Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland.
Cancer. 2021 Aug 1;127(15):2614-2622. doi: 10.1002/cncr.33530. Epub 2021 Apr 1.
Women who have coexisting comorbidities at the time of breast cancer diagnosis have an increased risk of breast cancer and overall mortality. However, the associations between newly diagnosed comorbidities and the risk of cardiovascular disease (CVD) mortality among these patients have not been examined.
The authors compared the associations between coexisting and newly diagnosed CVD, type 2 diabetes, and hypertension and the risk of CVD mortality among patients with breast cancer identified in the Missouri Cancer Registry. In total, 33,099 women who had incident invasive breast cancer with inpatient and outpatient hospital discharge data within 2 years after breast cancer diagnosis were included: 9.3% were Black. Subdistribution hazard ratios (sdHRs) and 95% CIs were calculated for the risk of CVD-related mortality using adjusted Cox proportional hazards regression models, accounting for a competing risk of breast cancer deaths.
Within the first 2 years after breast cancer, the most reported newly diagnosed comorbidity was hypertension (9%), followed by CVD (4%), and type 2 diabetes (2%). CVD mortality was increased in women who had newly diagnosed CVD (sdHR, 2.49; 95% CI, 2.09-2.99), diabetes (sdHR, 2.16; 95% CI, 1.68-2.77), or hypertension (sdHR, 2.06; 95% CI, 1.71-2.48) compared with women who did not have these conditions. Associations were similar by race. The strongest association was among women who received chemotherapy and then developed CVD (sdHR, 3.82; 95% CI, 2.69-5.43).
Monitoring for diabetes, hypertension, and CVD from the time of breast diagnosis may reduce CVD mortality.
患有乳腺癌诊断时并存合并症的女性患乳腺癌和总死亡率的风险增加。然而，新诊断出的合并症与这些患者心血管疾病（CVD）死亡率之间的关联尚未得到研究。
作者比较了在密苏里癌症登记处发现的患有乳腺癌的患者中并存和新诊断的 CVD、2 型糖尿病和高血压与 CVD 死亡率风险之间的关联。共有 33099 名女性患有浸润性乳腺癌，在乳腺癌诊断后 2 年内有住院和门诊住院数据：9.3%为黑人。使用调整后的 Cox 比例风险回归模型计算了 CVD 相关死亡率的风险比（sdHR）和 95%CI，考虑到乳腺癌死亡的竞争风险。
在乳腺癌后的头 2 年内，报告的新诊断合并症最多的是高血压（9%），其次是 CVD（4%）和 2 型糖尿病（2%）。与没有这些疾病的女性相比，患有新诊断的 CVD（sdHR，2.49；95%CI，2.09-2.99）、糖尿病（sdHR，2.16；95%CI，1.68-2.77）或高血压（sdHR，2.06；95%CI，1.71-2.48）的女性 CVD 死亡率增加。种族之间的关联相似。最强的关联是在接受化疗后发生 CVD 的女性中（sdHR，3.82；95%CI，2.69-5.43）。
从乳腺癌诊断时开始监测糖尿病、高血压和 CVD，可能会降低 CVD 死亡率。
