Chronic Disease Research Institute, The Children's Hospital, and National Clinical Research Center for Child Health, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, China.
Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Hangzhou, China.
JAMA Netw Open. 2023 Jul 3;6(7):e2323752. doi: 10.1001/jamanetworkopen.2023.23752.
A large proportion of patients with breast cancer concomitantly use adjuvant hormone therapy and cardiovascular therapy.
To examine the relative risk of discontinuing cardiovascular therapy during the periods before and after discontinuation of adjuvant hormone therapy.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study included all women aged 40 to 74 years in Stockholm, Sweden, who were diagnosed with breast cancer and concomitantly using adjuvant hormone therapy and cardiovascular therapy. Patients were enrolled from July 1, 2005, to August 31, 2020, with a median follow-up of 7.2 years. Data were analyzed from November 3, 2021, to May 12, 2022.
Discontinuation of adjuvant hormone therapy.
The main outcome was discontinuation of cardiovascular therapy (cardiovascular drugs, statins, or aspirin) within 1 year before and after discontinuation of adjuvant hormone therapy. Incidence rate ratios with 95% CIs were estimated using Poisson regression. Furthermore, hazard ratios (HRs) with 95% CIs for cause-specific mortality were estimated using Cox proportional hazards regression models, comparing those who discontinued and continued adjuvant hormone therapy.
A total of 5493 patients with breast cancer who concomitantly used cardiovascular therapy were identified; 1811 who discontinued adjuvant hormone therapy were individually matched to 1 patient each who continued therapy by year of breast cancer diagnosis, age at diagnosis, and use of the same cardiovascular therapy. Most patients (4070 [74.1%]) were aged 60 years or older at diagnosis. At the time when patients discontinued adjuvant hormone therapy, 248 (12.2%) concomitantly discontinued their cardiovascular therapy. During follow-up, a higher discontinuation rate of cardiovascular therapy was also observed among those who discontinued adjuvant hormone therapy. Consistently, adjuvant hormone therapy discontinuation was associated with an increased risk of death not only due to breast cancer (HR, 1.43; 95 CI%, 1.01-2.01) but also cardiovascular disease (HR, 1.79; 95 CI%, 1.15-2.81). Stratifying the analyses on baseline type of adjuvant hormone therapy yielded consistent results.
In this cohort study of data from population-based registers in Sweden, patients who discontinued adjuvant hormone therapy were also more likely to discontinue cardiovascular therapy, especially at the time when they discontinued adjuvant hormone therapy. These findings suggest that clinicians should shift from single- to multiple-disease focus to prevent discontinuation of therapies for other diseases among patients with breast cancer.
很大一部分乳腺癌患者同时使用辅助激素治疗和心血管治疗。
研究在停止辅助激素治疗前后期间停止心血管治疗的相对风险。
设计、设置和参与者：这项基于人群的队列研究包括瑞典斯德哥尔摩所有年龄在 40 至 74 岁之间、被诊断患有乳腺癌且同时使用辅助激素治疗和心血管治疗的女性。患者于 2005 年 7 月 1 日至 2020 年 8 月 31 日入组，中位随访时间为 7.2 年。数据于 2021 年 11 月 3 日至 2022 年 5 月 12 日进行分析。
停止辅助激素治疗。
主要结局是在停止辅助激素治疗前 1 年和后 1 年内停止心血管治疗（心血管药物、他汀类药物或阿司匹林）。使用泊松回归估计发生率比率及其 95%置信区间。此外，使用 Cox 比例风险回归模型估计了特定原因死亡率的危险比（HR）及其 95%置信区间，比较了那些停止和继续接受辅助激素治疗的患者。
共确定了 5493 名同时使用心血管治疗的乳腺癌患者；1811 名停止辅助激素治疗的患者，根据乳腺癌诊断年份、诊断时的年龄和使用相同的心血管治疗，每人分别匹配 1 名继续接受治疗的患者。大多数患者（4070 [74.1%]）在诊断时年龄在 60 岁或以上。当患者停止辅助激素治疗时，有 248 名（12.2%）同时停止了他们的心血管治疗。在随访期间，停止辅助激素治疗的患者中，心血管治疗的停药率也更高。一致的是，停止辅助激素治疗与乳腺癌（HR，1.43；95%CI%，1.01-2.01）和心血管疾病（HR，1.79；95%CI%，1.15-2.81）导致的死亡风险增加有关。对基线辅助激素治疗类型进行分层分析得出了一致的结果。
在这项来自瑞典基于人群登记的队列研究中，停止辅助激素治疗的患者也更有可能停止心血管治疗，尤其是在他们停止辅助激素治疗的时候。这些发现表明，临床医生应该从单一疾病重点转向多疾病重点，以防止乳腺癌患者停止治疗其他疾病。
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