Distinct risk profiles of heart failure and non-heart failure major adverse cardiovascular events among patients with early breast cancer: a competing-risk analysis
5 affiliations
- 1Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan
- 2Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551 Japan
- 3Department of Perioperative and Critical Care Management, Hiroshima University, Hiroshima, Japan
- 4Department of Cardiovascular Medicine, Hiroshima University, Hiroshima, Japan
- 5Department of Breast Surgery, Hiroshima University Hospital, Hiroshima, Japan
Abstract
Background: Cardiovascular complications are increasingly recognized among patients with breast cancer; however, heart failure has been the primary focus of studies to date. We aimed to evaluate the cumulative incidence of heart failure and other major adverse cardiovascular events among patients with early breast cancer and to identify risk factors.
Methods: We conducted a retrospective cohort study of patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center during 2010–2019. The endpoints were heart failure and other major adverse cardiovascular events (stroke, atrial fibrillation, myocardial infarction, or cardiovascular death). The cumulative incidence was estimated using the cumulative incidence function, and risk factors were evaluated using Fine–Gray competing-risk regression models. Breast cancer recurrence and non-cardiovascular event-related death were treated as competing events.
Results: Over a median follow-up of 7.7 years, heart failure occurred in 24/1,328 (1.8%) patients, whereas other major adverse cardiovascular events occurred in 38 (2.9%). The cumulative incidence of heart failure differed according to perioperative systemic therapy (p = 0.002). Anthracycline use (subdistribution hazard ratio, 2.67; 95% confidence interval, 1.08–6.65; p = 0.034) and trastuzumab use (2.52; 1.00–6.33; p = 0.050) were independently associated with heart failure. By contrast, other major adverse cardiovascular events were associated with age (> 65 years; 3.75; 1.59–8.88; p = 0.003) and cardiovascular risk factors (4.02; 1.77–9.10; p < 0.001).
Conclusions: Heart failure was primarily associated with cardiotoxic cancer therapies, and other events by patient-related cardiovascular risk factors. These findings highlight the importance of integrating cardiotoxicity surveillance with long-term cardiovascular risk management in breast cancer survivorship.
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BibTeX
@article{shigematsu2026distinct,
title = {{Distinct risk profiles of heart failure and non-heart failure major adverse cardiovascular events among patients with early breast cancer: a competing-risk analysis}},
author = {Hideo Shigematsu and Atsuyoshi Norishige and Kazuaki Tanabe and Hiroyuki Sawatari and Yukiko Nakano and Ai Amioka and Daiki Okamoto and Sakiko Hino and Haruka Ikejiri and Shinsuke Sasada and Morihito Okada},
journal = {International Journal of Clinical Oncology},
year = {2026},
month = sep,
doi = {10.1007/s10147-026-03200-1},
url = {https://doi.org/10.1007/s10147-026-03200-1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Distinct risk profiles of heart failure and non-heart failure major adverse cardiovascular events among patients with early breast cancer: a competing-risk analysis
AU - Hideo Shigematsu
AU - Atsuyoshi Norishige
AU - Kazuaki Tanabe
AU - Hiroyuki Sawatari
AU - Yukiko Nakano
AU - Ai Amioka
AU - Daiki Okamoto
AU - Sakiko Hino
AU - Haruka Ikejiri
AU - Shinsuke Sasada
AU - Morihito Okada
PY - 2026
DA - 2026/09/15
JO - International Journal of Clinical Oncology
DO - 10.1007/s10147-026-03200-1
UR - https://doi.org/10.1007/s10147-026-03200-1
AB - Background: Cardiovascular complications are increasingly recognized among patients with breast cancer; however, heart failure has been the primary focus of studies to date. We aimed to evaluate the cumulative incidence of heart failure and other major adverse cardiovascular events among patients with early breast cancer and to identify risk factors. Methods: We conducted a retrospective cohort study of patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center during 2010–2019. The endpoints were heart failure and other major adverse cardiovascular events (stroke, atrial fibrillation, myocardial infarction, or cardiovascular death). The cumulative incidence was estimated using the cumulative incidence function, and risk factors were evaluated using Fine–Gray competing-risk regression models. Breast cancer recurrence and non-cardiovascular event-related death were treated as competing events. Results: Over a median follow-up of 7.7 years, heart failure occurred in 24/1,328 (1.8%) patients, whereas other major adverse cardiovascular events occurred in 38 (2.9%). The cumulative incidence of heart failure differed according to perioperative systemic therapy (p = 0.002). Anthracycline use (subdistribution hazard ratio, 2.67; 95% confidence interval, 1.08–6.65; p = 0.034) and trastuzumab use (2.52; 1.00–6.33; p = 0.050) were independently associated with heart failure. By contrast, other major adverse cardiovascular events were associated with age (> 65 years; 3.75; 1.59–8.88; p = 0.003) and cardiovascular risk factors (4.02; 1.77–9.10; p < 0.001). Conclusions: Heart failure was primarily associated with cardiotoxic cancer therapies, and other events by patient-related cardiovascular risk factors. These findings highlight the importance of integrating cardiotoxicity surveillance with long-term cardiovascular risk management in breast cancer survivorship.
SN - 1341-9625
SN - 1437-7772
ER -