Zhang Lili, Song Justin, Hanif Waqas, Clark Rachel, Haroun Magued, McNaughton Caroline, Slipczuk Leandro, Garcia Mario J, Pu Min, Gongora Carlos A, Neilan Tomas G, Makower Della, Hall Charles B, Chambers Earle C, Rodriguez Carlos J
Division of Cardiology, Department of Medicine, Montefiore Medical Center Albert Einstein College of Medicine Bronx NY USA.
Department of Medicine, Montefiore Medical Center Albert Einstein College of Medicine Bronx NY USA.
J Am Heart Assoc. 2025 Apr;14(7):e037780. doi: 10.1161/JAHA.124.037780. Epub 2025 Mar 19.
Cardiotoxicity in patients with cancer treated with anthracyclines is associated with increased morbidity and mortality. We aimed to examine the incidence of and risk factors for cardiotoxicity in a racially and ethnically diverse cohort with cancer treated with anthracyclines.
We included consecutive adult patients who underwent anthracycline-based chemotherapy from 2016 to 2019 for any type of cancer. The end point was the development of cardiotoxicity (defined as clinical heart failure or drop in left ventricular ejection fraction ≥10% to ≤50%).
A total of 743 individuals were included (28.0% Non-Hispanic [NH] White, 30.5% NH Black, 38.5% Hispanic, 3.0% Asian). Hypertension, diabetes, hyperlipidemia, obesity, and low socioeconomic status were more common in NH Black and Hispanic individuals. During a median follow-up of 21 months, 98 individuals (13.2%) developed cardiotoxicity. The incidence of cardiotoxicity was significantly higher in NH Black (16.3%), Hispanic (14.7%) and Asian (18.2%) individuals than in NH White (7.2%) individuals (=0.024). After adjusting for cardiovascular risk factors, socioeconomic status score, anthracycline dose, baseline left ventricular ejection fraction, and cancer type, being NH Black (hazard ratio [HR], 2.62 [95% CI, 1.23-5.56]) or Hispanic (HR, 2.37 [95% CI, 1.11-5.07]) was independently associated with a higher risk of cardiotoxicity. NH Black and Hispanic individuals had a greater decline in left ventricular ejection fraction compared with NH White and Asian counterparts. The associations between baseline characteristics and incident cardiotoxicity were similar across different racial and ethnic groups.
In a large retrospective multiracial and ethnic cohort treated with anthracyclines, NH Black, Hispanic, and Asian individuals had an increased risk of cardiotoxicity compared with their NH White counterparts.
接受蒽环类药物治疗的癌症患者发生心脏毒性与发病率和死亡率增加相关。我们旨在研究在接受蒽环类药物治疗的种族和民族多样化的癌症队列中，心脏毒性的发生率及危险因素。
我们纳入了2016年至2019年期间因任何类型癌症接受基于蒽环类药物化疗的连续成年患者。终点是心脏毒性的发生（定义为临床心力衰竭或左心室射血分数下降≥10%至≤50%）。
共纳入743人（28.0%非西班牙裔白人、30.5%非西班牙裔黑人、38.5%西班牙裔、3.0%亚裔）。高血压、糖尿病、高脂血症、肥胖和低社会经济地位在非西班牙裔黑人和西班牙裔个体中更为常见。在中位随访21个月期间，98人（13.2%）发生了心脏毒性。非西班牙裔黑人（16.3%）、西班牙裔（14.7%）和亚裔（18.2%）个体的心脏毒性发生率显著高于非西班牙裔白人（7.2%）个体（P = 0.024）。在调整心血管危险因素、社会经济地位评分、蒽环类药物剂量、基线左心室射血分数和癌症类型后，非西班牙裔黑人（风险比[HR]，2.62[95%置信区间，1.23 - 5.56]）或西班牙裔（HR，2.37[95%置信区间，1.11 - 5.07]）与心脏毒性风险较高独立相关。与非西班牙裔白人和亚裔相比，非西班牙裔黑人和西班牙裔个体的左心室射血分数下降幅度更大。不同种族和民族群体中，基线特征与心脏毒性事件之间的关联相似。
在接受蒽环类药物治疗的大型多种族和民族回顾性队列中，与非西班牙裔白人相比，非西班牙裔黑人、西班牙裔和亚裔个体发生心脏毒性的风险增加。
