Background 

Breast cancer (BC) survivors are at an increased risk of long-term cardiovascular disease (CVD), often attributed to cancer treatment. However, cancer treatment may also negatively impact health-related quality of life (HRQoL), a risk factor of CVD in the general population.

Objective 

We examined whether sleep disturbance, and physical or mental HRQoL were associated with CVD risk in BC survivors.

Methods 

We conducted a longitudinal analysis in the Women’s Health Initiative of postmenopausal women given a diagnosis of invasive BC during follow-up through 2010 with no history of CVD before BC. The primary outcome was incident CVD, defined as physician-adjudicated coronary heart disease or stroke, after BC. Physical and mental HRQoL, measured by the Short-Form 36 Physical and Mental Component Summary scores, and sleep disturbance, measured by the Women’s Health Initiative Insomnia Rating Scale, were recorded post BC. Time-dependent Cox proportional hazards models were used starting at BC diagnosis until 2010 or censoring and adjusted for relevant confounders.

Results 

In 2884 BC survivors, 157 developed CVD during a median follow-up of 9.5 years. After adjustment, higher Physical Component Summary scores were significantly associated with a lower risk of CVD (hazard ratio, 0.90 [95% confidence interval, 0.81-0.99]; per 5-point increment in Physical Component Summary). No associations with CVD were found for Mental Component Summary or Insomnia Rating Scale.

Conclusion 

In BC survivors, poor physical HRQoL is a significant predictor of CVD.

Implications for Practice 

Our findings highlight the importance for nurses to assess and promote physical HRQoL as part of a holistic approach to mitigating the risk of CVD in BC survivors.

中文翻译：

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绝经后乳腺癌幸存者的健康相关生活质量和睡眠障碍与心血管疾病风险的关联

背景 

乳腺癌（BC）幸存者患长期心血管疾病（CVD）的风险增加，这通常归因于癌症治疗。然而，癌症治疗也可能对健康相关的生活质量（HRQoL）产生负面影响，这是一般人群中心血管疾病的危险因素。

客观的 

我们检查了睡眠障碍、身体或精神 HRQoL 是否与 BC 幸存者的 CVD 风险相关。

方法 

我们在妇女健康倡议中对 2010 年随访期间被诊断为侵袭性 BC 且之前没有 CVD 病史的绝经后妇女进行了纵向分析。主要结局是 BC 后发生的 CVD，定义为医生判定的冠心病或中风。BC 后记录了身体和精神 HRQoL（通过简式 36 身体和精神成分汇总评分测量）和睡眠障碍（通过妇女健康倡议失眠评定量表测量）。从 BC 诊断开始直至 2010 年，使用时间依赖性 Cox 比例风险模型，或进行审查并针对相关混杂因素进行调整。

结果 

在 2884 名 BC 幸存者中，157 人在中位随访 9.5 年期间患上 CVD。调整后，较高的身体成分摘要分数与较低的 CVD 风险显着相关（风险比，0.90 [95% 置信区间，0.81-0.99]；身体成分摘要每增加 5 分）。精神成分总结或失眠评定量表未发现与 CVD 相关。

结论 

在 BC 幸存者中，较差的身体 HRQoL 是 CVD 的重要预测因素。

对实践的影响 

我们的研究结果强调了护士评估和促进身体 HRQoL 的重要性，作为降低 BC 幸存者 CVD 风险的整体方法的一部分。