编者按：乳腺癌患者死亡的主要原因并非乳腺癌，而是心血管病，尤其对于老年女性。不过，心血管病风险因素（糖尿病、高血压、高胆固醇血症、冠状动脉病）与心脏事件和长期生存的相关性尚不明确。
2018年3月27日，美国临床肿瘤学会《临床肿瘤学杂志》在线发表纽约哥伦比亚大学医学中心、西雅图华盛顿大学弗雷德·哈钦森癌症研究中心的研究报告，调查了西南肿瘤协作组（SWOG）临床研究入组乳腺癌患者心血管病风险因素与心脏事件和生存结局的相关性。
该研究将1999～2011年SWOG开展的乳腺癌研究记录与联邦医疗保险索赔数据库进行关联，确定患者入组时的糖尿病、高血压、高胆固醇血症、冠状动脉病，主要结局为总生存，次要结局为无进展生存、无癌症生存，并对患者入组时和随访索赔时的心脏事件进行调查，通过多因素比例风险回归分析，对心血管病风险因素与结局之间的相关性进行评定。
结果，根据5项研究确定≥66岁患者1460例，其中符合生存结局分析条件患者842例。患者入组时中位年龄70岁，中位随访时间6年。
高血压（73%）和高胆固醇血症（57%）发生率最高，87%的患者有一种或多种心血管病风险因素。
任何单一心血管病风险因素与总生存之间均无显著相关性，除了高胆固醇血症与总生存改善显著相关：
死亡风险减少27%（风险比：0.73，95%置信区间：0.57～0.93，P=0.01）
进展风险减少20%（风险比：0.80，95%置信区间：0.65～0.99，P=0.04）
癌症风险减少24%（风险比：0.76，95%置信区间：0.57～1.00，P=0.05）
心血管病风险因素数量与总生存显著相关，心血管病风险因素每增加一种：
死亡风险增加23%（风险比：1.23，95%置信区间：1.08～1.40，P=0.002）
进展风险增加12%（风险比：1.12，95%置信区间：1.00～1.25，P=0.05）
癌症风险增加15%（风险比：1.15，95%置信区间：0.99～1.34；P=0.07）
根据对736例患者入组时心血管病风险因素与心脏事件之间的相关性分析，可见心血管病风险因素数量与心脏事件显著成正比，心血管病风险因素每增加一种，心脏事件风险增加41%（风险比：1.41，95%置信区间：1.17～1.69，P＜0.001）。
因此，对于这些临床研究参与者，入组时心血管病风险因素数量增加，与心脏事件和死亡风险增加相关，需要努力加强控制能够改变的心血管病风险因素，尤其对于具有多种风险因素的人群。
J Clin Oncol. 2018 Mar 27. [Epub ahead of print]
Association of Cardiovascular Risk Factors With Cardiac Events and Survival Outcomes Among Patients With Breast Cancer Enrolled in SWOG Clinical Trials.
Dawn L. Hershman, Cathee Till, Sherry Shen, Jason D. Wright, Scott D. Ramsey, William E. Barlow, Joseph M. Unger.
Columbia University Medical Center, New York, NY; Fred Hutchinson Cancer Research Center, Seattle, WA.
BACKGROUND: Cardiovascular disease is the primary cause of death among patients with breast cancer. However, the association of cardiovascular-disease risk factors (CVD-RFs) with long-term survival and cardiac events is not well studied.
METHODS: We examined SWOG (formerly the Southwest Oncology Group) breast cancer trials from 1999 to 2011. We identified baseline diabetes, hypertension, hypercholesterolemia, and coronary artery disease by linking trial records to Medicare claims. The primary outcome was overall survival. Patients with both baseline and follow-up claims were examined for cardiac events. Cox regression was used to assess the association between CVD-RFs and outcomes.
RESULTS: We identified 1,460 participants older than 66 years of age from five trials; 842 were eligible for survival outcomes analysis. At baseline, median age was 70 years, and median follow-up was 6 years. Hypertension (73%) and hypercholesterolemia (57%) were the most prevalent conditions; 87% of patients had one or more CVD-RF. There was no association between any of the individual CVD-RFs and overall survival except for hypercholesterolemia, which was associated with improved overall survival (hazard ratio [HR], 0.73; 95% CI, 0.57 to 0.93; P = .01). With each additional CVD-RF, there was an increased risk of death (HR, 1.23; 95% CI, 1.08 to 1.40; P = .002), worse progression-free survival (HR, 1.12; 95% CI, 1.00 to 1.25; P = .05), and marginally worse cancer-free survival (HR, 1.15; 95% CI, 0.99 to 1.34; P = .07). The relationship between baseline CVD-RFs and cardiac events was analyzed in 736 patients. A strong linear association between the number of CVD-RFs and cardiac event was observed (HR per CVD-RF, 1.41; 95% CI, 1.17 to 1.69; P < .001).
CONCLUSION: Among participants in clinical trials, each additional baseline CVD-RF was associated with an increased risk of cardiac events and death. Efforts to improve control of modifiable CVD-RFs are needed, especially among those with multiple risk factors.
PMID: 29584550
DOI: 10.1200/JCO.2017.77.4414
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