Key result
Anthracycline chemotherapy linked to ~100% greater HF risk in breast cancer survivors.
Why the study?
Anticancer drugs in females with comorbidity increase cancer therapy-related cardiovascular toxicity risk, but long-term risks and predictors in women with early breast cancer eligible for adjuvant chemotherapy needed assessment.
What is the long-term incidence and what are the predictors of cancer therapy-related cardiovascular toxicity in women with early breast cancer?
Cohort (n=433)
Yes
What is the long-term incidence and what are the predictors of cancer therapy-related cardiovascular toxicity in women with early breast cancer?
Effect estimate: HR 2.0 (95% CI 1.4-2.8)
p-value: p=0.001
There is a high long-term incidence of cardiovascular toxicity and mortality in women treated for early breast cancer, particularly those receiving anthracyclines, underscoring the need for long-term cardio-oncology monitoring.
Anthracycline exposure was associated with higher long-term CV risks in breast cancer survivors; extends prior cohorts but leaves open causal confirmation and monitoring protocols.
Background: The administration of anticancer drugs in females with comorbidity increases the risk for cancer therapy-related cardiovascular toxicity (CTR-CVT), which in turn contributes to cardiovascular disease (CVD). Furthermore, a pathophysiological connection between cancer and cardiovascular disease may exist. Objective: To assess the long-term risks and predictors of CTR-CVT, including clinical hypertension (HT), coronary artery disease (CAD), heart failure (HF), atrial fibrillation (AF), as well as all-cause mortality in women diagnosed with early breast cancer (BC) and eligible for adjuvant chemotherapy in Sweden. Methods: Data were extracted from Swedish registers and medical records on 433 women, 18-60 years of age, diagnosed 1998-2002 with lymph node-positive BC, and considered for adjuvant chemotherapy. CTR-CVT was defined as HT, CAD, HF, or AF after the diagnosis of BC. Follow-up was from the date of BC diagnosis until November 30, 2021, or death. Prevalence of CTR-CVT and all-cause mortality were calculated. Hazard ratios (HR) were determined for factors associated with CTR-CVT. Results: The median age was 50 (interquartile range (IQR) 32) years. 910 CTR-CVT events were diagnosed in 311 women with a median of 19.3 (IQR 15,3) years follow-up. The proportions of CTR-CVT events were: HT 281 (64%); CAD 198 (46%); HF 206 (47%); and AF 225 (51%). The cumulative incidence of CTR-CVT was 71.8%, and 50% of all 433 patients developed CTR-CVT within 11.7 years of BC diagnosis (standard deviation (SD) 0.57, 95% confidence interval (CI) 10.6-12.9). Age was a risk factor for CTR-CVT. Anthracycline increased the risk for HF (p=0,001; HR 2,0; 95%CI 1,4-2,8), CAD (p= 0,002; HR 1,7; 95% CI 1,2-2,4), and AF (p=0,013; HR 1,5; 95% CI 1,0-2,0). At the end of the 24-year study period, 227 of the 433 women were alive, and the total cumulative mortality was 47,6%. Conclusion: The prevalence of CTR-CVT and all-cause mortality is high after BC diagnosis and treatment, particularly in older patients and those receiving anthracyclines. These findings and the onset of CTR-CVT support cardio-oncology guidelines recommending initial risk stratification and cardiovascular monitoring during treatment, followed by long-term annual screening for cardiovascular risk factors and CTR-CVT among BC survivors.
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Hűbbert et al. (2023) conducted a cohort in Early breast cancer (n=433). Anthracycline-containing chemotherapy vs. Non-anthracycline chemotherapy or no chemotherapy was evaluated on Heart failure (HR 2.0, 95% CI 1.4-2.8, p=0.001). Anthracycline-containing chemotherapy significantly increased the long-term risk of heart failure (HR 2.0), coronary artery disease (HR 1.7), and atrial fibrillation (HR 1.5) in breast cancer survivors.
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