Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer
Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer
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DOI：
10.1200/jco.2015.65.6603
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发表时间：
2016-08-10
影响因子：
45.3
通讯作者：
Caan, Bette J.
中科院分区：
文献类型：
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作者：
Jones, Lee W.;Habel, Laurel A.;Caan, Bette J.
目的心血管疾病(CVD)是导致女性非转移性乳腺癌死亡的主要原因。在心血管疾病风险表型升高的乳腺癌患者中，运动是否与心血管风险降低有关尚不清楚。方法采用前瞻性设计，在两项基于登记的区域队列研究中，诊断为非转移性乳腺癌的女性(n=2,973；平均年龄，57岁)完成了一份评估休闲娱乐体力活动(代谢等值任务[MET]-h/wk)的问卷。主要终点是在研究登记后首次出现以下任何一种情况：新诊断的冠状动脉疾病、心力衰竭、瓣膜异常、心律失常、中风或心血管死亡。结果中位随访时间为8.6年(范围为0.2至14.8年)。在多变量分析中，心血管事件的发生率随着总MET-h/Wk类别的增加而降低(P-趋势和lt；.001)。与~lt；2 Met-h/wk相比，2~10.9 Met-h/wk的调整危险比为0.91(95%CI，0.76~1.09)，11~24.5 Met-h/wk的调整危险比为0.79(95%CI，0.66~0.96)，>；=24.5 Met-h/wk的调整危险比为0.65(95%CI，0.53~0.80)。冠状动脉疾病和心力衰竭的发生率也观察到了类似的趋势(PValue<；0.05)。与不遵守国家运动指南(即9 Met-h/wk；P<；)相比，坚持国家癌症成人患者锻炼指南(即9 Met-h/wk)与心血管事件风险调整后降低23%相关。运动与年龄、心血管危险因素、绝经状态或抗癌治疗的关系没有不同。结论运动与非转移性乳腺癌女性心血管事件发生率的显著、分级降低有关。(C)2016年度美国临床肿瘤学会
PurposeCardiovascular disease (CVD) is a leading cause of death among women with nonmetastatic breast cancer. Whether exercise is associated with reductions in CVD risk in patients with breast cancer with an elevated CVD risk phenotype is not known.MethodsUsing a prospective design, women (n = 2,973; mean age, 57 years) diagnosed with nonmetastatic breast cancer participating in two registry-based, regional cohort studies, completed a questionnaire that assessed leisure-time recreational physical activity (metabolic equivalent task [MET]-h/wk). The primary end point was the first occurrence of any of the following: new diagnosis of coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, occurring after study enrollment.ResultsMedian follow-up was 8.6 years (range, 0.2 to 14.8 years). In multivariable analysis, the incidence of cardiovascular events decreased across increasing total MET-h/wk categories (P-trend < .001). Compared with, < 2 MET-h/wk, the adjusted hazard ratio was 0.91 (95% CI, 0.76 to 1.09) for 2 to 10.9 MET-h/wk, 0.79 (95% CI, 0.66 to 0.96) for 11 to 24.5 MET-h/wk, and 0.65 (95% CI, 0.53 to 0.80) for >= 24.5 MET-h/wk. Similar trends were observed for the incidence of coronary artery disease and heart failure (Pvalues < .05). Adherence to national exercise guidelines for adult patients with cancer (ie, >= 9 MET-h/wk) was associated with an adjusted 23% reduction in the risk of cardiovascular events in comparison with not meeting the guidelines (< 9 MET-h/wk; P < .001). The association with exercise did not differ according to age, CVD risk factors, menopausal status, or anticancer treatment.ConclusionExercise is associated with substantial, graded reductions in the incidence of cardiovascular events in women with nonmetastatic breast cancer. (C) 2016 by American Society of Clinical Oncology