Atrial fibrillation risk greater in younger breast cancer survivors compared to older survivors in Korea

1. In a Korean cohort of breast cancer survivors, younger survivors had an increased risk of incident atrial fibrillation compared to older breast cancer survivors, regardless of length of follow-up.

Evidence Rating Level: 2 (Good)

Individuals previously treated with breast cancer may be at increased risk of developing atrial fibrillation (AF). Several mechanisms, such as the sharing of common risk factors between AF and cancer, cardiotoxicity of treatments, and health effects of cancer itself have been proposed to explain this association. Less known however, is the association between age of diagnosis and subsequent risk of developing AF. In this nationwide population-based cohort study, data from the Korean National Health Insurance Service (NHIS) database was used to evaluate the AF risk in breast cancer survivors of different ages at diagnosis. The mean age of the population was 51.6 years with 10.8% of participants being less than 40 years old. Of breast cancer survivors, 61.0% used chemotherapy, 15.0% used target therapy, 61.8% used endocrine treatment and 69.8% used radiation therapy. Survivors of breast cancer had an increased risk of developing AF compared to cancer-free individuals (sHR 1.06; 95% CI 1.00-1.13) however, the association began decreasing over time. Survivors aged < 40 years had a greater than 2-fold increase in AF risk (sHR 2.79; 95% CI 1.98-3.94) however, there was not an increased risk in older breast cancer survivors (>65 years). In all breast cancer survivors, the use of anthracyclines was associated with higher AF risk (sHR 1.57; 95% CI 1.28-1.92), especially in younger survivors (sHR 1.94; 95% CI 1.40-2.69 in those aged ≤50 years). When compared to the general population, breast cancer survivors had an increased risk of developing AF among those without CV or CVD at baseline. The use of anthracyclines was associated with a higher risk of AF when accounting for cancer treatments. Overall, younger breast cancer survivors or survivors who were treated with anthracyclines may be associated with a higher risk of mid- to long-term risk of AF.

Click to read the study in BMC Medicine

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