Author: Lynda Williams
medwireNews: Patients who receive an anthracycline during treatment for breast cancer or lymphoma are more than three times as likely to develop congestive heart failure (CHF) than healthy individuals, indicates a case–control study published in JAMA Network Open.
“Further prospective studies are required to balance the potential benefits of anthracycline vs the cardiovascular risks and to develop surveillance models and susceptibility indexes”, write Hector Villarraga (Mayo Clinic, Rochester, Minnesota, USA) and co-authors.
To better quantify the established risk of CHF following anthracycline therapy, the team collated information for 812 people who were diagnosed with breast cancer or lymphoma between 1984 and 2010 and 1384 people without cancer matched by age, sex and comorbidity, all of whom were resident in Olmsted County, Minnesota. The patient and control groups were followed up for a median of 8.6 and 12.5 years, respectively.
The patients with cancer were a significant 2.86 times more likely than controls to be diagnosed with CHF according to modified Framingham criteria after adjusting for age, sex, diabetes, hypertension, coronary artery disease, hyperlipidemia, obesity and smoking status.
Moreover, patients who received anthracycline therapy continued to have a significantly greater risk of CHF than controls after adjustment for confounding factors, whereas patients who were not given doxorubicin or similar had a nonsignificant risk increase (hazard ratios=3.25 and 1.78, respectively).
Villarraga and co-authors note that anthracycline-treated patients had a significantly higher cumulative incidence of CHF than controls from 1 year of follow-up (1.81 vs 0.09%), and this pattern continued until at least 20 years of follow-up (10.75 vs 4.98%).
However, contrary to earlier research indicating a dose–response relationship between anthracycline use and CHF, the investigators found no significant difference in the risk of CHF between patients given an cumulative doxorubicin or equivalent dose of less than 180 mg/m2, 180–250 mg/m2 or more than 250 mg/m2.
The author of an invited commentary notes that the case–control study has several limitations, such as lack of patient diversity, and the use of the modified Framingham criteria for CHF, “which relies predominantly on symptoms and physical examination findings, as opposed to diagnostic testing.”
Nevertheless, Michael Fradley (University of Pennsylvania, Philadelphia, USA) observes that the study population included individuals with or without a reduced left ventricular ejection fraction and that baseline use of cardioprotective drugs, such as beta blockers or statins, did not prevent the development of CHF.
He concludes: “It is essential that we better understand the mechanism of anthracycline-associated cardiac dysfunction to offer better surveillance and management recommendations”.
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This independent news story was supported by an educational grant from L’Institut Servier, Suresnes, France.
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