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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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of patients with non-metastatic breast cancer who underwent curative surgery at a tertiary center during 2010\u20132019. 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\u2013Gray competing-risk regression models. Breast cancer recurrence and non-cardiovascular event-related death were treated as competing events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      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 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Anthracycline use (subdistribution hazard ratio, 2.67; 95% confidence interval, 1.08\u20136.65;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.034) and trastuzumab use (2.52; 1.00\u20136.33;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.050) were independently associated with heart failure. By contrast, other major adverse cardiovascular events were associated with age (&gt;\u200965 years; 3.75; 1.59\u20138.88;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003) and cardiovascular risk factors (4.02; 1.77\u20139.10;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10147-026-03200-1","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T11:29:43Z","timestamp":1789471783000},"page":"2803-2811","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"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"],"prefix":"10.1007","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9393-9655","authenticated-orcid":false,"given":"Hideo","family":"Shigematsu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsuyoshi","family":"Norishige","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuaki","family":"Tanabe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroyuki","family":"Sawatari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yukiko","family":"Nakano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ai","family":"Amioka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daiki","family":"Okamoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakiko","family":"Hino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruka","family":"Ikejiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Sasada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morihito","family":"Okada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"3200_CR1","doi-asserted-by":"publisher","first-page":"e074684","DOI":"10.1136\/bmj-2022-074684","volume":"381","author":"C Taylor","year":"2023","unstructured":"Taylor C, McGale P, Probert J, Broggio J, Charman J, Darby SC, Kerr AJ, Whelan T, Cutter DJ, Mannu G, Dodwell D (2023) Breast cancer mortality in 500 000 women with early invasive breast cancer diagnosed in England, 1993\u20132015: population based observational cohort study. 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Ann Oncol 36:1356\u20131365. https:\/\/doi.org\/10.1016\/j.annonc.2025.08.002","journal-title":"Ann Oncol"}],"container-title":["International Journal of Clinical Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03200-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10147-026-03200-1","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10147-026-03200-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T04:48:22Z","timestamp":1792990102000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10147-026-03200-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":32,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["3200"],"URL":"https:\/\/doi.org\/10.1007\/s10147-026-03200-1","relation":{},"ISSN":["1341-9625","1437-7772"],"issn-type":[{"value":"1341-9625","type":"print"},{"value":"1437-7772","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"assertion":[{"value":"22 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Hideo Shigematsu has received honoraria for lectures and chairing sessions organized by Daiichi Sankyo, Eisai, Chugai, Kyowa Kirin, Eli Lilly, Pfizer, Taiho, AstraZeneca, and MSD. Shinsuke Sasada has received grants from Chugai, Daiichi Sankyo, Eli Lilly, Gilead Sciences, and Nipro, and honoraria for lectures from Chugai, Daiichi Sankyo, Eisai, Eli Lilly, and Kyowa Kirin. Shinsuke Sasada is also a stock owner of Daiichi Sankyo. The other authors declare that they have no competing interests.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Ethics Review Committee of Hiroshima University (approval number: E2024-0224). All procedures were performed in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki Declaration and its later amendments.","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Owing to the retrospective nature of the study and the use of data obtained from hospital records with appropriate protection of patient privacy, the requirement for written informed consent was waived by the Ethics Review Committee.","order":3,"name":"Ethics","label":"Consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":4,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}}]}}