Cheang Iokfai, Zhu Xu, Lu Xinyi, Li Ying, Ni Gehui, Yang Ying, Zhang Yue, Ren Qing-Wen, Wu Mei-Zhen, Gao Rongrong, Yiu Kai-Hang, Li Xinli
State Key Laboratory for Innovation and Transformation of Luobing Theory, Department of Cardiology The First Affiliated Hospital with Nanjing Medical University, Jiangsu Province Hospital Nanjing 210029 China.
Division of Cardiology, Department of Medicine The University of Hong Kong-ShenZhen Hospital Shenzhen 518009 China.
J Am Heart Assoc. 2025 Jun 3;14(11):e040876. doi: 10.1161/JAHA.124.040876. Epub 2025 May 22.
Anthracycline-based chemotherapy is a vital treatment for various cancers but carries notable risks of cardiotoxicity. This study aimed to assess how different body mass index values and glycemic status influence the risk of major adverse cardiovascular events (MACE) in chemotherapy-naïve adult patients with cancer treated with anthracyclines.
This retrospective cohort included 11 393 chemotherapy-naïve patients who initiated anthracycline-based chemotherapy between 2000 and 2019. Follow-up began from the first anthracycline dose. Body mass index was categorized as underweight/normal weight (<25 kg/m), overweight (25-29.9 kg/m), and obese (≥30 kg/m). Glycemic status was classified as normoglycemic or diabetes/prediabetes (diabetes: hemoglobin A1c ≥6.5% or fasting glucose ≥126 mg/dL; prediabetes: hemoglobin A1c 5.7%-6.4% or fasting glucose 100-125 mg/dL).
Over a median follow-up of 8.7 years, 985 (8.64%) patients experienced MACE. Obesity was significantly associated with an increased risk of MACE (hazard ratio [HR], 1.38 [95% CI, 1.10-1.73], reference: underweight/normal weight) and heart failure hospitalization, and diabetes/prediabetes also significantly predicted MACE (HR, 1.28 [95% CI, 1.10-1.50], reference: normoglycemic). Notably, overweight (HR, 0.85 [95% CI, 0.80-0.91]) and obesity (HR, 0.85 [95% CI, 0.74-0.96]) were associated with lower risk of all-cause mortality. Joint analysis revealed that patients with both obesity and diabetes/prediabetes had the highest risk of MACE (HR, 1.74 [95% CI, 1.28-2.37]) and heart failure hospitalization (HR, 1.99 [95% CI, 1.41-2.81]).
In patients with cancer undergoing anthracycline-based chemotherapy, both body mass index and glycemic status significantly affect cardiovascular risks, with the highest risk observed in those with concurrent obesity and diabetes/prediabetes, emphasizing the need for tailored risk assessment and management.
基于蒽环类药物的化疗是多种癌症的重要治疗方法，但具有显著的心脏毒性风险。本研究旨在评估不同体重指数值和血糖状态如何影响接受蒽环类药物治疗的初治成年癌症患者发生主要不良心血管事件（MACE）的风险。
这项回顾性队列研究纳入了11393例在2000年至2019年间开始接受基于蒽环类药物化疗的初治患者。随访从首次使用蒽环类药物剂量开始。体重指数分为体重过轻/正常体重（<25kg/m²）、超重（25-29.9kg/m²）和肥胖（≥30kg/m²）。血糖状态分为血糖正常或糖尿病/糖尿病前期（糖尿病：糖化血红蛋白A1c≥6.5%或空腹血糖≥126mg/dL；糖尿病前期：糖化血红蛋白A1c 5.7%-6.4%或空腹血糖100-125mg/dL）。
在中位随访8.7年期间，985例（8.64%）患者发生了MACE。肥胖与MACE风险增加（风险比[HR]，1.38[95%CI，1.10-1.73]，参照：体重过轻/正常体重）及心力衰竭住院显著相关，糖尿病/糖尿病前期也显著预测了MACE（HR，1.28[95%CI，1.10-1.50]，参照：血糖正常）。值得注意的是，超重（HR，0.85[95%CI，0.80-0.91]）和肥胖（HR，0.85[95%CI，0.74-0.96]）与全因死亡率较低风险相关。联合分析显示，同时患有肥胖和糖尿病/糖尿病前期的患者发生MACE的风险最高（HR，1.74[95%CI，1.28-2.37]）和心力衰竭住院风险最高（HR，1.99[95%CI，1.41-2.81]）。
在接受基于蒽环类药物化疗的癌症患者中，体重指数和血糖状态均显著影响心血管风险，同时患有肥胖和糖尿病/糖尿病前期的患者风险最高，强调了进行个性化风险评估和管理的必要性。
