Subramaniam Shridevi, Kong Yek-Ching, Zaharah Hafizah, Uiterwaal Cuno S P M, Richard Andrea, Taib Nur Aishah, Deniel Azura, Chee Kok-Han, Bustamam Ros Suzanna, See Mee-Hoong, Fong Alan, Yip Cheng-Har, Bhoo-Pathy Nirmala
Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
Centre of Clinical Epidemiology, Institute for Clinical Research, National Institutes of Health, Setia Alam, 40170 Shah Alam, Malaysia.
Ecancermedicalscience. 2021 Sep 21;15:1293. doi: 10.3332/ecancer.2021.1293. eCollection 2021.
To measure the baseline prevalence of cardiovascular disease (CVD), its modifiable and non-modifiable risk factors in breast cancer patients, and determine their association with adjuvant treatment decision-making.
From 2016 to 2017, 2,127 women newly-diagnosed with breast cancer were prospectively recruited. Participants' cardiovascular biomarkers were measured prior to adjuvant treatment decision-making. Clinical data and medical histories were obtained from hospital records. Adjuvant treatment decisions were collated 6-8 months after recruitment. A priori risk of cardiotoxicity was predicted using the Cardiotoxicity Risk Score.
Mean age was 54 years. Eighty-five patients had pre-existing cardiac diseases and 30 had prior stroke. Baseline prevalence of hypertension was 47.8%. Close to 20% had diabetes mellitus, or were obese. Dyslipidaemia was present in 65.3%. The proportion of women presenting with ≥2 modifiable CVD risk factors at initial cancer diagnosis was substantial, irrespective of age. Significant ethnic variations were observed. Multivariable analyses showed that pre-existing CVD was consistently associated with lower administration of adjuvant breast cancer therapies (odds ratio for chemotherapy: 0.32, 95% confidence interval: 0.17-0.58). However, presence of multiple risk factors of CVD did not appear to influence adjuvant treatment decision-making. In this study, 63.6% of patients were predicted to have high risks of developing cardiotoxicities attributed to a high baseline burden of CVD risk factors and anthracycline administration.
While recent guidelines recommend routine assessment of cardiovascular comorbidities in cancer patients prior to initiation of anticancer therapies, this study highlights the prevailing gap in knowledge on how such data may be used to optimise cancer treatment decision-making.
测量乳腺癌患者心血管疾病（CVD）的基线患病率、其可改变和不可改变的危险因素，并确定它们与辅助治疗决策的关联。
2016年至2017年，前瞻性招募了2127名新诊断为乳腺癌的女性。在辅助治疗决策前测量参与者的心血管生物标志物。从医院记录中获取临床数据和病史。招募后6 - 8个月整理辅助治疗决策。使用心脏毒性风险评分预测心脏毒性的先验风险。
平均年龄为54岁。85名患者有既往心脏病史，30名有既往中风史。高血压的基线患病率为47.8%。近20%患有糖尿病或肥胖。血脂异常的患病率为65.3%。无论年龄如何，在初次癌症诊断时出现≥2种可改变的CVD危险因素的女性比例都很高。观察到显著的种族差异。多变量分析表明，既往存在的CVD与辅助性乳腺癌治疗的较低给药率持续相关（化疗的优势比：0.32，95%置信区间：0.17 - 0.58）。然而，CVD多种危险因素的存在似乎并未影响辅助治疗决策。在本研究中，63.6%的患者因CVD危险因素的高基线负担和蒽环类药物的使用而被预测有发生心脏毒性的高风险。
虽然最近的指南建议在开始抗癌治疗前对癌症患者进行心血管合并症的常规评估，但本研究强调了在如何利用此类数据优化癌症治疗决策方面存在的普遍知识差距。
