{"doi":"10.1093/jnci/djae107","title":"Long-term cardiovascular disease risk after anthracycline and trastuzumab treatments in US breast cancer survivors","abstract":"BACKGROUND: Although breast cancer survivors are at risk for cardiovascular disease (CVD) from treatment late effects, evidence to inform long-term and age-specific cardiovascular surveillance recommendations is lacking. METHODS: We conducted a retrospective cohort study of 10 211 women diagnosed with first primary unilateral breast cancer in Kaiser Permanente Washington or Colorado (aged 20 years and older, survived ≥1 year). We estimated multivariable adjusted hazard ratios (HRs) for associations between initial chemotherapy regimen type (anthracycline and/or trastuzumab, other chemotherapies, no chemotherapy [referent]) and CVD risk, adjusted for patient characteristics, other treatments, and CVD risk factors. Cumulative incidence was calculated considering competing events. RESULTS: After 5.79 median years, 14.67% of women developed CVD (cardiomyopathy and/or heart failure [HF], ischemic heart disease, stroke). Women treated with anthracyclines and/or trastuzumab had a higher risk of CVD compared with no chemotherapy (adjusted HR = 1.53, 95% confidence interval [CI] = 1.31 to 1.79), persisting at least 5 years postdiagnosis (adjusted HR5-<10 years = 1.85, 95% CI = 1.44 to 2.39; adjusted HR≥10 years = 1.83, 95% CI = 1.34 to 2.49). Cardiomyopathy and/or HF risks were elevated among women treated with anthracyclines and/or trastuzumab compared with no chemotherapy, especially for those aged younger than 65 years (adjusted HR20-54years = 2.97, 95% CI = 1.72 to 5.12; adjusted HR55-64years = 2.21, 95% CI = 1.52 to 3.21), differing for older women (adjusted HR≥65 years = 1.32, 95% CI = 0.97 to 1.78), and at least 5 years postdiagnosis (adjusted HR5-<10years = 1.89, 95% CI = 1.35 to 2.64; adjusted HR≥10 years = 2.21, 95% CI = 1.52 to 3.20). Anthracyclines and/or trastuzumab receipt was associated with increased ischemic heart disease risks after 5 or more years (adjusted HR5-<10years = 1.51, 95% CI = 1.06 to 2.14; adjusted HR≥10 years = 1.86, 95% CI = 1.18 to 2.93) with no clear age effects, and stroke risk (adjusted HR = 1.33, 95% CI = 1.05 to 1.69), which did not vary by time or age. There was some evidence of long-term cardiomyopathy and/or HF and ischemic heart disease risks with other chemotherapies. Among women aged younger than 65 treated with anthracyclines and/or trastuzumab, up to 16% developed CVD by 10 years (20-54 years = 6.91%; 55-64 years = 16.00%), driven by cardiomyopathy and/or HF (20-54 years = 3.90%; 55-64 years = 9.78%). CONCLUSIONS: We found increased long-term risks of cardiomyopathy and/or HF and ischemic heart disease among breast cancer survivors treated with anthracyclines and/or trastuzumab and increased cardiomyopathy and/or HF risk among women aged younger than 65 years.","journal":"JNCI Journal of the National Cancer Institute","year":2024,"id":418397,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":51,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9015,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2024-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":663913,"name":"Cody Ramin","orcid":"0000-0002-2007-2840","position":1,"is_corresponding":false},{"id":886670,"name":"Lene H. S. Veiga","orcid":"0000-0002-6537-1481","position":2,"is_corresponding":false},{"id":1187431,"name":"Carolyn Brandt","orcid":null,"position":3,"is_corresponding":false},{"id":310851,"name":"Rochelle E. Curtis","orcid":"0000-0002-7883-5652","position":4,"is_corresponding":false},{"id":33570,"name":"Clara Bodelón","orcid":"0000-0002-6578-2678","position":5,"is_corresponding":false},{"id":232179,"name":"Ana Barac","orcid":"0000-0002-9935-8904","position":6,"is_corresponding":false},{"id":270374,"name":"Véronique L. Roger","orcid":"0000-0002-9347-7865","position":7,"is_corresponding":false},{"id":611961,"name":"Heather Spencer Feigelson","orcid":"0000-0001-6691-3740","position":8,"is_corresponding":false},{"id":335036,"name":"Diana S.M. Buist","orcid":"0000-0001-5408-2804","position":9,"is_corresponding":false},{"id":441921,"name":"Erin J. Aiello Bowles","orcid":"0000-0001-6287-7391","position":10,"is_corresponding":false},{"id":302470,"name":"Gretchen L. Gierach","orcid":"0000-0002-0165-5522","position":11,"is_corresponding":false},{"id":251248,"name":"Amy Berrington de González","orcid":"0000-0002-7332-8387","position":12,"is_corresponding":false},{"id":672906,"name":"Jacqueline B. Vo","orcid":"0000-0001-8891-4437","position":0,"is_corresponding":true}],"reference_count":43,"raw_metadata":null,"created_at":"2026-07-19T01:57:02.483590Z","pmid":"38718210","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}