Breast cancer patients treated with Anthracyclines at increased risk of HF: JAMA

Anthracyclines were linked to a higher risk of congestive heart failure (CHF), and the risk continued to increase over time, says an article published in the Journal of American Medical Association. 

Congestive heart failure risk is increased by anthracyclines, however population-based studies have not been able to establish the cumulative incidence over time or the risk factors for CHF following anthracycline treatment. In order to assess the long-term cumulative incidence of CHF in breast cancer or lymphoma patients treated with anthracycline treatment to healthy controls from the same population, Carolyn Larsen and colleagues conducted this study.

The Rochester Epidemiology Project was used to collect data for this retrospective population-based case-control research. With a final ratio of 1 case to 1.5 controls, participants comprised inhabitants of Olmsted County, Minnesota, who had been diagnosed with breast cancer or lymphoma between January 1985 and December 2010. Participants were matched for age, sex, and comorbidities with healthy controls. The period of statistical analysis was from July 2017 to February 2022. The primary outcome, according to the modified Framingham criteria, was new-onset CHF. In order to examine the risk of CHF in individuals with cancer vs. controls after adjusting for sex, age, diabetes, hyperlipidemia, hypertension, obesity, coronary artery disease, and smoking history, hazard ratios (HRs) were estimated using Cox proportional hazards regression.

The key findings of this study were:

812 cancer patients and 1384 healthy volunteers made up the total number of participants, which was 2196. 

The participants' average age (SD) was 52.62 (14.56) years, and 1704 (78%) of them were female. The case group's median (IQR) follow-up was 8.6 (5.2-13.4) years, while the control group was 12.5 (8.7-17.5) years. 

Even after accounting for factors such as gender, age, hypertension, diabetes, coronary artery disease, obesity, hyperlipidemia, and smoking status, patients with cancer still had a greater overall risk of CHF than the control group. 

Following the same factors' adjustments, CHF risk was higher for cancer patients who were getting anthracyclines and attenuated and lost statistical significance for cancer patients who were not.\

At 1 year, 5 years, 10 years, 15 years, and 20 years, patients receiving anthracyclines had higher cumulative incidence than the comparison cohort (P .001). 

Patients taking anthracycline at doses of less than 180 mg/m2, 180 to 250 mg/m2, or more than 250 mg/m2 did not significantly vary in their chance of developing CHF. 

Age was a standalone risk factor for CHF at the time of diagnosis.

This case-control study discovered that, compared to a matched control group, patients with a diagnosis of breast cancer or non-Hodgkin or Hodgkin lymphoma treated with anthracyclines had a significantly higher risk of CHF in the year following diagnosis and for up to 20 years after cancer diagnosis. Another major risk factor linked to CHF was age.

Reference: 

Larsen, C. M., Garcia Arango, M., Dasari, H., Arciniegas Calle, M., Adjei, E., Rico Mesa, J., Scott, C. G., Thompson, C. A., Cerhan, J. R., Haddad, T. C., Goetz, M. P., Herrmann, J., & Villarraga, H. R. (2023). Association of Anthracycline With Heart Failure in Patients Treated for Breast Cancer or Lymphoma, 1985-2010. In JAMA Network Open (Vol. 6, Issue 2, p. e2254669). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.54669