Williams Karen Patricia, Lin Chyongchiou J, Felix Ashley S, Addison Daniel, Sheppard Vanessa B, Sutton Arnethea L, Mumma Michael T, Im Wansoo, Juarez Paul D, Hood Darryl B
Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States.
Martha S. Pitzer Center for Women, Children, and Youth, College of Nursing, The Ohio State University, Columbus, Ohio, United States.
J Natl Med Assoc. 2023 Oct;115(5):466-474. doi: 10.1016/j.jnma.2023.07.004. Epub 2023 Aug 7.
Little is known about whether a breast or gynecologic cancer diagnosis increases long-term cardiovascular disease (CVD) risk among Black females. The purpose of this study was to determine whether a breast or gynecologic cancer diagnosis is associated with CVD risk and identify determinants of subsequent CVD risk among Black females with an incident breast or gynecologic cancer diagnosis.
Using the Southern Community Cohort Study data from 2002-2016, this study was designed to analyze CVD incidence among Black females without cancer or CVD at enrollment. Cox proportional hazards regression models with or without covariates were used to explore the relationship between a breast or gynecologic cancer diagnosis and CVD risk among women without cancer as well as without CVD at enrollment (N=11,486). In addition, Cox proportional hazards regression models, excluding those who developed CVD before breast and gynecologic cancer diagnosis and those with other types of cancers, were used to assess determinants of CVD risk among breast and gynecologic cancer survivors.
Of 11,486 Black females, 531 developed a breast or gynecological cancer (4.6%) over a median follow-up of 140 months (interquartile range: 123-159 months). Compared to women without cancer, women with a breast or gynecological cancers had greater than 20% higher risk of incident CVD during the follow-up period. Without adjusting for covariates, positive association between CVD risk and breast cancer was observed (hazard ratio (HR) = 1.24; 95% confidence interval (CI) = 1.11 - 1.39; p < 0.001); as well as between CVD risk and a gynecological cancer (HR = 1.23; 95% CI = 1.03 - 1.46; p = 0.021). Yet, after adjusting for covariates, CVD risk was only significantly associated with breast cancer (p = 0.001) but not gynecologic cancer. In cancer case-only analyses, CVD risk was significantly increasing with age (p < 0.05).
Like study populations of predominantly White females, our results suggest that, adjusting for covariates, Black females possess a higher risk of CVD following a breast cancer diagnosis compared to women who did not develop breast cancer. Our results suggest a need for active CVD surveillance in the cancer survivorship phase.
关于乳腺癌或妇科癌症诊断是否会增加黑人女性患长期心血管疾病（CVD）的风险，目前所知甚少。本研究的目的是确定乳腺癌或妇科癌症诊断是否与心血管疾病风险相关，并确定初次诊断为乳腺癌或妇科癌症的黑人女性后续心血管疾病风险的决定因素。
利用2002 - 2016年南方社区队列研究的数据，本研究旨在分析入组时无癌症或心血管疾病的黑人女性的心血管疾病发病率。使用带有或不带有协变量的Cox比例风险回归模型，探讨无癌症且入组时无心血管疾病的女性（N = 11486）中乳腺癌或妇科癌症诊断与心血管疾病风险之间的关系。此外，使用Cox比例风险回归模型，排除在乳腺癌和妇科癌症诊断前已患心血管疾病的患者以及患有其他类型癌症的患者，来评估乳腺癌和妇科癌症幸存者心血管疾病风险的决定因素。
在11486名黑人女性中，531人（4.6%）在中位随访140个月（四分位间距：123 - 159个月）期间患了乳腺癌或妇科癌症。与无癌症的女性相比，患有乳腺癌或妇科癌症的女性在随访期间发生心血管疾病的风险高出20%以上。在未调整协变量的情况下，观察到心血管疾病风险与乳腺癌之间存在正相关（风险比（HR）= 1.24；95%置信区间（CI）= 1.11 - 1.39；p < 0.001）；心血管疾病风险与妇科癌症之间也存在正相关（HR = 1.23；95% CI = 1.03 - 1.46；p = 0.021）。然而，在调整协变量后，心血管疾病风险仅与乳腺癌显著相关（p = 0.001），而与妇科癌症无关。在仅针对癌症病例的分析中，心血管疾病风险随年龄显著增加（p < 0.05）。
与主要为白人女性的研究人群一样，我们的结果表明，在调整协变量后，与未患乳腺癌的女性相比，黑人女性在诊断乳腺癌后患心血管疾病的风险更高。我们的结果表明在癌症 survivorship 阶段需要积极进行心血管疾病监测。
