Yang Shuang, Lou Xiwei, Ahmed Mustafa M, Kimmel Stephen E, Daily Karen C, George Thomas J, Pepine Carl J, Bian Jiang, Braithwaite Dejana, Zhang Dongyu, Guo Yi
Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, Florida, USA.
Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA.
JACC CardioOncol. 2025 Feb;7(2):110-121. doi: 10.1016/j.jaccao.2024.10.012. Epub 2025 Jan 7.
Prior research suggests that breast cancer patients with a high burden of frailty may face an increased risk of cardiotoxicity.
This study sought to examine the association between frailty and cardiotoxicity rates in female breast cancer patients receiving adjuvant therapy after surgery.
We analyzed data from the OneFlorida+ clinical research network, focusing on breast cancer patients treated with adjuvant chemotherapy and targeted therapy from 2012 to 2022. Cardiovascular rates during adjuvant treatments were calculated based on pre-existing frailty, measured using the cumulative deficit frailty index (electronic health record frailty index). We employed multivariable Gray's method to examine the association between frailty with cardiotoxicity.
The final cohort included 2,050 patients (mean age 50.6 years), with 415 (20.2%) experiencing nonfatal adverse cardiovascular events after adjuvant therapy. The incidence of adverse cardiovascular events was 17.8% in robust, 23.2% in prefrail, and 29.4% in frail patients. In multivariable analysis, prefrail (adjusted subdistribution HR [sHR]: 1.35; 95% CI: 1.06-1.71; P = 0.015) and frail (adjusted sHR: 1.70; 95% CI: 1.11-2.61; P = 0.015) patients had a higher likelihood of experiencing adverse cardiovascular events compared with robust patients. Among non-Hispanic White and Black patients, prefrail (adjusted sHR: 1.48; 95% CI: 1.04-2.11; P = 0.031; and adjusted sHR: 1.59; 95% CI: 1.06-2.37; P = 0.024, respectively) and frail (adjusted sHR: 1.96; 95% CI: 1.10-3.50; P = 0.022; and adjusted sHR: 2.13; 95% CI: 1.11-4.10; P = 0.023, respectively) patients were more likely to experience adverse cardiovascular events compared with robust patients. No significant differences were observed in other racial/ethnic groups.
These findings highlight the need for close monitoring of cardiotoxicity in frail breast cancer patients undergoing adjuvant treatments to improve cardiovascular risk management.
先前的研究表明，体弱负担较重的乳腺癌患者可能面临更高的心脏毒性风险。
本研究旨在探讨接受术后辅助治疗的女性乳腺癌患者的体弱与心脏毒性发生率之间的关联。
我们分析了来自OneFlorida+临床研究网络的数据，重点关注2012年至2022年接受辅助化疗和靶向治疗的乳腺癌患者。辅助治疗期间的心血管发生率是根据预先存在的体弱情况计算的，体弱情况使用累积缺陷体弱指数（电子健康记录体弱指数）进行测量。我们采用多变量Gray方法来研究体弱与心脏毒性之间的关联。
最终队列包括2050名患者（平均年龄50.6岁），其中415名（20.2%）在辅助治疗后发生了非致命性不良心血管事件。健康患者的不良心血管事件发生率为17.8%，准体弱患者为23.2%，体弱患者为29.4%。在多变量分析中，与健康患者相比，准体弱患者（调整后的亚分布风险比[sHR]：1.35；95%置信区间：1.06-1.71；P = 0.015）和体弱患者（调整后的sHR：1.70；95%置信区间：1.11-2.61；P = 0.015）发生不良心血管事件的可能性更高。在非西班牙裔白人和黑人患者中，与健康患者相比，准体弱患者（调整后的sHR分别为：1.48；95%置信区间：1.04-2.11；P = 0.031；和调整后的sHR：1.59；95%置信区间：1.06-2.37；P = 0.024）和体弱患者（调整后的sHR分别为：1.96；95%置信区间：1.10-3.50；P = 0.022；和调整后的sHR：
