BACKGROUND Cardiovascular disease (CVD) is the leading cause of death among patients with early-stage breast cancer (BC), but adherence to cardiovascular disease risk factor (CVD-RF) medications is reported to be poor in BC survivors. The objective of the current study was to determine the association between nonadherence to CVD-RF medications and cardiovascular events in BC survivors. METHODS The authors included patients with stages I to III BC from the Surveillance, Epidemiology, and End Results (SEER)-Medicare database who had Medicare part D coverage and who were taking at least 1 CVD-RF medication prior to their BC diagnosis (2008-2013). Logistic regression was performed to define factors associated with nonadherence. Cox regression was used to calculate the association between nonadherence and new cardiac events after treatment. RESULTS Among 15,576 patients included in the current analysis, 4797 (30.8%) were nonadherent to at least 1 category after the initial BC treatment period. Black race, greater comorbidity burden, more advanced cancer stage, hormone receptor-negative status, and receipt of chemotherapy were found to be associated with nonadherence. Nonadherence after treatment demonstrated a trend toward an increased risk of a subsequent cardiac event (hazard ratio [HR], 1.15; 95% CI 1.00-1.33 [P = .06]). This effect size increased with nonadherence to a greater number of medications (P < .01). There was an increased risk of experiencing a cardiac event noted with becoming nonadherent to hypertension medications (HR, 1.33; 95% CI, 1.18-1.51 [P < .0001]), hyperlipidemia medications (HR, 1.21; 95% CI, 1.05-1.40 [P = .009]), and diabetes medications (HR, 1.31; 95% CI, 1.10-1.56 [P = .003]). CONCLUSIONS Nonadherence to CVD-RF medications after treatment of BC is associated with an increased risk of a cardiac event. Improving outcomes and reducing morbidity after a diagnosis of BC requires attention to non-BC conditions.

中文翻译：

---

乳腺癌诊断后不遵守心血管危险因素药物与心脏事件发生率之间的关联。

背景技术心血管疾病（CVD）是早期乳腺癌（BC）患者死亡的主要原因，但是据报道，在BC幸存者中对心血管疾病危险因子（CVD-RF）药物的依从性较差。本研究的目的是确定不坚持CVD-RF药物治疗与BC幸存者心血管事件之间的关系。方法作者包括来自监测，流行病学和最终结果（SEER）-Medicare数据库的具有I至III期BC期的患者，这些患者具有Medicare D部分的承保范围，并且在其BC诊断之前服用了至少一种CVD-RF药物（2008年） -2013）。进行逻辑回归以定义与不依从相关的因素。使用Cox回归来计算治疗后不依从性与新心脏事件之间的关联。结果在当前分析中包括的15576例患者中，有4797例（30.8％）在最初的BC治疗期后未坚持至少一种类别。黑人种族，更大的合并症负担，更晚期的癌症分期，荷尔蒙受体阴性状态以及接受化疗与不依从有关。治疗后的不依从性表现出随后发生心脏事件的风险增加的趋势（危险比[HR]为1.15； 95％CI 1.00-1.33 [P = .06]）。在不坚持使用更多药物的情况下，这种效应的大小会增加（P <.01）。出现心脏病事件的风险增加，原因是对高血压药物（HR，1.33; 95％CI，1.18-1.51 [P <.0001]），高脂血症药物（HR，1.21; 95％CI，1.05-）不依从1.40 [P = .009]和糖尿病药物（HR，1.31；95％CI，1.10-1.56 [P = .003]。结论BC治疗后不坚持CVD-RF药物治疗会增加心脏事件的风险。在诊断出BC后改善结局和降低发病率需要注意非BC疾病。