Racial and Socioeconomic Disparities in Cardiotoxicity Among Women With HER2-Positive Breast Cancer.
Racial and Socioeconomic Disparities in Cardiotoxicity Among Women With HER2-Positive Breast Cancer.
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DOI：
10.1016/j.amjcard.2021.02.013
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发表时间：
2021-05-15
期刊：
影响因子：
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通讯作者：
Yu AF
中科院分区：
文献类型：
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作者：
Al-Sadawi M;Hussain Y;Copeland-Halperin RS;Tobin JN;Moskowitz CS;Dang CT;Liu JE;Steingart RM;Johnson MN;Yu AF
与白人相比，黑人的乳腺癌和心血管特异性死亡率更高，但癌症治疗相关的不良心血管结局的差异尚未得到充分研究。我们评估了种族和社会经济地位对HER 2阳性乳腺癌女性心脏毒性的影响。这项回顾性队列分析研究了2004-2013年诊断为I-III期HER 2阳性乳腺癌的女性。所有患者均在基线时进行左心室射血分数（LVEF）评估，并在开始曲妥珠单抗治疗后进行至少一次随访。多变量逻辑回归用于评估种族和社会经济地位（SES）与心脏毒性之间的关系，心脏毒性定义为临床心力衰竭（纽约心脏协会[NYHA] III或IV级）或无症状LVEF下降（绝对下降> 10%至≥ 53%，或≥ 16%）。黑人高血压、糖尿病和BMI增加的患病率最高。社区一级的SES措施，包括家庭收入和教育程度较低的黑人相比，白人和其他人。与白色女性相比，黑人女性未校正的心脏毒性风险显著更高（OR，2.10; 95%CI，1.42-3.10）。在多变量分析中，在控制相关心血管风险因素后，这种差异仍然存在（校正OR，1.88; 95%CI，1.25-2.84）。调整收入、教育程度和保险状况等SES因素的其他模型并没有显著改变种族和心脏毒性之间的关联。总之，黑人女性在HER 2靶向乳腺癌治疗期间心脏毒性的风险增加。未来的病因学分析，特别是探索生物学或遗传学机制的研究，需要进一步阐明和减少心脏毒性的种族差异。
Breast cancer and cardiovascular-specific mortality are higher among blacks compared with whites, but disparities in cancer therapy-related adverse cardiovascular outcomes have not been well studied. We assessed for the contribution of race and socioeconomic status on cardiotoxicity among women with HER2-positive breast cancer. This retrospective cohort analysis studied women diagnosed with stage I-III HER2-positive breast cancer from 2004–2013. All underwent left ventricular ejection fraction (LVEF) assessment at baseline and at least one follow-up after beginning trastuzumab. Multivariable logistic regression was used to assess the association between race and socioeconomic status (SES) on cardiotoxicity, defined by clinical heart failure (New York Heart Association [NYHA] class III or IV) or asymptomatic LVEF decline (absolute decrease > 10% to ≥ 53%, or ≥ 16%). Blacks had the highest prevalence of hypertension, diabetes, and increased BMI. Neighborhood-level SES measures including household income and educational attainment were lower for blacks compared to whites and others. The unadjusted cardiotoxicity risk was significantly higher in black compared with white women (OR, 2.10; 95% CI, 1.42–3.10). In a multivariable analysis, this disparity persisted after controlling for relevant cardiovascular risk factors (adjusted OR, 1.88; 95% CI, 1.25–2.84). Additional models adjusting for SES factors of income, educational attainment, and insurance status did not significantly alter the association between race and cardiotoxicity. In conclusion, black women are at increased risk of cardiotoxicity during HER2-targeted breast cancer therapy. Future etiologic analyses, particularly studies exploring biologic or genetic mechanisms, are needed to further elucidate and reduce racial disparities in cardiotoxicity.