Huang Yuhan, Kwan Marilyn L, Heckbert Susan R, Smith Nicholas L, Othus Megan, Laurent Cecile A, Roh Janise M, Rillamas-Sun Eileen, Lee Valerie S, Kolevska Tatjana, Cheng Richard K, Irribarren Carlos, Nguyen-Huynh Mai, Hershman Dawn L, Kushi Lawrence H, Greenlee Heather
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.
Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, United States.
JNCI Cancer Spectr. 2025 Jan 3;9(1). doi: 10.1093/jncics/pkaf009.
There are limited data on duration of aromatase inhibitor (AI) and cardiovascular disease (CVD) risk in breast cancer (BC) survivors. We examined the risk of CVD and mortality associated with the duration of AI use in postmenopausal women with early stage hormone receptor-positive BC.
Postmenopausal women diagnosed with hormone receptor-positive BC (n = 5853) who used an AI were included. Cause-specific hazards models estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for associations between AI use duration (short term: >0 and <2 years; intermediate term: ≥2 and <5 years; long term: ≥5 years) and CVD and mortality outcomes. The landmark method was used to avoid immortal time bias; the selected landmark was 6 years after BC diagnosis.
Anastrozole was the AI predominantly prescribed (95.4%). Over a median follow-up of 3 years for women who survived 6 years after BC diagnosis, a lower risk of stroke was observed in intermediate-term AI users (HR = 0.60, 95% CI = 0.37 to 0.96) and long-term AI users (HR = 0.51, 95% CI = 0.30 to 0.85), than in short-term AI users. The longer duration of AI use was also associated with lower risk of all-cause mortality and non-CVD-related mortality. In addition, long-term AI users were at 37% lower risk of CVD-related mortality than short-term AI users. No statistically significant differences were observed in risks of major adverse cardiovascular events, ischemic heart disease, and heart failure across the 3 groups.
Among postmenopausal women with early stage hormone receptor-positive BC who survived 6 years after BC diagnosis, longer duration of AI use was not associated with elevated CVD risk.
关于芳香化酶抑制剂（AI）的使用时长与乳腺癌（BC）幸存者心血管疾病（CVD）风险的数据有限。我们研究了早期激素受体阳性BC的绝经后女性中，AI使用时长与CVD及死亡率的相关性。
纳入使用AI的绝经后激素受体阳性BC女性患者（n = 5853）。特定病因风险模型估计AI使用时长（短期：>0且<2年；中期：≥2且<5年；长期：≥5年）与CVD及死亡结局之间关联的风险比（HR）和95%置信区间（CI）。采用标志性方法避免不朽时间偏倚；选定的标志性时间为BC诊断后6年。
阿那曲唑是主要开具的AI（95.4%）。在BC诊断后存活6年的女性中，中位随访3年，中期AI使用者（HR = 0.60，95%CI = 0.37至0.96）和长期AI使用者（HR = 0.51，95%CI = 0.30至0.85）的卒中风险低于短期AI使用者。AI使用时间越长，全因死亡率和非CVD相关死亡率的风险也越低。此外，长期AI使用者的CVD相关死亡率比短期AI使用者低37%。三组在主要不良心血管事件、缺血性心脏病和心力衰竭风险方面未观察到统计学显著差异。
在BC诊断后存活6年的早期激素受体阳性BC绝经后女性中，AI使用时间较长与CVD风险升高无关。
