Calvillo-Argüelles Oscar, Thavendiranathan Paaladinesh, Chen Yue, Fang Jiming, Austin Peter C, Amir Eitan, Lee Douglas S, Abdel-Qadir Husam
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
ICES, Cardiovascular Research Program, Toronto, Ontario, Canada.
JACC CardioOncol. 2024 Nov 5;6(6):893-903. doi: 10.1016/j.jaccao.2024.08.008. eCollection 2024 Dec.
Cardiovascular disease (CVD) is associated with higher rates of incident cancer. Data are scarce regarding the association of incident CVD with oncologic outcomes after a cancer diagnosis.
This study sought to determine whether incident myocardial infarction (MI) or heart failure (HF) in breast cancer survivors is associated with oncologic outcomes.
This was a population-based cohort study in Ontario, Canada, using linked administrative data sets of women diagnosed with first breast cancer between April 1, 2007, and March 31, 2015. A landmark analysis was conducted of women alive 2 years after breast cancer diagnosis, aged ≥40 years, and with available staging data and without recurrent/distant disease or preceding CVD. The exposure was a composite of MI and/or HF after the landmark date. The outcomes were cancer mortality, new non-breast malignancy diagnosis, and new chemotherapy initiation. Multivariable cause-specific hazards regression was used to determine the association of incident MI/HF (time-varying exposure) with outcomes.
A total of 30,694 women (median age of 60 years) were included, of whom 1,346 developed incident MI/HF at a median of 3.9 years after the landmark date. At 5 years, the cumulative incidence was 5.9% (95% CI: 5.6%-6.1%) for cancer death, 4.3% (95% CI: 4.1%-4.6%) for non-breast malignancy, and 25.7% (95% CI: 25.2%-26.2%) for new chemotherapy. Incident MI/HF was associated with a higher hazard of cancer death (HR: 3.94; 95% CI: 3.38-4.59), non-breast malignancy (HR: 1.39; 95% CI: 1.06-1.82), and new chemotherapy (HR: 1.25; 95% CI: 1.02-1.53).
Incident MI and/or HF after breast cancer treatment are associated with higher hazards of adverse oncologic outcomes, highlighting the need to prioritize care for these patients.
心血管疾病（CVD）与较高的癌症发病率相关。关于癌症诊断后新发CVD与肿瘤学结局之间的关联，数据较为匮乏。
本研究旨在确定乳腺癌幸存者中发生的心肌梗死（MI）或心力衰竭（HF）是否与肿瘤学结局相关。
这是一项基于人群的队列研究，在加拿大安大略省进行，使用了2007年4月1日至2015年3月31日期间首次诊断为乳腺癌的女性的关联行政数据集。对乳腺癌诊断后存活2年、年龄≥40岁、有可用分期数据且无复发/远处疾病或既往CVD的女性进行了标志性分析。暴露因素为标志性日期后发生的MI和/或HF的复合情况。结局指标为癌症死亡率、新发非乳腺癌恶性肿瘤诊断和新的化疗开始情况。采用多变量特定病因风险回归分析来确定新发MI/HF（随时间变化的暴露因素）与结局之间的关联。
共纳入30694名女性（中位年龄60岁），其中1346名在标志性日期后中位3.9年发生了新发MI/HF。5年时，癌症死亡的累积发病率为5.9%（95%CI：5.6%-6.1%），非乳腺癌恶性肿瘤为4.3%（95%CI：4.1%-4.6%），新的化疗为25.7%（95%CI：25.2%-26.2%）。新发MI/HF与更高的癌症死亡风险（HR：3.94；95%CI：3.38-4.59）、非乳腺癌恶性肿瘤风险（HR：1.39；95%CI：1.06-1.82）和新的化疗风险（HR：1.25；95%CI：1.02-1.53）相关。
乳腺癌治疗后发生的新发MI和/或HF与不良肿瘤学结局的更高风险相关，这凸显了对这些患者进行优先护理的必要性。
