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Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors
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 unil...
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| Published in: | JNCI : Journal of the National Cancer Institute 2024-08, Vol.116 (8), p.1384-1394 |
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| creator | 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 |
| description | 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- |
| doi_str_mv | 10.1093/jnci/djae107 |
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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-<10 years = 1.85, 95% CI = 1.44 to 2.39; adjusted HR≥10 years = 1.83, 95% CI = 1.34 to 2.49). Cardiomyopathy and/or HF risks were elevated among women treated with anthracyclines and/or trastuzumab compared with no chemotherapy, especially for those aged younger than 65 years (adjusted HR20-54years = 2.97, 95% CI = 1.72 to 5.12; adjusted HR55-64years = 2.21, 95% CI = 1.52 to 3.21), differing for older women (adjusted HR≥65 years = 1.32, 95% CI = 0.97 to 1.78), and at least 5 years postdiagnosis (adjusted HR5-<10years = 1.89, 95% CI = 1.35 to 2.64; adjusted HR≥10 years = 2.21, 95% CI = 1.52 to 3.20). Anthracyclines and/or trastuzumab receipt was associated with increased ischemic heart disease risks after 5 or more years (adjusted HR5-<10years = 1.51, 95% CI = 1.06 to 2.14; adjusted HR≥10 years = 1.86, 95% CI = 1.18 to 2.93) with no clear age effects, and stroke risk (adjusted HR = 1.33, 95% CI = 1.05 to 1.69), which did not vary by time or age. There was some evidence of long-term cardiomyopathy and/or HF and ischemic heart disease risks with other chemotherapies. Among women aged younger than 65 treated with anthracyclines and/or trastuzumab, up to 16% developed CVD by 10 years (20-54 years = 6.91%; 55-64 years = 16.00%), driven by cardiomyopathy and/or HF (20-54 years = 3.90%; 55-64 years = 9.78%).
We found increased long-term risks of cardiomyopathy and/or HF and ischemic heart disease among breast cancer survivors treated with anthracyclines and/or trastuzumab and increased cardiomyopathy and/or HF risk among women aged younger than 65 years.</description><identifier>ISSN: 0027-8874</identifier><identifier>ISSN: 1460-2105</identifier><identifier>EISSN: 1460-2105</identifier><identifier>DOI: 10.1093/jnci/djae107</identifier><identifier>PMID: 38718210</identifier><language>eng</language><publisher>United States: Oxford University Press</publisher><subject>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</subject><ispartof>JNCI : Journal of the National Cancer Institute, 2024-08, Vol.116 (8), p.1384-1394</ispartof><rights>Published by Oxford University Press 2024.</rights><rights>Published by Oxford University Press 2024. 2024</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c272t-be162e0599276d98e9647c2834e9829544179855e0f888810f30a39040ef1a583</cites><orcidid>0000-0002-9935-8904 ; 0000-0002-9347-7865 ; 0000-0002-7883-5652 ; 0000-0002-6537-1481 ; 0000-0001-5408-2804 ; 0000-0001-6691-3740 ; 0000-0002-0165-5522 ; 0000-0001-8891-4437 ; 0000-0002-6578-2678 ; 0000-0002-2007-2840 ; 0000-0002-7332-8387</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38718210$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Vo, Jacqueline B</creatorcontrib><creatorcontrib>Ramin, Cody</creatorcontrib><creatorcontrib>Veiga, Lene H S</creatorcontrib><creatorcontrib>Brandt, Carolyn</creatorcontrib><creatorcontrib>Curtis, Rochelle E</creatorcontrib><creatorcontrib>Bodelon, Clara</creatorcontrib><creatorcontrib>Barac, Ana</creatorcontrib><creatorcontrib>Roger, Véronique L</creatorcontrib><creatorcontrib>Feigelson, Heather Spencer</creatorcontrib><creatorcontrib>Buist, Diana S M</creatorcontrib><creatorcontrib>Bowles, Erin J Aiello</creatorcontrib><creatorcontrib>Gierach, Gretchen L</creatorcontrib><creatorcontrib>Berrington de González, Amy</creatorcontrib><title>Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors</title><title>JNCI : Journal of the National Cancer Institute</title><addtitle>J Natl Cancer Inst</addtitle><description>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-<10 years = 1.85, 95% CI = 1.44 to 2.39; adjusted HR≥10 years = 1.83, 95% CI = 1.34 to 2.49). Cardiomyopathy and/or HF risks were elevated among women treated with anthracyclines and/or trastuzumab compared with no chemotherapy, especially for those aged younger than 65 years (adjusted HR20-54years = 2.97, 95% CI = 1.72 to 5.12; adjusted HR55-64years = 2.21, 95% CI = 1.52 to 3.21), differing for older women (adjusted HR≥65 years = 1.32, 95% CI = 0.97 to 1.78), and at least 5 years postdiagnosis (adjusted HR5-<10years = 1.89, 95% CI = 1.35 to 2.64; adjusted HR≥10 years = 2.21, 95% CI = 1.52 to 3.20). Anthracyclines and/or trastuzumab receipt was associated with increased ischemic heart disease risks after 5 or more years (adjusted HR5-<10years = 1.51, 95% CI = 1.06 to 2.14; adjusted HR≥10 years = 1.86, 95% CI = 1.18 to 2.93) with no clear age effects, and stroke risk (adjusted HR = 1.33, 95% CI = 1.05 to 1.69), which did not vary by time or age. There was some evidence of long-term cardiomyopathy and/or HF and ischemic heart disease risks with other chemotherapies. Among women aged younger than 65 treated with anthracyclines and/or trastuzumab, up to 16% developed CVD by 10 years (20-54 years = 6.91%; 55-64 years = 16.00%), driven by cardiomyopathy and/or HF (20-54 years = 3.90%; 55-64 years = 9.78%).
We found increased long-term risks of cardiomyopathy and/or HF and ischemic heart disease among breast cancer survivors treated with anthracyclines and/or trastuzumab and increased cardiomyopathy and/or HF risk among women aged younger than 65 years.</description><subject>Adult</subject><subject>Aged</subject><subject>Anthracyclines - administration & dosage</subject><subject>Anthracyclines - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - adverse effects</subject><subject>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Breast Neoplasms - epidemiology</subject><subject>Cancer Survivors - statistics & numerical data</subject><subject>Cardiovascular Diseases - chemically induced</subject><subject>Cardiovascular Diseases - epidemiology</subject><subject>Early Career Investigator Research</subject><subject>Female</subject><subject>Humans</subject><subject>Incidence</subject><subject>Middle Aged</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Trastuzumab - adverse effects</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>0027-8874</issn><issn>1460-2105</issn><issn>1460-2105</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNpVkU1v1DAQhi0Eokvhxhn5yIHQ8UcS-4RQVWillThAz9asM2m9JE6xnZXKr8dVlwrm4hnPM69Hfhl7K-CjAKvO9tGHs2GPJKB_xjZCd9BIAe1ztgGQfWNMr0_Yq5z3UMNK_ZKdKNMLU6ENS9sl3jSF0sw9piEsB8x-nTDxIWTCTDyF_JPjWBGOsdwm9Pd-CpFqNfCSMJf19zrjruaEZaZYMg-RX3_nu3qRS9WNvg7nNR3CYUn5NXsx4pTpzfE8ZddfLn6cXzbbb1-vzj9vGy97WZodiU4StNbKvhusIdvp3kujNFkjbau16K1pW4LR1BAwKkBlQQONAlujTtmnR927dTfT4OtmCSd3l8KM6d4tGNz_nRhu3c1ycEIoMPV_qsL7o0Jafq2Ui5tD9jRNGGlZs1PQKqG06URFPzyiPi05Jxqf3hHgHnxyDz65o08Vf_fvbk_wX2PUH9ljkhM</recordid><startdate>20240801</startdate><enddate>20240801</enddate><creator>Vo, Jacqueline B</creator><creator>Ramin, Cody</creator><creator>Veiga, Lene H S</creator><creator>Brandt, Carolyn</creator><creator>Curtis, Rochelle E</creator><creator>Bodelon, Clara</creator><creator>Barac, Ana</creator><creator>Roger, Véronique L</creator><creator>Feigelson, Heather Spencer</creator><creator>Buist, Diana S M</creator><creator>Bowles, Erin J Aiello</creator><creator>Gierach, Gretchen L</creator><creator>Berrington de González, Amy</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9935-8904</orcidid><orcidid>https://orcid.org/0000-0002-9347-7865</orcidid><orcidid>https://orcid.org/0000-0002-7883-5652</orcidid><orcidid>https://orcid.org/0000-0002-6537-1481</orcidid><orcidid>https://orcid.org/0000-0001-5408-2804</orcidid><orcidid>https://orcid.org/0000-0001-6691-3740</orcidid><orcidid>https://orcid.org/0000-0002-0165-5522</orcidid><orcidid>https://orcid.org/0000-0001-8891-4437</orcidid><orcidid>https://orcid.org/0000-0002-6578-2678</orcidid><orcidid>https://orcid.org/0000-0002-2007-2840</orcidid><orcidid>https://orcid.org/0000-0002-7332-8387</orcidid></search><sort><creationdate>20240801</creationdate><title>Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors</title><author>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</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c272t-be162e0599276d98e9647c2834e9829544179855e0f888810f30a39040ef1a583</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anthracyclines - administration & dosage</topic><topic>Anthracyclines - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - adverse effects</topic><topic>Antineoplastic Combined Chemotherapy Protocols - therapeutic use</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Breast Neoplasms - epidemiology</topic><topic>Cancer Survivors - statistics & numerical data</topic><topic>Cardiovascular Diseases - chemically induced</topic><topic>Cardiovascular Diseases - epidemiology</topic><topic>Early Career Investigator Research</topic><topic>Female</topic><topic>Humans</topic><topic>Incidence</topic><topic>Middle Aged</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Trastuzumab - adverse effects</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vo, Jacqueline B</creatorcontrib><creatorcontrib>Ramin, Cody</creatorcontrib><creatorcontrib>Veiga, Lene H S</creatorcontrib><creatorcontrib>Brandt, Carolyn</creatorcontrib><creatorcontrib>Curtis, Rochelle E</creatorcontrib><creatorcontrib>Bodelon, Clara</creatorcontrib><creatorcontrib>Barac, Ana</creatorcontrib><creatorcontrib>Roger, Véronique L</creatorcontrib><creatorcontrib>Feigelson, Heather Spencer</creatorcontrib><creatorcontrib>Buist, Diana S M</creatorcontrib><creatorcontrib>Bowles, Erin J Aiello</creatorcontrib><creatorcontrib>Gierach, Gretchen L</creatorcontrib><creatorcontrib>Berrington de González, Amy</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>JNCI : Journal of the National Cancer Institute</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vo, Jacqueline B</au><au>Ramin, Cody</au><au>Veiga, Lene H S</au><au>Brandt, Carolyn</au><au>Curtis, Rochelle E</au><au>Bodelon, Clara</au><au>Barac, Ana</au><au>Roger, Véronique L</au><au>Feigelson, Heather Spencer</au><au>Buist, Diana S M</au><au>Bowles, Erin J Aiello</au><au>Gierach, Gretchen L</au><au>Berrington de González, Amy</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors</atitle><jtitle>JNCI : Journal of the National Cancer Institute</jtitle><addtitle>J Natl Cancer Inst</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>116</volume><issue>8</issue><spage>1384</spage><epage>1394</epage><pages>1384-1394</pages><issn>0027-8874</issn><issn>1460-2105</issn><eissn>1460-2105</eissn><abstract>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-<10 years = 1.85, 95% CI = 1.44 to 2.39; adjusted HR≥10 years = 1.83, 95% CI = 1.34 to 2.49). Cardiomyopathy and/or HF risks were elevated among women treated with anthracyclines and/or trastuzumab compared with no chemotherapy, especially for those aged younger than 65 years (adjusted HR20-54years = 2.97, 95% CI = 1.72 to 5.12; adjusted HR55-64years = 2.21, 95% CI = 1.52 to 3.21), differing for older women (adjusted HR≥65 years = 1.32, 95% CI = 0.97 to 1.78), and at least 5 years postdiagnosis (adjusted HR5-<10years = 1.89, 95% CI = 1.35 to 2.64; adjusted HR≥10 years = 2.21, 95% CI = 1.52 to 3.20). Anthracyclines and/or trastuzumab receipt was associated with increased ischemic heart disease risks after 5 or more years (adjusted HR5-<10years = 1.51, 95% CI = 1.06 to 2.14; adjusted HR≥10 years = 1.86, 95% CI = 1.18 to 2.93) with no clear age effects, and stroke risk (adjusted HR = 1.33, 95% CI = 1.05 to 1.69), which did not vary by time or age. There was some evidence of long-term cardiomyopathy and/or HF and ischemic heart disease risks with other chemotherapies. Among women aged younger than 65 treated with anthracyclines and/or trastuzumab, up to 16% developed CVD by 10 years (20-54 years = 6.91%; 55-64 years = 16.00%), driven by cardiomyopathy and/or HF (20-54 years = 3.90%; 55-64 years = 9.78%).
We found increased long-term risks of cardiomyopathy and/or HF and ischemic heart disease among breast cancer survivors treated with anthracyclines and/or trastuzumab and increased cardiomyopathy and/or HF risk among women aged younger than 65 years.</abstract><cop>United States</cop><pub>Oxford University Press</pub><pmid>38718210</pmid><doi>10.1093/jnci/djae107</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-9935-8904</orcidid><orcidid>https://orcid.org/0000-0002-9347-7865</orcidid><orcidid>https://orcid.org/0000-0002-7883-5652</orcidid><orcidid>https://orcid.org/0000-0002-6537-1481</orcidid><orcidid>https://orcid.org/0000-0001-5408-2804</orcidid><orcidid>https://orcid.org/0000-0001-6691-3740</orcidid><orcidid>https://orcid.org/0000-0002-0165-5522</orcidid><orcidid>https://orcid.org/0000-0001-8891-4437</orcidid><orcidid>https://orcid.org/0000-0002-6578-2678</orcidid><orcidid>https://orcid.org/0000-0002-2007-2840</orcidid><orcidid>https://orcid.org/0000-0002-7332-8387</orcidid><oa>free_for_read</oa></addata></record> |
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| 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 |
| title | Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors |
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