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Predictors of CVD among breast cancer survivors in an integrated health system

综合卫生系统中乳腺癌幸存者 CVD 的预测因素

基本信息

批准号：
9390001
负责人：
Heather Greenlee
金额：
$ 61.64万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-07-15 至 2021-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9390001
关键词：
21 year old Accounting Adherence Affect Age Ancillary Study Anthracyclines Antihypertensive Agents Arrhythmia Behavior Behavioral Biological Response Modifier Therapy Blood Pressure Breast Cancer Patient Breast Cancer Treatment Breast Cancer survivor California Cancer Control Cancer Prognosis Cardiomyopathies Cardiotoxicity Cardiovascular Diseases Caring Clinical Cohort Studies Common Data Element Common Terminology Criteria for Adverse Events Comorbidity Control Groups Data Databases Diabetes Mellitus Diagnosis Diet Disease Disease Outcome Diuretics Drug usage Dyslipidemias Educational workshop Electronic Health Record Eligibility Determination Enrollment Ethnic Origin Event Female Funding Health Planning Health system Healthcare Systems Heart failure Hypertension Iatrogenesis Intervention Laboratories Left Length Life Style Link Lipids Literature Malignant Neoplasms Medical Minority Myocardial Ischemia Myocarditis National Heart, Lung, and Blood Institute Observational Study Outcome Pathway interactions Patients Pericarditis Pharmaceutical Preparations Physical activity Race Radiation therapy Recording of previous events Relative Risks Research Design Risk Risk Behaviors Risk Factors Side Smoking Socioeconomic Status Stroke Subgroup Thromboembolism Transient Ischemic Attack Trastuzumab Treatment Factor Treatment Protocols Treatment-Related Cancer Venous Woman base breast cancer diagnosis cancer therapy cardiovascular disorder risk chemotherapy clinical risk cohort comparison group data resource diet and exercise disorder risk fasting glucose follow-up hazard high risk hormone therapy improved improved outcome lifestyle factors malignant breast neoplasm medication compliance member patient population response sudden cardiac death

项目摘要

PROJECT SUMMARY / ABSTRACT Breast cancer survivors are at high risk of developing and dying from cardiovascular disease (CVD) following breast cancer diagnosis, but subpopulations at increased risk and targets for intervention have not been well- characterized. A growing body of literature links CVD with specific cardiotoxic cancer treatments. CVD risk among breast cancer survivors might vary by concomitant non-adherence to CVD medications and presence of CVD risk factors. However, most of the studies on CVD risk among breast cancer patient populations have had significant limitations, including poorly characterized CVD outcomes, lack of CVD medication adherence data and risk factors, and poorly matched cancer-free control groups. Well-designed studies are needed to identify subpopulations of breast cancer survivors at high risk for CVD events and modifiable targets for intervention while accounting for specific breast cancer treatments received, CVD medications, and CVD risk factors. We propose to conduct an ancillary study within an ongoing study of breast cancer survivors which will overcome limitations of prior studies. The proposed study will comprehensively examine clinical and behavioral predictors of CVD outcomes among breast cancer survivors, and will maximize unique patient and data resources available at Kaiser Permanente Northern California (KPNC). We will compare CVD events in the Pathways Study, a cohort of female KPNC members age ≥21 years diagnosed with invasive breast cancer (n=4,453, R01CA105274) with CVD events in a new age, race/ethnicity, history of comorbidity, and length of KPNC membership matched cohort of healthy KPNC female members (n=22,265). Specific aims are: Aim 1) To examine the absolute risk and relative risk of incident CVD events (ischemic heart disease, stroke/transient ischemic attack, and cardiomyopathy/heart failure, and others) and new onset CVD risk factors (hypertension, diabetes, dyslipidemia) in women with breast cancer (Pathways) and a cancer-free comparison group (KPNC matched cohort); Aim 2) In women with a history of breast cancer (Pathways), to examine the relative risk of incident CVD events and new onset of CVD risk factors, by type of cardiotoxic breast cancer treatment received, including chemotherapy/biologic therapy (anthracyclines, trastuzamab), hormonal therapy (Tamoxifen, aromatase inhibitors), and radiation therapy, controlling for confounders related to baseline CVD medication adherence, clinical and behavioral risk factors, medical care and health care system factors, and socioeconomic status (SES); Aim 3) To assess adherence to CVD medications in women with a history of breast cancer (Pathways) using 14 years of follow-up data, and to examine the association of adherence with risk of CVD events controlling for cardiotoxic cancer treatment received, baseline CVD clinical and behavioral risk factors, medical care and health care system factors, and SES. Impact: Results from this study will have important implications for identifying breast cancer subgroups at high risk of CVD and identifying potential targets for intervention, such as medication adherence and control of CVD risk factors.

项目概要/摘要乳腺癌幸存者在以下情况下患心血管疾病（CVD）和死亡的风险很高乳腺癌的诊断，但高风险亚人群和干预目标尚未得到很好的确定特点。越来越多的文献将心血管疾病与特定的心脏毒性癌症治疗联系起来。心血管疾病风险乳腺癌幸存者之间的差异可能会因不遵守心血管疾病药物治疗和存在而有所不同 CVD 危险因素。然而，大多数关于乳腺癌患者人群 CVD 风险的研究都表明具有显着的局限性，包括 CVD 结果描述不明确、缺乏 CVD 药物依从性数据和危险因素，以及匹配不佳的无癌症对照组。需要精心设计的研究确定罹患 CVD 事件高风险的乳腺癌幸存者亚群以及可修改的目标干预，同时考虑到接受的特定乳腺癌治疗、CVD 药物和 CVD 风险因素。我们建议在一项正在进行的乳腺癌幸存者研究中进行一项辅助研究，该研究将克服先前研究的局限性。拟议的研究将全面检查临床和行为乳腺癌幸存者 CVD 结果的预测因素，并将最大化独特的患者和数据北加州凯撒医疗机构 (KPNC) 提供的资源。我们将比较 CVD 事件 Pathways 研究，一组年龄≥21 岁的女性 KPNC 成员，被诊断患有浸润性乳腺癌（n=4,453，R01CA105274）新时代的 CVD 事件、种族/族裔、合并症史以及患病时长 KPNC 会员资格与健康 KPNC 女性会员队列相匹配 (n=22,265)。具体目标是：目标 1) 检查 CVD 事件（缺血性心脏病、中风/短暂性心脏病）的绝对风险和相对风险缺血性发作、心肌病/心力衰竭等）和新发 CVD 危险因素（高血压、患有乳腺癌的女性（Pathways）和无癌对照组（KPNC）中的糖尿病、血脂异常）匹配的队列）；目标 2) 在有乳腺癌病史的女性中（途径），检查患乳腺癌的相对风险按心脏毒性乳腺癌治疗类型划分的 CVD 事件和新发 CVD 危险因素接受的治疗，包括化疗/生物治疗（蒽环类药物、曲妥珠单抗）、激素治疗（他莫昔芬、芳香酶抑制剂）和放射治疗，控制与基线 CVD 相关的混杂因素药物依从性、临床和行为风险因素、医疗保健和卫生保健系统因素，以及社会经济地位（SES）；目标 3) 评估有 CVD 病史的女性对 CVD 药物的依从性乳腺癌（Pathways）使用 14 年的随访数据，并检查依从性与控制接受的心脏毒性癌症治疗、基线 CVD 临床和行为的 CVD 事件风险风险因素、医疗保健和卫生保健系统因素以及社会经济地位。影响：这项研究的结果将产生对于识别 CVD 高风险乳腺癌亚组并识别潜在的重要意义干预目标，例如药物依从性和CVD危险因素的控制。