运动与非转移性乳腺癌女性心血管事件风险

　　2016年5月23日，美国临床肿瘤学会（ASCO）官方期刊《临床肿瘤学杂志》在线发表美国纽约纪念斯隆·凯特林癌症中心（MSKCC）、凯撒医疗集团、国家航空航天局（NASA）约翰逊航天中心的研究报告，对2973例平均年龄57岁非转移性乳腺癌女性中位随访8.6年（范围：0.2～14.8年），结果发现业余休闲体育运动可显著降低非转移性乳腺癌女性心血管事件发生率，而且不受年龄、心血管病危险因素、绝经与否、抗癌治疗的影响。

J Clin Oncol. 2016 May 23. [Epub ahead of print]

Exercise and Risk of Cardiovascular Events in Women With Nonmetastatic Breast Cancer.

Lee W. Jones, Laurel A. Habel, Erin Weltzien, Adrienne Castillo, Dipti Gupta, Candyce H. Kroenke, Marilyn L. Kwan, Charles P. Quesenberry Jr, Jessica Scott, Barbara Sternfeld, Anthony Yu, Lawrence H. Kushi, Bette J. Caan.

Memorial Sloan Kettering Cancer Center, New York, NY; Kaiser Permanente, Oakland, CA; NASA Johnson Space Center, Houston, TX.

PURPOSE: Cardiovascular disease (CVD) is a leading cause of death among women with nonmetastatic breast cancer. Whether exercise is associated with reductions in CVD risk in patients with breast cancer with an elevated CVD risk phenotype is not known.

METHODS: Using a prospective design, women (n = 2,973; mean age, 57 years) diagnosed with nonmetastatic breast cancer participating in two registry-based, regional cohort studies, completed a questionnaire that assessed leisure-time recreational physical activity (metabolic equivalent task [MET]-h/wk). The primary end point was the first occurrence of any of the following: new diagnosis of coronary artery disease, heart failure, valve abnormality, arrhythmia, stroke, or CVD death, occurring after study enrollment.

RESULTS: Median follow-up was 8.6 years (range, 0.2 to 14.8 years). In multivariable analysis, the incidence of cardiovascular events decreased across increasing total MET-h/wk categories (Ptrend < .001). Compared with < 2 MET-h/wk, the adjusted hazard ratio was 0.91 (95% CI, 0.76 to 1.09) for 2 to 10.9 MET-h/wk, 0.79 (95% CI, 0.66 to 0.96) for 11 to 24.5 MET-h/wk, and 0.65 (95% CI, 0.53 to 0.80) for ≥ 24.5 MET-h/wk. Similar trends were observed for the incidence of coronary artery disease and heart failure (P values < .05). Adherence to national exercise guidelines for adult patients with cancer (ie, ≥ 9 MET-h/wk) was associated with an adjusted 23% reduction in the risk of cardiovascular events in comparison with not meeting the guidelines (< 9 MET-h/wk; P < .001). The association with exercise did not differ according to age, CVD risk factors, menopausal status, or anticancer treatment.

CONCLUSION: Exercise is associated with substantial, graded reductions in the incidence of cardiovascular events in women with nonmetastatic breast cancer.

DOI: 10.1200/JCO.2015.65.6603