Risk of death from cardiovascular disease following breast cancer in Southeast Asia: a prospective cohort study

Gernaat, Sofie A M; Ho, Peh Joo; Rijnberg, N; Lee, Soo‐Chin; Lim, Swee Ho; Yap, Yoon Sim; Grobbee, Diederick E.; Hartman, Mikael; Verkooijen, Helena M.

doi:10.1038/s41598-017-01540-7

Cited by 11 publications

(11 citation statements)

References 26 publications

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“…Cardiovascular disease (CVD) was the leading cause of death worldwide from 2006 through 2016, and several studies have assessed CVD mortality in cancer survivors . However, studies of mortality from other noncancer events are outdated or only report on deaths from specific causes, such as suicide and respiratory disease .…”

Section: Introductionmentioning

confidence: 99%

“…11 Cardiovascular disease (CVD) was the leading cause of death worldwide from 2006 through 2016, 12 and several studies have assessed CVD mortality in cancer survivors. [13][14][15][16][17] However, studies of mortality from other noncancer events are outdated 9 or only report on deaths from specific causes, such as suicide 14,15 and respiratory disease. 7,17 To the best of our knowledge, only 1 recent study from the United States reported the risk of death from specific noncancer events among patients with all cancers combined.…”

Section: Introductionmentioning

confidence: 99%

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Cardiovascular and other competing causes of death among patients with cancer from 2006 to 2015: An Australian population‐based study

Otáhal

Marwick

et al. 2018

Cancer

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Background With improved cancer survivorship, cardiovascular disease (CVD) and other noncancer events compete with cancer as the underlying cause of death, but the risks of mortality in competing‐risk settings have not been well characterized. Methods The authors identified 21,637 individuals who had a first cancer registered between 2006 and 2013, with follow‐up to 2015, in the Australian population‐based Tasmanian Cancer Registry. The cumulative incidence of deaths from specific competing events was assessed in competing‐risk analyses. Standardized mortality ratios (SMRs) and absolute excess risks (AERs) for deaths from noncancer causes were calculated for comparison with the general population. Results Overall, 8844 deaths were observed, with 1946 (22%) from competing events. The cumulative incidence of deaths from CVD increased significantly with age at first cancer diagnosis and exceeded other competing events at age ≥65 years. The risk of death from CVD was more common than expected in the first year of follow‐up (SMR, 1.44 [95% confidence interval, 1.26‐1.64]; AER, 36.8 per 10,000 person‐years). The SMR and AER for CVD deaths varied by first cancer site, indicating increased risks after a first diagnosis of lung cancer, hematologic malignancy, and urinary tract cancer. For other noncancer events, the SMRs increased significantly for deaths from infectious disease and respiratory disease and were highest in the first year of follow‐up. Conclusions CVD was the leading cause of competing mortality among Tasmanian patients with cancer who were diagnosed from 2006 to 2013. The higher than expected occurrence of death from CVD and other noncancer events during the first year after a cancer diagnosis highlights the importance of early preventive interventions.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cardiovascular and other competing causes of death among patients with cancer from 2006 to 2015: An Australian population‐based study

Otáhal

Marwick

et al. 2018

Cancer

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“…9 , 10 , 11 Although the Japan Breast Cancer Research Group (JBCRG) reported that the 3‐year cumulative incidence of trastuzumab‐related cardiotoxicity was only 0.54% among 2024 patients, in other single‐centre studies in Saudi Arabia, Singapore and China, 17 showed that the overall percentages of LVEF reduction ranged from 11.2 to 39.1%. 4 , 23 , 24 However, most of these studies had small sample sizes and lacked comparison groups. Notably, although a relative large portion of patents included in this study were premenopause and free from traditional cardiovascular risk factors, the incidence of trastuzumab‐related cardiotoxicity was not significantly different from that in the Western countries.…”

Section: Resultsmentioning

confidence: 99%

Risks of trastuzumab‐related cardiotoxicity in breast cancer patients in Taiwan

et al. 2021

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Aims In contrast to Western patients with breast cancer, Asian patients are relatively younger at diagnosis, and most are free from traditional cardiovascular risk factors. Despite trastuzumab‐related major adverse cardiac and cerebrovascular event (MACCE) being reported, its incidence and predictors remain unknown in Taiwan. Methods and results Through a three‐hospital retrospective cohort study, we analysed the incidence of MACCE in 386 breast cancer patients' exposure to trastuzumab from 2010 to 2018. To further reconfirm our findings, in a nationwide study using the Taiwanese National Health Insurance Research Database and National Cancer Registry, we identified 13 502 women diagnosed with breast cancer who received chemotherapy from 2010 to 2015 and found 6751 women who received initial treatment with trastuzumab. After 1:1 propensity score matching with trastuzumab non‐users, the incidence of MACCE was measured with a median follow‐up of 36 months. In the hospital‐based study, among 386 patients receiving trastuzumab, the 5‐year incidences of MACCE and heart failure (HF) were 5.4 and 2.8%, respectively. In the national cohort, the crude incidences of MACCEs and HF were 4.67 and 3.21%, respectively. After adjustment for age and comorbidities, the hazard ratio of MACCE was 1.485 (95% CI 1.246–1.769). Notably, among the endpoints, only the hazard ratio of HF was significantly higher in patients receiving trastuzumab than in nonusers. In the subgroup analysis, except for patients also using taxanes, those receiving trastuzumab had a higher risk of MACCE than non‐users. Conclusions From clinical observations in a nationwide cohort, we found an increased risk of MACCE, especially HF, in patients receiving trastuzumab. Given that its cardiotoxicity is independent of traditional cardiovascular risks, our findings highlight critical concerns regarding the cardiac safety of trastuzumab use.

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“…The 5-year survival rate for breast cancer has significantly increased over the last two to three decades in multiple countries including Korea , studies reveal that breast cancer survivors who received anthracycline-based chemotherapy have been identified with heart disease, referred to as cardiomyopathy, up to 4 to 20 years after the completion of chemotherapy 6,7 , contributing to a higher risk for cardiovascular disease (CVD) compared to non-cancer controls [8][9][10] . These disadvantageous elements can be furthered supplemented by the fact that adverse effects caused by cancer therapies, accompanied by preexisting comorbidities such as obesity 11 , hypertension 12 , and type 2 diabetes 13 , increase the risk of developing CVD in breast cancer survivors as well 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Clinical Exercise Prescription for Cardiovascular Health in Breast Cancer Survivors

Lee

2021

KJSM

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Conventional treatments accessible to breast cancer survivors after diagnosis include cancer therapies with cardiotoxic effects such as trastuzumab and/or anthracycline-based chemotherapy, which can result in undesirable cardiac injuries known as cancer therapy-induced cardiotoxicity. Cancer therapy-induced cardiotoxicity is among a variety of cardiovascular comorbidities responsible for increased mortality in cancer survivors, and when accompanied by preexisting cardiovascular comorbidities, this detrimental side effect becomes a major health concern. Breast cancer survivors may be predisposed to this additional concern due to preexisting comorbidities related to cardiovascular diseases such as obesity, hypertension, and type 2 diabetes. Research in the rapidly emerging field of study which focuses on improving cardiovascular health in cancer survivors, known as cardio-oncology, reveals that exercise can improve the aforementioned comorbidities in clinical settings. However, the evidence has not been comprehensively evaluated to prescribe exercise as a clinical therapeutic option to improve cardiovascular health in breast cancer survivors. Therefore, the purpose of this review is to summarize the current evidence on the effects of exercise on cardiovascular outcomes in women with breast cancer at three different time points; before, during, and after cancer therapy. In addition, current knowledge gaps and future directions in the field of exercise science and cardio-oncology will be addressed.

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Risk of death from cardiovascular disease following breast cancer in Southeast Asia: a prospective cohort study

Cited by 11 publications

References 26 publications

Cardiovascular and other competing causes of death among patients with cancer from 2006 to 2015: An Australian population‐based study

Cardiovascular and other competing causes of death among patients with cancer from 2006 to 2015: An Australian population‐based study

Risks of trastuzumab‐related cardiotoxicity in breast cancer patients in Taiwan

Clinical Exercise Prescription for Cardiovascular Health in Breast Cancer Survivors

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