Risk of heart disease following treatment for breast cancer - results from a population-based cohort study
Document Type
Article
Publication Date
3-16-2022
Abstract
Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices.
Keywords
Breast cancer, Arrhythmia, Heart failure, Ischemic heart disease, Human
Divisions
fac_med
Funders
Natural Science Foundation of Fujian Province [Grant No: 2021J01721],Startup Fund for High-level Talents of Fujian Medical University [Grant No: XRCZX2020007],Startup Fund for Scientific Research, Fujian Medical University [Grant No: 2019QH1002],Laboratory Construction Program of Fujian Medical University [Grant No: 1100160208],Swedish Research Council [Grant No: 2018-02547],Swedish Cancer Foundation [Grant No: CAN-19-0266],Forskningsradet om Halsa, Arbetsliv och Valfard [Grant No: 2016-00081],University of Malaya Impact-Oriented Interdisciplinary Research Grant Programme [Grant No: IIRG006C-19HWB],China Scholarship Council,Swedish Research Council Swedish Research Council for Health Working Life & Welfare (Forte) Swedish Research Council Formas [Grant No: 2018-02547]
Publication Title
eLife
Volume
11
Publisher
eLife Sciences Publications
Publisher Location
SHERATON HOUSE, CASTLE PARK, CAMBRIDGE, CB3 0AX, ENGLAND