{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T03:00:03Z","timestamp":1761102003177},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2012,3,15]],"date-time":"2012-03-15T00:00:00Z","timestamp":1331769600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2012,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To quantify incidence of cardiovascular outcomes in patients with advanced breast cancer receiving cardiotoxic and non\u2010cardiotoxic chemotherapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study identified all women at a Midwestern health system with initial diagnosis of American Joint Commission on Cancer Stage III\/IV breast cancer (1995\u20132003) and random sample of 50 women initially diagnosed with Stage I\/II who progressed to Stage III\/IV. The rate of new cardiovascular outcomes (heart failure, dysrhythmia, and ischemia events) for cardiotoxic (anthracycline or trastuzumab) and non\u2010cardiotoxic agents was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 315 patients, 90.5% (<jats:italic>n<\/jats:italic>\u2009=\u2009285) received systemic cancer therapy; 67.7% (<jats:italic>n<\/jats:italic>\u2009=\u2009193) received cardiotoxic drugs. Older patients were less likely to receive cardiotoxic agents (86.4%, \u226459\u2009years vs. 31.9%, 70+ years). Adjusting for age, race, stage, surgery\/radiation, estrogen receptor\/progesterone receptor status, and diagnosis year, rate of new cardiac events was higher in patients exposed to cardiotoxic drugs compared with those exposed to non\u2010cardiotoxic drugs (adjusted hazard ratio\u2009=\u20092.5, 95%CI = 0.9\u20137.2). Patients with cardiac event history (relative risk\u2009=\u20093.2, 95%CI = 2.0\u20135.1) and those with heart failure history (relative risk\u2009=\u20095.9, 95%CI = 2.4\u201314.6) were more likely to receive non\u2010cardiotoxic treatment. Heart failure events occurred steadily over time; after 3\u2009years of follow\u2010up, 16% exposed to cardiotoxic drugs experienced an event, and 8% of those exposed to non\u2010cardiotoxic drugs experienced an event.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with cardiac comorbidity are less likely to receive cardiotoxic agents. Use of cardiotoxic agents is common; treatment is related to patient and tumor characteristics and is associated with substantial risk of cardiotoxicity that persists during patients' remaining lifespan. Copyright \u00a9 2012 John Wiley &amp; Sons, Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.3239","type":"journal-article","created":{"date-parts":[[2012,3,15]],"date-time":"2012-03-15T09:43:16Z","timestamp":1331804596000},"page":"818-827","source":"Crossref","is-referenced-by-count":14,"title":["Cardiovascular outcomes in women with advanced breast cancer exposed to chemotherapy"],"prefix":"10.1002","volume":"21","author":[{"given":"Marianne Ulcickas","family":"Yood","sequence":"first","affiliation":[{"name":"EpiSource  Newton MA USA"},{"name":"Department of Public Health Sciences Henry Ford Hospital  Detroit MI USA"},{"name":"Department of Epidemiology Boston University School of Public Health  Boston MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen E.","family":"Wells","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Hospital  Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon Hensley","family":"Alford","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Hospital  Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather","family":"Dakki","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences Henry Ford Hospital  Detroit MI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annette B.","family":"Beiderbeck","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Analytics Abbott Laboratories  Rungis Cedex France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arti","family":"Hurria","sequence":"additional","affiliation":[{"name":"Cancer and Aging Research Program City of Hope Cancer Center  Duarte CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cary P.","family":"Gross","sequence":"additional","affiliation":[{"name":"Section of General Internal Medicine Yale University School of Medicine  New Haven CT USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan A.","family":"Oliveria","sequence":"additional","affiliation":[{"name":"EpiSource  Newton MA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2012,3,15]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"Breast Cancer Facts and Figures.2003.http:\/\/www.cancer.org(accessed April 15 2006)."},{"key":"e_1_2_10_3_1","unstructured":"National Health Interview Survey.2002.http:\/\/www.cdc.gov(accessed April 15 2006)."},{"key":"e_1_2_10_4_1","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9780511527081","volume-title":"The Cancer Chemotherapy Handbook","author":"Fischer D","year":"2003"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-125-1-199607010-00008"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-91-5-710"},{"key":"e_1_2_10_7_1","first-page":"23","article-title":"The cardiotoxicity of anticancer agents","volume":"9","author":"Von Hoff D","year":"1982","journal-title":"Semin Oncol"},{"key":"e_1_2_10_8_1","first-page":"529","article-title":"The cardiotoxicity of chemotherapeutic drugs","volume":"19","author":"Allen A","year":"1992","journal-title":"Semin Oncol"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11407"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199856030-00009"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.02.5841"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2006.10.4976"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.breast.2003.09.002"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1158\/1078-0432.CCR-07-1033"},{"key":"e_1_2_10_15_1","unstructured":"National Comprehensive Cancer Network.NCCN Task Force Report: Breast Cancer in Older Women Hollywood FL; 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