Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study
Abstract Background Cardiovascular toxicity concerns have limited the use of anthracyclines and trastuzumab among breast cancer patients with cardiovascular disease (CVD) but evidence on real-world prescribing patterns is scarce. We aimed to describe the use of these drugs in women with and without...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-06-01
|
| Series: | Cardio-Oncology |
| Online Access: | https://doi.org/10.1186/s40959-025-00356-z |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850207059289571328 |
|---|---|
| author | Helena Carreira Helen Strongman Maria Feychting Laila Hubbert Elham Hedayati Patrick Bidulka Anthony Matthews Krishnan Bhaskaran |
| author_facet | Helena Carreira Helen Strongman Maria Feychting Laila Hubbert Elham Hedayati Patrick Bidulka Anthony Matthews Krishnan Bhaskaran |
| author_sort | Helena Carreira |
| collection | DOAJ |
| description | Abstract Background Cardiovascular toxicity concerns have limited the use of anthracyclines and trastuzumab among breast cancer patients with cardiovascular disease (CVD) but evidence on real-world prescribing patterns is scarce. We aimed to describe the use of these drugs in women with and without CVD when diagnosed with non-metastatic breast cancer in Sweden. Methods Using Swedish national registers (2010–15), we identified breast cancer treatment and prior CVD from hospital and prescription data. We calculated prevalence of anthracycline and trastuzumab use in women with and without prior CVD, and estimated prevalence ratios (PR) comparing these groups, adjusted for age, stage, and other patient and tumour-related factors. Results Among 32,590 women with breast cancer, 10,702 (33%) had prior CVD. Anthracycline use was lower in those with vs without prior CVD (2,169/10,702 [20.3%] vs 8,654/21,888 [39.5%], crude PR 0.51, 0.49–0.53); the PR attenuated after adjustment for age and other factors (adj-PR 0.90, 0.87–0.93). There was substantial variation by type of CVD: patients with heart failure were much less likely to receive anthracyclines (adj-PR 0.46, 0.35–0.57) while prior venous thromboembolism (VTE) had no impact (adj-PR 0.98, 0.88–1.09). Among HER2 + patients, trastuzumab use showed similar patterns, with prevalence of 630/1,100 [57.3%] vs 2,279/2,866 [79.5%] for any vs no prior CVD (crude PR = 0.72, 0.68–0.76, adjusted PR = 0.95, 0.90–0.99); adjusted PRs for specific outcomes ranged from 0.77 (0.61–0.93) for heart failure, to 1.04 (0.92–1.15) for VTE. Conclusion While prior CVD was associated with lower use of potentially cardiotoxic breast cancer therapies, substantial numbers of patients with CVD still received these treatments, with marked variation by type of CVD. These real-world data suggest variable cardiovascular toxicity risk stratification before anticancer therapy and highlight the need for evidence-based guidance on negotiating the risk–benefit balance in these patients. |
| format | Article |
| id | doaj-art-38a4f7e30e92407b8d3f9b3aa426221f |
| institution | OA Journals |
| issn | 2057-3804 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardio-Oncology |
| spelling | doaj-art-38a4f7e30e92407b8d3f9b3aa426221f2025-08-20T02:10:38ZengBMCCardio-Oncology2057-38042025-06-0111111510.1186/s40959-025-00356-zUse of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional studyHelena Carreira0Helen Strongman1Maria Feychting2Laila Hubbert3Elham Hedayati4Patrick Bidulka5Anthony Matthews6Krishnan Bhaskaran7Electronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineElectronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineUnit of Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetDepartment of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping UniversityUnit of Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetElectronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineUnit of Epidemiology, Institute of Environmental Medicine, Karolinska InstitutetElectronic Health Records Research Group, Department of Non-Communicable Diseases Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical MedicineAbstract Background Cardiovascular toxicity concerns have limited the use of anthracyclines and trastuzumab among breast cancer patients with cardiovascular disease (CVD) but evidence on real-world prescribing patterns is scarce. We aimed to describe the use of these drugs in women with and without CVD when diagnosed with non-metastatic breast cancer in Sweden. Methods Using Swedish national registers (2010–15), we identified breast cancer treatment and prior CVD from hospital and prescription data. We calculated prevalence of anthracycline and trastuzumab use in women with and without prior CVD, and estimated prevalence ratios (PR) comparing these groups, adjusted for age, stage, and other patient and tumour-related factors. Results Among 32,590 women with breast cancer, 10,702 (33%) had prior CVD. Anthracycline use was lower in those with vs without prior CVD (2,169/10,702 [20.3%] vs 8,654/21,888 [39.5%], crude PR 0.51, 0.49–0.53); the PR attenuated after adjustment for age and other factors (adj-PR 0.90, 0.87–0.93). There was substantial variation by type of CVD: patients with heart failure were much less likely to receive anthracyclines (adj-PR 0.46, 0.35–0.57) while prior venous thromboembolism (VTE) had no impact (adj-PR 0.98, 0.88–1.09). Among HER2 + patients, trastuzumab use showed similar patterns, with prevalence of 630/1,100 [57.3%] vs 2,279/2,866 [79.5%] for any vs no prior CVD (crude PR = 0.72, 0.68–0.76, adjusted PR = 0.95, 0.90–0.99); adjusted PRs for specific outcomes ranged from 0.77 (0.61–0.93) for heart failure, to 1.04 (0.92–1.15) for VTE. Conclusion While prior CVD was associated with lower use of potentially cardiotoxic breast cancer therapies, substantial numbers of patients with CVD still received these treatments, with marked variation by type of CVD. These real-world data suggest variable cardiovascular toxicity risk stratification before anticancer therapy and highlight the need for evidence-based guidance on negotiating the risk–benefit balance in these patients.https://doi.org/10.1186/s40959-025-00356-z |
| spellingShingle | Helena Carreira Helen Strongman Maria Feychting Laila Hubbert Elham Hedayati Patrick Bidulka Anthony Matthews Krishnan Bhaskaran Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study Cardio-Oncology |
| title | Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study |
| title_full | Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study |
| title_fullStr | Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study |
| title_full_unstemmed | Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study |
| title_short | Use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in Sweden: a national cross-sectional study |
| title_sort | use of anthracyclines and trastuzumab for breast cancer in women with and without a history of cardiovascular disease in sweden a national cross sectional study |
| url | https://doi.org/10.1186/s40959-025-00356-z |
| work_keys_str_mv | AT helenacarreira useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT helenstrongman useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT mariafeychting useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT lailahubbert useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT elhamhedayati useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT patrickbidulka useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT anthonymatthews useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy AT krishnanbhaskaran useofanthracyclinesandtrastuzumabforbreastcancerinwomenwithandwithoutahistoryofcardiovasculardiseaseinswedenanationalcrosssectionalstudy |