Risk of heart disease following treatment for breast cancer - results from a population-based cohort study.

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).

Informations de copyright

© 2022, Yang et al.

Déclaration de conflit d'intérêts

HY, JB, EH, FG, EZ, WB, PH, KC No competing interests declared, NB received educational grants to their institution from Novartis, Pfizer, AIA Bhd and Pharmaceutical Association of Malaysia.Has received speaker's fees from Novartis, Pfizer and Roche, and received travel support from Roche and Pharmaceutical Association of Malaysia to attend conferences in 2018 and 2019. Has served on the advisory board of Pfizer Asia Pacific, Malaysia (2017/18 year), and been a committee member for Together Against Cancer (NGO) (2018 and 2019). Roche Diagnostics also provided Nirmala Bhoo-Pathy with research material, namely COVID-19 total antibody kits. The author has no other competing interests to declare, JB research was supported by payments from Amgen, AstraZeneca, Bayer, Merck, Roche and Sanofi-Aventis to their institution, along with payments from non-profit organisations (Swedish Cancer Society and Knut Alice Wallenberg) and the Swedish Research Council. Also gave lectures to Astra Zeneca and Roche (no personal payment was received for these). Is a scientific advisor to The Medical product agency and to EMA, and is a representative of Swedish Breast Cancer Group. The author has no other competing interests to declare, JL coordinates a study on behalf of the Swedish IBD quality register (SWIBREG). This study has received funding from Janssen corporation. The author has no other competing interests to declare