The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study

Abstract

Background Data are limited regarding the risk of heart failure (HF) requiring hospital-based care after early stage breast cancer (EBC) and its relationship to other types of cardiovascular disease (CVD). Methods We conducted a population-based, retrospective cohort study of EBC patients (diagnosed April 1, 2005–March 31, 2015) matched 1:3 on birth-year to cancer-free control subjects. We identified hospitalizations and emergency department visits for CVD through March 31, 2017. We used cumulative incidence function curves to estimate CVD incidence and cause-specific regression models to compare CVD rates between cohorts. All statistical tests were two-sided. Results We identified 78 318 EBC patients and 234 954 control subjects. The 10-year incidence of CVD hospitalization was 10.8% (95% confidence interval [CI] = 10.5% to 11.1%) after EBC and 9.1% (95% CI = 8.9% to 9.2%) in control subjects. Ischemic heart disease was the most common reason for CVD hospitalization after EBC. After regression adjustment, the relative rates compared with control subjects remained statistically significantly elevated for HF (hazard ratio [HR] = 1.21, 95% CI = 1.14 to 1.29, P < .001), arrhythmias (HR = 1.31, 95% CI = 1.23 to 1.39, P < .001), and cerebrovascular disease (HR 1.10, 95% CI = 1.04 to 1.17, P = .002) hospitalizations. It was rare for HF hospital presentations (2.9% of cases) to occur in EBC patients without recognized risk factors (age >60 years, hypertension, diabetes, prior CVD). Anthracycline and/or trastuzumab were used in 28 950 EBC patients; they were younger than the overall cohort with lower absolute rates of CVD, hypertension, and diabetes. However, they had higher relative rates of CVD in comparison with age-matched control subjects. Conclusions Atherosclerotic diagnoses, rather than HF, were the most common reasons for CVD hospitalization after EBC. HF hospital presentations were often preceded by risk factors other than chemotherapy, suggesting potential opportunities for prevention.

Cardiovascular Disease in Women with Breast Cancer – A Nationwide Registry Study

“…Contrary to our results, Abel-Qadir et al [11] found that the prevalence of different types of CVD was signi cantly higher in BC patients compared to cancerfree controls. A possible explanation for this discrepancy could be that Abel-Qadir et al used different algorithms to determine the presence of CVD preceding the index date.…”

“…Abel-Qadir et al [11] found a signi cantly higher incidence of CVD hospitalizations due to heart failure, cerebrovascular disease and arrhythmias in BC patients compared to cancer-free controls whereas we did not nd this for cerebrovascular disease or arrhythmias. In accordance with our results, Strongman et al [12] found a statistically signi cantly higher incidence of heart failure and venous thromboembolism in BC patients compared to cancer-free controls, but not signi cant differences in the incidence of arrhythmia, stroke or peripheral vascular disease.…”

Evolution of Physical Status From Diagnosis to the End of First-Line Treatment in Breast, Lung, and Colorectal Cancer Patients: The PROTECT-01 Cohort Study Protocol

“…For example, the prevalence of cachexia is high (~50%) and greater in lung or colorectal cancers compared to breast cancer ( 3 ). Therefore, resistance training may be of particular interest for lung or colorectal cancer patients, while breast cancer patients may get more health benefits from aerobic exercise to focus on cardiovascular outcomes ( 9 , 50 ). However, it should be emphasized that this speculation is done without a global and comparative approach, which is needed for such a conclusion.…”

“…This variability appears to be accountable for the lack of tailored exercise interventions ( 49 ) and occurs due to the large number of parameters that influence the effects of exercise prescribed to patients: the type and stage of cancer, the type of treatment, and the physical status at the time of diagnosis. For example, lung cancer patients present a higher risk of cachexia, whereas breast cancer patients present a higher risk of heart failure ( 9 , 50 ). All these different parameters, and their evolution throughout treatment, should be considered in prescribing the best exercise strategies on an individual basis, as opposed to generic exercise programs.…”

Major Adverse Cardiovascular Events after Treatment in Early-stage Breast Cancer Patients Receiving Hormone Therapy

“…In few cases, antimetabolite drugs, such as 5-fluorouracil, are related to myocardial infarction, heart failure, and arrhythmias 21 . A matched cohort study from Canada examining the risk of cardiovascular hospitalisation and heart failure demonstrated that the10-year incidence of cardiovascular disease hospitalisation was 10.8% for patients with breast cancer; moreover, 37% of their study population received anthracyclines and/or trastuzumab and the relative rate of cardiovascular disease was higher compared to their age-matched subjects 22 . In our study, we excluded those who received trastuzumab to simplify the division of the patients into four adjuvant groups that represented the majority of the breast cancer population.…”