What is the clinical evidence from this study?

Study design: Cohort. Population: Early breast cancer (n=1328). Intervention: Anthracycline use vs. No anthracycline use. Primary outcome: Heart failure (sHR 2.67, 95% CI 1.08-6.65, p=0.034).

What question did this study set out to answer?

To assess the cumulative incidence and distinct risk factors for heart failure compared with other major adverse cardiovascular events in patients with early breast cancer.

September 17, 2026International Journal of Clinical OncologyOpen Access

Distinct risk profiles of heart failure and non-heart failure major adverse cardiovascular events among patients with early breast cancer: a competing-risk analysis

Q: What does this research mean for the field?

Anthracycline and trastuzumab use are independently associated with an increased risk of heart failure in early breast cancer patients, whereas non-heart failure major adverse cardiovascular events are driven by age and baseline cardiovascular risk factors. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Population

1,328 patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center during…

Design

Cohort

Follow-up

median 7.7 years

Key result

Anthracycline use (sHR 2.67) and trastuzumab use (sHR 2.52) were independently associated with an increased risk of heart failure among patients with early breast cancer.

Authors

HSHideo Shigematsu ANAtsuyoshi Norishige KTKazuaki Tanabe

Discussion

Member takes

Overview

Anthracycline- and trastuzumab-associated heart failure risk warrants vigilance in early breast cancer; leaves open optimal prevention beyond current monitoring.

Key Points

To assess the cumulative incidence and distinct risk factors for heart failure compared with other major adverse cardiovascular events in patients with early breast cancer.
Retrospective cohort study of 1,328 patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center between 2010 and 2019, followed for a median of 7.7 years.
Cumulative incidence was calculated using the cumulative incidence function, and risk predictors were evaluated via Fine-Gray competing-risk regression models with cancer recurrence and non-cardiovascular death as competing events.
Heart failure occurred in 24 of 1,328 patients (1.8%) and was independently associated with anthracycline use (subdistribution hazard ratio [sHR] 2.67; 95% CI, 1.08–6.65; p = 0.034) and trastuzumab use (sHR 2.52; 95% CI, 1.00–6.33; p = 0.050).
Other major adverse cardiovascular events occurred in 38 of 1,328 patients (2.9%) and were significantly associated with age over 65 years (sHR 3.75; 95% CI, 1.59–8.88; p = 0.003) and preexisting cardiovascular risk factors (sHR 4.02; 95% CI, 1.77–9.10; p < 0.001).

Study Design

Type

Cohort (n=1,328)

Multicenter

Structured PICO

Population

1,328 patients with early non-metastatic breast cancer undergoing curative surgery, free of prior cardiovascular disease, followed for a median of 7.7 years.

Outcome

Heart failure and other major adverse cardiovascular events (stroke, atrial fibrillation, myocardial infarction, or cardiovascular death)composite

Main Result

Hazard Ratio: 2.67 (95% CI 1.08–6.65)

p-value: p=0.034

In patients with early breast cancer, heart failure is primarily driven by cardiotoxic therapies like anthracyclines and trastuzumab, while other major adverse cardiovascular events are driven by traditional cardiovascular risk factors and older age.

Limitations

Retrospective, single-center design might have limited the generalizability of the findings.
Cardiovascular events were identified based on medical records without formal event adjudication, which might have resulted in misclassification.
Few cardiovascular events occurred, restricting multivariable models and raising the possibility of model overfitting.

Cite This Study

Shigematsu et al. (2026) conducted a cohort in Early breast cancer (n=1,328). Anthracycline use vs. No anthracycline use was evaluated on Heart failure (sHR 2.67, 95% CI 1.08-6.65, p=0.034). Anthracycline use (sHR 2.67) and trastuzumab use (sHR 2.52) were independently associated with an increased risk of heart failure among patients with early breast cancer.

synapsesocial.com/papers/6aabb7975f706d05830e6c18 https://doi.org/10.1007/s10147-026-03200-1

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September 17, 2026International Journal of Clinical OncologyOpen Access

Distinct risk profiles of heart failure and non-heart failure major adverse cardiovascular events among patients with early breast cancer: a competing-risk analysis

View Full Paper

Ask AI

Bookmark

Population

1,328 patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center during…

Design

Cohort

Follow-up

median 7.7 years

Key result

Anthracycline use (sHR 2.67) and trastuzumab use (sHR 2.52) were independently associated with an increased risk of heart failure among patients with early breast cancer.

Authors

HSHideo Shigematsu ANAtsuyoshi Norishige KTKazuaki Tanabe

Discussion

Member takes

Overview

Anthracycline- and trastuzumab-associated heart failure risk warrants vigilance in early breast cancer; leaves open optimal prevention beyond current monitoring.

Key Points

To assess the cumulative incidence and distinct risk factors for heart failure compared with other major adverse cardiovascular events in patients with early breast cancer.
Retrospective cohort study of 1,328 patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center between 2010 and 2019, followed for a median of 7.7 years.
Cumulative incidence was calculated using the cumulative incidence function, and risk predictors were evaluated via Fine-Gray competing-risk regression models with cancer recurrence and non-cardiovascular death as competing events.
Heart failure occurred in 24 of 1,328 patients (1.8%) and was independently associated with anthracycline use (subdistribution hazard ratio [sHR] 2.67; 95% CI, 1.08–6.65; p = 0.034) and trastuzumab use (sHR 2.52; 95% CI, 1.00–6.33; p = 0.050).
Other major adverse cardiovascular events occurred in 38 of 1,328 patients (2.9%) and were significantly associated with age over 65 years (sHR 3.75; 95% CI, 1.59–8.88; p = 0.003) and preexisting cardiovascular risk factors (sHR 4.02; 95% CI, 1.77–9.10; p < 0.001).

Study Design

Type

Cohort (n=1,328)

Multicenter

Structured PICO

Population

1,328 patients with early non-metastatic breast cancer undergoing curative surgery, free of prior cardiovascular disease, followed for a median of 7.7 years.

Outcome

Heart failure and other major adverse cardiovascular events (stroke, atrial fibrillation, myocardial infarction, or cardiovascular death)composite

Main Result

Hazard Ratio: 2.67 (95% CI 1.08–6.65)

p-value: p=0.034

Limitations

Retrospective, single-center design might have limited the generalizability of the findings.
Cardiovascular events were identified based on medical records without formal event adjudication, which might have resulted in misclassification.
Few cardiovascular events occurred, restricting multivariable models and raising the possibility of model overfitting.

Cite This Study

synapsesocial.com/papers/6aabb7975f706d05830e6c18 https://doi.org/10.1007/s10147-026-03200-1

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