Associations of age at diagnosis of breast cancer with incident myocardial infarction and heart failure: A prospective cohort study
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, China
- Clinical Research Institute, Institute of Advanced Clinical Medicine, Peking University, China
- Peking University First Hospital, China
- Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, China
Figures
Figure 1 with 14 supplements
Flow chart of participant selection for this study.
Figure 1—figure supplement 1
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age <50 and their controls by using Cox proportional hazards models (n = 10,696).
Figure 1—figure supplement 2
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age 50–59 and their controls by using Cox proportional hazards models (n = 22,548).
Figure 1—figure supplement 3
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age ≥60 and their controls by using Cox proportional hazards models (n = 31,720).
Figure 1—figure supplement 4
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident heart failure in breast cancer participants diagnosed at age <50 and their controls by using Cox proportional hazards models (n = 10,696).
Figure 1—figure supplement 5
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident heart failure in breast cancer participants diagnosed at age 50–59 and their controls by using Cox proportional hazards models (n = 22,548).
Figure 1—figure supplement 6
Subgroup analyses to identify potential modifying effects from covariates on the associations between breast cancer and incident heart failure in breast cancer participants diagnosed at age ≥60 and their controls by using Cox proportional hazards models (n = 31,720).
Figure 1—figure supplement 7
Cubic spline curves of the association between diagnosis age of breast cancer and incident myocardial infarction.
Figure 1—figure supplement 8
Cubic spline curves of the association between diagnosis age of breast cancer and incident heart failure.
Figure 1—figure supplement 9
Kaplan–Meier curves of the association between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age <50 and their controls (n = 10,696).
Figure 1—figure supplement 10
Kaplan–Meier curves of the association between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age 50–59 and their controls (n = 22,548).
Figure 1—figure supplement 11
Kaplan–Meier curves of the association between breast cancer and incident myocardial infarction in breast cancer participants diagnosed at age ≥60 and their controls (n = 31,720).
Figure 1—figure supplement 12
Kaplan–Meier curves of the association between breast cancer and incident heart failure in breast cancer participants diagnosed at age <50 and their controls (n = 10,696).
Figure 1—figure supplement 13
Kaplan–Meier curves of the association between breast cancer and incident myocardial infarction in participants with heart failure diagnosed at age 50–59 and their controls (n = 22,548).
Figure 1—figure supplement 14
Kaplan–Meier curves of the association between breast cancer and incident heart failure in breast cancer participants diagnosed at age ≥60 and their controls (n = 31,720).
Tables
Table 1
Baseline characteristics of the study participants by whether they had a history of breast cancer at baseline or incident breast cancer during follow-up (n = 251,277).
| Characteristic | Breast cancer (n = 16,241) | Non-breast cancer (n = 235,036) | Effect size* |
|---|---|---|---|
| Age (years) | 58.9 ± 7.3 | 56.7 ± 8.0 | 0.275 |
| White | 15,619 (96.2) | 221,292 (94.2) | 0.021 |
| Higher education | 7571 (46.6) | 109,362 (46.5) | <0.001 |
| Current smoking | 1390 (8.6) | 20,764 (8.8) | –0.002 |
| Current drinking | 10,451 (64.4) | 146,679 (62.4) | 0.010 |
| Obesity | 3934 (24.2) | 54,321 (23.1) | 0.007 |
| Exercise | 12,506 (77.0) | 182,852 (77.8) | –0.005 |
| SBP, mmHg | 137.4 ± 19.4 | 135.1 ± 19.2 | 0.118 |
| DBP, mmHg | 81.4 ± 9.9 | 80.7 ± 10.0 | 0.065 |
| HbA1c, % | 3.63 ± 0.60 | 3.57 ± 0.59 | 0.093 |
| TC, mmol/L | 5.95 ± 1.14 | 5.88 ± 1.12 | 0.060 |
| HDL-C, mmol/L | 1.60 ± 0.38 | 1.59 ± 0.38 | 0.008 |
| LDL-C, mmol/L | 3.67 ± 0.88 | 3.63 ± 0.87 | 0.049 |
| Depressed mood | 778 (4.8) | 12,351 (5.3) | –0.005 |
| Hypertension | 8643 (53.2) | 112,667 (47.9) | 0.026 |
| Diabetes | 795 (4.9) | 9883 (4.2) | 0.008 |
| Antihypertensive drug use | 3203 (19.7) | 39,767 (16.9) | 0.018 |
| Antidiabetic drug use | 449 (2.8) | 5628 (2.4) | 0.006 |
| Statin use | 1885 (11.6) | 24,502 (10.4) | 0.010 |
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The results are presented as the mean ± standard deviation or no. (%).
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*
The effect sizes are standardized mean differences for continuous outcomes and the Phi coefficient for dichotomous outcomes.
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SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycated hemoglobin; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol.
Table 2
Associations of breast cancer with incident myocardial infarction and heart failure (n = 251,277).
| Outcome | HR (95% CI)Breast cancer vs. non-breast cancer | p-Value |
|---|---|---|
| Myocardial infarction | ||
| Model 1* | 0.84 (0.74–0.95) | 0.005 |
| Model 2† | 0.83 (0.73–0.94) | 0.002 |
| Heart failure | ||
| Model 1* | 1.24 (1.12–1.27) | <0.001 |
| Model 2† | 1.20 (1.09–1.33) | <0.001 |
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HR, hazard ratio; CI, confidence interval.
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*
Adjusted for age, ethnicity, and education.
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†
Further adjusted for current smoking, current drinking, obesity, exercise, low-density lipoprotein cholesterol, depressed mood, hypertension, diabetes, antihypertensive drug use, antidiabetic drug use, and statin use.
Table 3
Associations of age at diagnosis of breast cancer with incident myocardial infarction and heart failure among breast cancer participants (n = 16,241).
| Outcome | HR (95% CI)* | p-Value |
|---|---|---|
| Myocardial infarction | ||
| ≥60 years (n = 7930) | Reference | / |
| 50–59 years (n = 5637) | 1.05 (0.78–1.40) | 0.750 |
| <50 years (n = 2674) | 2.20 (1.54–3.15) | <0.001 |
| Per 10-year decrease | 1.36 (1.19–1.56) | <0.001 |
| Heart failure | ||
| ≥60 years (n = 7930) | Reference | / |
| 50–59 years (n = 5637) | 1.32 (1.07–1.64) | 0.010 |
| <50 years (n = 2674) | 1.68 (1.22–2.31) | 0.001 |
| Per 10-year decrease | 1.31 (1.18–1.46) | <0.001 |
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*
Adjusted for age, ethnicity, education, current smoking, current drinking, obesity, exercise, low-density lipoprotein cholesterol, depressed mood, hypertension, diabetes, antihypertensive drug use, antidiabetic drug use, and statin use.
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HR, hazard ratio; CI, confidence interval.
Table 4
Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups after propensity score matching (n = 64,964).
| Outcome | HR (95% CI)*Breast cancer vs. non-breast cancer | p-Value |
|---|---|---|
| Myocardial infarction | ||
| ≥60 years (n = 31,720) | 0.75 (0.63–0.89) | 0.001 |
| 50–59 years (n = 22,548) | 0.75 (0.58–0.97) | 0.028 |
| <50 years (n = 10,696) | 1.75 (1.21–2.52) | 0.003 |
| Heart failure | ||
| ≥60 years (n = 31,720) | 1.03 (0.90–1.19) | 0.650 |
| 50–59 years (n = 22,548) | 1.38 (1.13–1.69) | 0.002 |
| <50 years (n = 10,696) | 2.21 (1.55–3.17) | <0.001 |
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*
Adjusted for age, ethnicity, education, current smoking, current drinking, obesity, exercise, low-density lipoprotein cholesterol, depressed mood, hypertension, diabetes, antihypertensive drug use, antidiabetic drug use, and statin use.
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HR, hazard ratio; CI, confidence interval.
Additional files
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Supplementary file 1
STROBE Statement—Checklist, ascertainment of variables, comparison of baseline characteristics by breast cancer status after propensity score matching, sensitivity analysis, and comparison of baseline characteristics between participants included and excluded.
(A) STROBE Statement—Checklist of items that should be included in reports of cohort studies. (B) Ascertainment of breast cancer and age at breast cancer diagnosis. (C) Ascertainment of myocardial infarction and heart failure. (D) Definition and assessment of covariates. (E) Baseline characteristics of participants by breast cancer status after propensity score matching (n = 64,964). (F) Associations of age at breast cancer diagnosis with incident myocardial infarction and heart failure among breast cancer participants: competing risk models (n = 16,241). (G) Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups after propensity score matching: competing risk models (n = 64,964). (H) Associations of age at breast cancer diagnosis with incident myocardial infarction and heart failure among breast cancer participants after excluding myocardial infarction and heart failure diagnosed within 5 years since baseline (n = 15,589). (I) Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups after excluding myocardial infarction and heart failure diagnosed within 5 years since baseline, results from propensity score matching analyses (n = 62,356). (J) Associations of age at breast cancer diagnosis with incident myocardial infarction and heart failure among breast cancer participants after excluding participants aged <50 years at baseline (n = 14,000). (K) Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups after excluding participants aged <50 years at baseline, results from propensity score matching analyses (n = 56,000). (L) Associations of age at breast cancer diagnosis with incident myocardial infarction and heart failure among breast cancer participants when the follow-up period ends on December 31, 2019 (n = 15,909). (M) Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups when the follow-up period ends on December 31, 2019, results from propensity score matching analyses (n = 63,636). (N) Associations of age at breast cancer diagnosis with incident myocardial infarction and heart failure among breast cancer participants after further adjusting for menopausal status, breast cancer surgery, and hormone replacement therapy (n = 16,241). (O) Associations of breast cancer with incident myocardial infarction and heart failure among different diagnosis age groups after further adjusting for menopausal status, breast cancer surgery, and hormone replacement therapy, results from propensity score matching analyses (n = 64,964). (P) Comparison of baseline characteristics between participants included (n = 251,277) and excluded due to history of myocardial infarction or heart failure, without complete data on low-density lipoprotein cholesterol, or having myocardial infarction or heart failure before breast cancer at follow-ups (n = 22,048).
- https://cdn.elifesciences.org/articles/95901/elife-95901-supp1-v1.docx
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MDAR checklist
- https://cdn.elifesciences.org/articles/95901/elife-95901-mdarchecklist1-v1.docx
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Associations of age at diagnosis of breast cancer with incident myocardial infarction and heart failure: A prospective cohort study
eLife 13:RP95901.
https://doi.org/10.7554/eLife.95901.3
