Key result
Breast cancer diagnosis was associated with a significantly increased risk of heart failure within the first year (HR 2.71) compared to matched controls, with systemic adjuvant therapies further increasing this risk.
Why the study?
There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients, requiring determination of the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease.
Do systemic adjuvant therapies for breast cancer increase the risk of arrhythmia, heart failure, and ischemic heart disease in women with non-metastatic breast cancer?
Cohort (n=8,015)
Do systemic adjuvant therapies for breast cancer increase the risk of arrhythmia, heart failure, and ischemic heart disease in women with non-metastatic breast cancer?
Hazard Ratio: 2.71 (95% CI 1.7–4.33)
Systemic adjuvant therapies for breast cancer, particularly anthracyclines, trastuzumab, and aromatase inhibitors, are associated with long-term increased risks of heart failure and ischemic heart disease, highlighting the need for longitudinal cardiac monitoring.
Supports longitudinal cardiac monitoring for breast cancer survivors; extends known cardiotoxicity profiles by highlighting.
Background: There is a rising concern about treatment-associated cardiotoxicities in breast cancer patients. This study aimed to determine the time- and treatment-specific incidence of arrhythmia, heart failure, and ischemic heart disease in women diagnosed with breast cancer. Methods: A register-based matched cohort study was conducted including 8015 breast cancer patients diagnosed from 2001 to 2008 in the Stockholm-Gotland region and followed up until 2017. Time-dependent risks of arrhythmia, heart failure, and ischemic heart disease in breast cancer patients were assessed using flexible parametric models as compared to matched controls from general population. Treatment-specific effects were estimated in breast cancer patients using Cox model. Results: Time-dependent analyses revealed long-term increased risks of arrhythmia and heart failure following breast cancer diagnosis. Hazard ratios (HRs) within the first year of diagnosis were 2.14 (95% CI = 1.63-2.81) for arrhythmia and 2.71 (95% CI = 1.70-4.33) for heart failure. HR more than 10 years following diagnosis was 1.42 (95% CI = 1.21-1.67) for arrhythmia and 1.28 (95% CI = 1.03-1.59) for heart failure. The risk for ischemic heart disease was significantly increased only during the first year after diagnosis (HR = 1.45, 95% CI = 1.03-2.04). Trastuzumab and anthracyclines were associated with increased risk of heart failure. Aromatase inhibitors, but not tamoxifen, were associated with risk of ischemic heart disease. No increased risk of heart disease was identified following locoregional radiotherapy. Conclusions: Administration of systemic adjuvant therapies appears to be associated with increased risks of heart disease. The risk estimates observed in this study may aid adjuvant therapy decision-making and patient counseling in oncology practices. Funding: This work was supported by the Swedish Research Council (grant no: 2018-02547); Swedish Cancer Society (grant no: CAN-19-0266); and FORTE (grant no: 2016-00081).
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A 2022 study conducted a cohort in Breast cancer (n=8,015). Breast cancer and adjuvant therapies vs. Matched controls from the general population was evaluated on Heart failure within the first year of diagnosis (HR 2.71, 95% CI 1.70-4.33). Breast cancer diagnosis was associated with a significantly increased risk of heart failure within the first year (HR 2.71) compared to matched controls, with systemic adjuvant therapies further increasing this risk.
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