Risk of myocardial infarction, stroke, and fracture in a cohort of community-based breast cancer patients
Risk of myocardial infarction, stroke, and fracture in a cohort of community-based breast cancer patients
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DOI：
10.1007/s10549-011-1754-1
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发表时间：
2012-01-01
影响因子：
3.8
通讯作者：
Keating, Nancy L.
中科院分区：
文献类型：
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作者：
Ligibel, Jennifer A.;O'Malley, A. James;Keating, Nancy L.
临床试验表明，辅助芳香酶抑制剂 (AI) 唯一严重的副作用是骨质疏松和骨折风险增加，但对于非试验人群中 AI 的毒性知之甚少。我们评估了社区人群中人工智能的使用是否与心肌梗死、中风和骨折相关。利用 HealthCore 综合研究数据库的数据，我们对 2001 年至 2007 年间 44,463 名年龄在千分之 50 岁且拥有千分之一 2 乳腺癌诊断代码的女性进行了跟踪直至 2008 年。其中，44,026 名使用倾向评分方法与年龄在千分之 50 岁且没有乳腺癌代码的女性进行了匹配。我们使用具有时变治疗变量的 Cox 比例风险模型评估 AI 治疗是否与心肌梗塞、中风和骨折相关。在乳腺癌患者中，68.7%未接受激素治疗，20.6%接受AI治疗（15.8%仅接受AI治疗，4.8%还接受他莫昔芬治疗），10.7%仅接受他莫昔芬治疗。与未接受激素治疗的乳腺癌患者相比，接受 AI 治疗的乳腺癌患者发生骨折的风险更高（AHR = 1.13，95% CI = 1.02-1.25）。与未接受激素治疗的乳腺癌患者相比，服用他莫昔芬的患者髋部骨折的风险较低（AHR = 0.51，95% CI = 0.32-0.81）。接受 AI 或他莫昔芬治疗的患者的心肌梗塞和中风发生率与未接受治疗的乳腺癌患者没有显着差异。 AI 在社区人群中的副作用与临床试验中观察到的相似。这些发现让我们确信人工智能似乎与很少的严重副作用有关。
Clinical trials suggest that increased risk of osteoporosis and fracture are the only serious side effects of adjuvant aromatase inhibitors (AIs), but little is known regarding toxicities of AIs in non-trial populations. We evaluated whether use of AIs was associated with myocardial infarction, stroke, and fracture in a community-based population. Using data from the HealthCore Integrated Research Database, 44,463 women aged a parts per thousand yen50 years with a parts per thousand yen2 breast cancer diagnosis codes between 2001 and 2007 were followed through 2008. Of these, 44,026 were matched using propensity score methods to women aged a parts per thousand yen50 years with no breast cancer codes. We assessed whether treatment with AIs was associated with myocardial infarction, stroke, and fracture using Cox proportional hazards models with time-varying treatment variables. Among breast cancer patients, 68.7% received no hormonal therapy, 20.6% received AIs (15.8% received only AIs, 4.8% were also treated with tamoxifen), and 10.7% received tamoxifen only. Breast cancer patients on AIs had a higher risk of any fracture (AHR = 1.13, 95% CI = 1.02-1.25) than breast cancer patients not receiving hormonal therapy. Patients on tamoxifen had a lower risk of hip fracture (AHR = 0.51, 95% CI = 0.32-0.81) than breast cancer patients not receiving hormonal therapy. Rates of myocardial infarction and stroke for patients on AIs or tamoxifen did not differ significantly from breast cancer patients not on therapy. The side effect profile of AIs in this community-based population was similar to that seen in clinical trials. These findings provide reassurance that AIs appear to be associated with few serious side effects.