A Population-Based Study of Cardiovascular Mortality Following Early-Stage Breast Cancer
A Population-Based Study of Cardiovascular Mortality Following Early-Stage Breast Cancer
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DOI：
10.1001/jamacardio.2016.3841
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发表时间：
2017-01-01
期刊：
影响因子：
24
通讯作者：
Anderson, Geoffrey M.
中科院分区：
文献类型：
--
作者：
Abdel-Qadir, Husam;Austin, Peter C.;Anderson, Geoffrey M.
心血管疾病对癌症幸存者的影响越来越受到关注。然而，关于早期乳腺癌后心血管死亡风险的当代人群数据有限，目的描述当代早期乳腺癌女性人群中心血管死亡的发生率，同时考虑竞争风险。和参与者一项基于人群的队列研究在1998年4月1日，2012年3月31日患者随访至死亡或于2013年12月31日删失。基线特征由行政数据库和安大略癌症登记处确定。生命统计数据被用来确定死亡原因。使用累积发生率函数估计死因特异性死亡率。我们使用原因特异性风险函数研究了基线特征与心血管死亡率之间的关系。这些分析解释了非心血管死亡的竞争风险。统计分析时间为2015年7月16日至2016年8月4日。暴露早期乳腺癌、年龄、心血管疾病、高血压和糖尿病。主要结果和指标死亡原因，分为乳腺癌、心血管疾病、其他癌症或其他非癌症原因。（中位年龄，60岁[四分位距，50-71岁]），21123例（21.3%）在随访期间死亡。中位死亡时间为4.2年（IQR，2.2-7.1年）。乳腺癌是最常见的死亡原因（10 550例死亡[49.9%]）; 3444例死亡[16.3%]是心血管原因。心血管死亡在年龄小于66岁的女性中并不常见，既往无心血管疾病、糖尿病或高血压。在66岁或以上的女性中，10年时乳腺癌死亡和心血管死亡的风险分别为11.9%（95%CI，11.6%-12.3%）和7.6%（95%CI，7.3%-7.9%）。在既往有心血管疾病的患者中，前5年乳腺癌和心血管疾病的死亡风险相当，之后心血管原因的死亡更常见（乳腺癌的10年累积发生率为14.6%[95% CI，13.7%-15.4%]，心血管疾病为16.9%[95% CI，16.0%-17.8%]）。对于66岁或以上的女性，在诊断乳腺癌后存活5年或更长时间，心血管疾病超过乳腺癌成为诊断后10年的主要死亡原因，每种疾病的累积发生率为5%.CONCLUSIONS和相关性心血管死亡是早期乳腺癌老年女性的重要竞争风险。这一发现要求充分重视乳腺癌诊断后的心血管预防治疗。
IMPORTANCE There is increasing interest in the effect of cardiovascular disease on cancer survivors. However, there are limited contemporary population-based data on the risk of cardiovascular death after early-stage breast cancer.OBJECTIVE To describe the incidence of cardiovascular death in a contemporary population of women with early-stage breast cancer while accounting for competing risks.DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted among 98 999 women diagnosed with early-stage breast cancer between April 1, 1998, and March 31, 2012. Patients were followed up until death or were censored on December 31, 2013. Baseline characteristics were determined from administrative databases and the Ontario Cancer registry. Vital statistics data were used to determine the cause of death. Cumulative incidence functions were used to estimate the incidence of cause-specific mortality. We studied the association between baseline characteristics and rates of cardiovascular death using cause-specific hazard functions. The analyses accounted for competing risks of noncardiovascular death. Statistical analysis was performed from July 16, 2015, to August 4, 2016.EXPOSURES Early-stage breast cancer, age, cardiovascular disease, hypertension, and diabetes.MAIN OUTCOMES AND MEASURES Cause of death, which was classified as breast cancer, cardiovascular disease, other cancers, or other noncancer causes.RESULTS Of the 98 999 women (median age, 60 years [interquartile range, 50-71 years]) in the study, 21 123 (21.3%) died during follow-up. The median time to death was 4.2 years (IQR, 2.2-7.1 years). Breast cancer was the most common cause of death (10 550 deaths [49.9%]); 3444 deaths [16.3%] were from cardiovascular causes. Cardiovascular death was infrequent in women younger than 66 years without prior cardiovascular disease, diabetes, or hypertension. Among women 66 years or older, the risks of breast cancer death and cardiovascular death at 10 years were 11.9%(95% CI, 11.6%-12.3%) and 7.6%(95% CI, 7.3%-7.9%), respectively. Among patients with prior cardiovascular disease, the risk of death from breast cancer and cardiovascular disease were equivalent for the first 5 years, after which death from cardiovascular causes was more frequent (10-year cumulative incidence, 14.6%[95% CI, 13.7%-15.4%] for breast cancer vs 16.9%[95% CI, 16.0%-17.8%] for cardiovascular disease). For women 66 years or older who survived 5 years or more after diagnosis of breast cancer, cardiovascular disease exceeded breast cancer as the leading cause of death at 10 years after diagnosis, when the cumulative incidence of each was 5%.CONCLUSIONS AND RELEVANCE Cardiovascular death is an important competing risk for older women with early-stage breast cancer. This finding mandates adequate attention to cardiovascular preventive therapy after diagnosis of breast cancer.