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. 2017 Nov;166(1):259-266.
doi: 10.1007/s10549-017-4387-1. Epub 2017 Jul 17.

Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors

Dounya Schoormans  1 , Lonneke van de Poll-Franse  2   3   4   5 , Pauline Vissers  3 , Myrthe P P van Herk-Sukel  6 , Susanne S Pedersen  4   7 , Nina Rottmann  4   8 , Trine Horsbøl  9 , Susanne Dalton  9 , Johan Denollet  2
Affiliations

Pharmaceutically treated anxiety but not depression prior to cancer diagnosis predicts the onset of cardiovascular disease among breast cancer survivors

Dounya Schoormans et al. Breast Cancer Res Treat. 2017 Nov.

Abstract

Purpose: To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), while controlling for traditional cardiovascular risk factors and clinical characteristics in a population-based observational study.

Methods: Adult 1-year breast cancer survivors (n = 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD, anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus in the year prior to cancer diagnosis, tumor stage, and cancer treatment.

Results: During the 13-year follow-up period, 193 (3%) breast cancer survivors developed CVD. Women pharmaceutically treated for anxiety in the year prior to their cancer diagnosis had a 48% increased hazard for CVD [HR = 1.48; 95% CI 1.05-1.08] after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk [HR = 0.89; 95% CI 0.52-1.53]. Older age [HR = 1.06; 95% CI 1.05-1.08], hypertension [HR = 1.80; 95% CI 1.32-2.46], and hypercholesterolemia [HR = 1.63; 95% CI 1.15-2.33] were associated with an increased hazard for incident CVD, whereas hormone therapy [HR = 0.59; 95% CI 0.42-0.83] was protective.

Conclusions: Anxiety present in the year prior to breast cancer diagnosis increases the risk of incident CVD in 1-year breast cancer survivors, after adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics.

Keywords: Anxiety; Breast cancer survivors; Cardiotoxicity; Cardiovascular disease; Depression.

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Conflict of interest statement

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

As anonymous observational patient information was used, this study does not fall under the Medical Research Involving Human Subjects Act in the Netherlands; therefore, this study was exempted from medical ethics review and no informed consent was required. Hence, informed consent for each participant was neither possible nor needed.

Research involving human participants and/or animals

For this type of study formal consent is not required. All procedures performed in studies involving human participants were in accordance with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Association between pharmaceutically treated anxiety and incident CVD among younger (≤65 years) and older (>65) women (age at breast cancer diagnosis). Note CVD = cardiovascular disease, p = p value; *p < 0.05
See this image and copyright information in PMC

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