Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors

• Published in: JNCI : Journal of the National Cancer Institute 2024-08, Vol.116 (8), p.1384-1394
• Main Authors: Vo, Jacqueline B, Ramin, Cody, Veiga, Lene H S, Brandt, Carolyn, Curtis, Rochelle E, Bodelon, Clara, Barac, Ana, Roger, Véronique L, Feigelson, Heather Spencer, Buist, Diana S M, Bowles, Erin J Aiello, Gierach, Gretchen L, Berrington de González, Amy
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anthracyclines - administration & dosage; Anthracyclines - adverse effects; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Cancer Survivors - statistics & numerical data; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Early Career Investigator Research; Female; Humans; Incidence; Middle Aged; Retrospective Studies; Risk Factors; Trastuzumab - adverse effects; United States - epidemiology; Young Adult
• ISSN: 0027-8874; 1460-2105; 1460-2105
• DOI: 10.1093/jnci/djae107

Although breast cancer survivors are at risk for cardiovascular disease (CVD) from treatment late effects, evidence to inform long-term and age-specific cardiovascular surveillance recommendations is lacking. We conducted a retrospective cohort study of 10 211 women diagnosed with first primary unilateral breast cancer in Kaiser Permanente Washington or Colorado (aged 20 years and older, survived ≥1 year). We estimated multivariable adjusted hazard ratios (HRs) for associations between initial chemotherapy regimen type (anthracycline and/or trastuzumab, other chemotherapies, no chemotherapy [referent]) and CVD risk, adjusted for patient characteristics, other treatments, and CVD risk factors. Cumulative incidence was calculated considering competing events. After 5.79 median years, 14.67% of women developed CVD (cardiomyopathy and/or heart failure [HF], ischemic heart disease, stroke). Women treated with anthracyclines and/or trastuzumab had a higher risk of CVD compared with no chemotherapy (adjusted HR = 1.53, 95% confidence interval [CI] = 1.31 to 1.79), persisting at least 5 years postdiagnosis (adjusted HR5-