic left ventricular ejection fraction decline (absolute decrease ≥ 10% to < 53%, or ≥ 16%). Blacks had the highest prevalence of hypertension, diabetes, and increased BMI. Neighborhood-level SES measures including household income and educational attainment were lower for blacks compared with whites and others. The unadjusted cardiotoxicity risk was significantly higher in black compared with white women (OR, 2.10; 95% CI, 1.42 to 3.10). In a multivariable analysis, this disparity persisted after controlling for relevant cardiovascular risk factors (adjusted OR, 1.88; 95% CI, 1.25 to 2.84). Additional models adjusting for SES factors of income, educational attainment, and insurance status did not significantly alter the association between race and cardiotoxicity. In conclusion, black women are at increased risk of cardiotoxicity during HER2-targeted breast cancer therapy. Future etiologic analyses, particularly studies exploring biologic or genetic mechanisms, are needed to further elucidate and reduce racial disparities in cardiotoxicity.
黑人女性的乳腺癌和心血管疾病特异性死亡率高于白人，但癌症治疗相关不良心血管结局的差异尚未得到充分研究。我们评估了种族和社会经济地位对 HER2 阳性乳腺癌女性心脏毒性的影响。这项回顾性队列分析研究了 2004 年至 2013 年间诊断为 I-III 期 HER2 阳性乳腺癌的女性。所有患者在开始曲妥珠单抗治疗前和至少一次随访时均进行左心室射血分数评估。多变量逻辑回归用于评估种族和社会经济地位（SES）对心脏毒性的影响，心脏毒性定义为临床心力衰竭（纽约心脏协会 III 或 IV 级）或无症状左心室射血分数下降（绝对值下降≥10%至<53%，或≥16%）。黑人女性高血压、糖尿病和 BMI 增加的患病率最高。与白人女性和其他人相比，黑人女性的邻里 SES 衡量指标（包括家庭收入和教育程度）较低。未经调整的心脏毒性风险在黑人女性中明显高于白人女性（OR，2.10；95%CI，1.42 至 3.10）。在多变量分析中，在控制相关心血管危险因素后，这种差异仍然存在（调整后的 OR，1.88；95%CI，1.25 至 2.84）。进一步调整收入、教育程度和保险状况等 SES 因素的模型并未显著改变种族与心脏毒性之间的关联。总之，黑人女性在接受 HER2 靶向乳腺癌治疗期间发生心脏毒性的风险增加。需要进一步的病因分析，特别是探索生物学或遗传机制的研究，以阐明和减少心脏毒性的种族差异。
