Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, P.O. Box 980149, Richmond, VA, 23219, USA.
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA.
Breast Cancer Res Treat. 2021 Aug;188(3):769-778. doi: 10.1007/s10549-021-06202-x. Epub 2021 Apr 2.
Racial disparities in cardiovascular disease and cardiac dysfunction exist amongst breast cancer survivors. This study examined the prevalence of cardioprotective medication use in survivors and identified factors associated with use by race.
The analysis included women enrolled in the Women's Hormonal Initiation and Persistence study, a longitudinal observational trial of breast cancer survivors. The study outcome, angiotensin converting enzyme inhibitor (ACEi) or ß-Blocker (BB) use, were ascertained from pharmacy records. Demographic, psychosocial, healthcare, and quality of life factors were collected from surveys and clinical data were abstracted from medical records. Bivariate associations by race and ACEi/BB use were tested using chi square and t tests; logistic regression evaluated multivariable-adjusted associations.
Of the 246 survivors in the sample, 33.3% were Black and most were < 65 years of age (58.4%). Most survivors were hypertensive (57.6%) and one-third received ACEi/BBs. In unadjusted analysis, White women (vs. Black) (OR 0.33, 95% 0.19-0.58) and women with higher ratings of functional wellbeing (OR 0.94, 95% 0.89-0.99) were less likely to use ACEi/BBs. Satisfaction with provider communication was only significant for White women. In multivariable-adjusted analysis, ACEi/BB use did not differ by race. Correlates of ACEi/BB use included hypertension among all women and older age for Black women only.
After adjusting for age and comorbidities, no differences by race in ACEi/BB use were observed. Hypertension was a major contributor of ACEi/BB use in BC survivors.
心血管疾病和心脏功能障碍在乳腺癌幸存者中存在种族差异。本研究调查了幸存者中使用心脏保护药物的流行情况，并确定了与种族相关的使用因素。
该分析包括参加女性激素启动和维持研究的女性，这是一项对乳腺癌幸存者的纵向观察性试验。从药房记录中确定研究结果，即血管紧张素转换酶抑制剂（ACEi）或β-受体阻滞剂（BB）的使用情况。从调查中收集人口统计学、心理社会、医疗保健和生活质量因素，并从病历中提取临床数据。使用卡方检验和 t 检验测试种族和 ACEi/BB 使用之间的双变量关联；逻辑回归评估多变量调整后的关联。
在样本中的 246 名幸存者中，33.3%是黑人，大多数年龄<65 岁（58.4%）。大多数幸存者患有高血压（57.6%），三分之一接受 ACEi/BB 治疗。在未调整分析中，白人女性（与黑人女性相比）（OR 0.33，95%置信区间 0.19-0.58）和功能健康评分较高的女性（OR 0.94，95%置信区间 0.89-0.99）不太可能使用 ACEi/BB。与提供者沟通的满意度仅对白人女性有意义。在多变量调整分析中，ACEi/BB 的使用与种族无关。ACEi/BB 使用的相关因素包括所有女性的高血压和黑人女性仅年龄较大。
在调整年龄和合并症后，种族之间 ACEi/BB 使用没有差异。高血压是 BC 幸存者使用 ACEi/BB 的主要原因。
