乳腺癌幸存者的心血管结局：系统评价和荟萃分析。

Cardiovascular outcomes in breast cancer survivors: a systematic review and meta-analysis.

机构信息

Department of Propedeutics of Internal Disease, Semey Medical University, Semey, Kazakhstan.

Keele Cardiovascular Research Group, Center for Prognosis Research, Keele University, Stoke on Trent, Keele, UK.

出版信息

Eur J Prev Cardiol. 2023 Dec 21;30(18):2018-2031. doi: 10.1093/eurjpc/zwad243.

DOI:10.1093/eurjpc/zwad243

PMID:37499186

Abstract

AIMS

It is unclear whether the future risk of cardiovascular events in breast cancer (Bc) survivors is greater than in the general population. This meta-analysis quantifies the risk of cardiovascular disease development in Bc patients, compared to the risk in a general matched cancer-free population, and reports the incidence of cardiovascular events in patients with Bc.

METHODS AND RESULTS

We searched PubMed, Scopus, and Web of Science databases (up to 23 March 2022) for observational studies and post hoc analyses of randomized controlled trials. Cardiovascular death, heart failure (HF), atrial fibrillation (AF), coronary artery disease (CAD), myocardial infarction (MI), and stroke were the individual endpoints for our meta-analysis. We pooled incidence rates (IRs) and risk in hazard ratios (HRs), using random-effects meta-analyses. Heterogeneity was reported through the I2 statistic, and publication bias was examined using funnel plots and Egger's test in the meta-analysis of risk. One hundred and forty-two studies were identified in total, 26 (836 301 patients) relevant to the relative risk and 116 (2 111 882 patients) relevant to IRs. Compared to matched cancer-free controls, Bc patients had higher risk for cardiovascular death within 5 years of cancer diagnosis [HR = 1.09; 95% confidence interval (CI): 1.07, 1.11], HF within 10 years (HR = 1.21; 95% CI: 1.1, 1.33), and AF within 3 years (HR = 1.13; 95% CI: 1.05, 1.21). The pooled IR for cardiovascular death was 1.73 (95% CI 1.18, 2.53), 4.44 (95% CI 3.33, 5.92) for HF, 4.29 (95% CI 3.09, 5.94) for CAD, 1.98 (95% CI 1.24, 3.16) for MI, 4.33 (95% CI 2.97, 6.30) for stroke of any type, and 2.64 (95% CI 2.97, 6.30) for ischaemic stroke.

CONCLUSION

Breast cancer exposure was associated with the increased risk for cardiovascular death, HF, and AF. The pooled incidence for cardiovascular endpoints varied depending on population characteristics and endpoint studied.

REGISTRATION

CRD42022298741.

摘要

目的

目前尚不清楚乳腺癌（BC）幸存者未来发生心血管事件的风险是否高于一般人群。本荟萃分析量化了 BC 患者发生心血管疾病的风险与一般无癌症匹配人群的风险相比，同时报告了 BC 患者的心血管事件发生率。

方法和结果

我们检索了 PubMed、Scopus 和 Web of Science 数据库（截至 2022 年 3 月 23 日），以获取观察性研究和随机对照试验的事后分析。心血管死亡、心力衰竭（HF）、心房颤动（AF）、冠状动脉疾病（CAD）、心肌梗死（MI）和中风是本荟萃分析的个别终点。我们使用随机效应荟萃分析汇总了发病率（IRs）和风险的风险比（HRs）。通过 I2 统计量报告了异质性，并使用漏斗图和 Egger 检验在风险荟萃分析中检查了发表偏倚。总共确定了 142 项研究，其中 26 项（836301 例患者）与相对风险相关，116 项（2111882 例患者）与 IRs 相关。与匹配的无癌症对照组相比，BC 患者在癌症诊断后 5 年内发生心血管死亡的风险更高[HR=1.09；95%置信区间（CI）：1.07，1.11]，10 年内发生心力衰竭的风险更高[HR=1.21；95%CI：1.1，1.33]，3 年内发生 AF 的风险更高[HR=1.13；95%CI：1.05，1.21]。心血管死亡的汇总 IR 为 1.73（95%CI 1.18，2.53），HF 为 4.44（95%CI 3.33，5.92），CAD 为 4.29（95%CI 3.09，5.94），MI 为 1.98（95%CI 1.24，3.16），任何类型中风为 4.33（95%CI 2.97，6.30），缺血性中风为 2.64（95%CI 2.97，6.30）。