title: Determinants of newly diagnosed comorbidities among breast cancer survivors.
abstract: OBJECTIVE
  Comorbid conditions have become increasingly relevant for breast cancer care given the large numbers of long-term survivors. Our aim was to identify potential determinants associated with the development of comorbidities after breast cancer.
  
  
  METHODS
  Self-reported comorbidities and lifestyle were assessed at recruitment and after a median follow up of 69.4 months from diagnosis in a population-based cohort of breast cancer cases aged 50 to 74 years at diagnosis (MARIEplus study). Tumor and therapy data were extracted from medical records. Determinants potentially associated with incident diagnoses of hypertension, cardiovascular diseases (CVD), and osteoporosis were assessed using multivariable Cox proportional hazard regression models.
  
  
  RESULTS
  Follow-up interview was completed by 2,542 women (76.4 % of eligible patients). A diagnosis of hypertension was significantly associated with age, higher education (hazard ratio (HR) 0.54, CI 0.37-0.79), baseline body mass index (BMI; ≥30 kg/m(2); HR, 1.90; CI, 1.24-2.90), and trastuzumab medication (HR, 2.16; CI, 1.09-4.33). An increased risk for CVD was associated with age, BMI, and intake of aromatase inhibitors (AI; HR, 1.42; CI, 1.09-1.84). Risk of osteoporosis was also positively associated with AI treatment (HR, 2.15; CI, 1.64-2.82) but inversely associated with a higher BMI (≥30 kg/m(2); HR, 0.50; CI, 0.31-0.79).
  
  
  CONCLUSIONS
  In breast cancer survivors, treatment with AI constituted a risk factor for incident CVD and osteoporosis. Besides known risk factors, patients who were treated with trastuzumab may have an increased risk for hypertension.
  
  
  CONCLUSIONS
  Reducing overweight and regular sport/cycling activities may help to prevent CVD after breast cancer. Patients should be monitored for risk factors and advised on possible cardiac side effects of AI and trastuzumab.
authors.affiliation: University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany, n.obi@uke.de.
authors.forename: Nadia
authors.initials: N
authors.lastname: Obi
authors.forename: Daniela
authors.initials: D
authors.lastname: Gornyk
authors.forename: Judith
authors.initials: J
authors.lastname: Heinz
authors.forename: Alina
authors.initials: A
authors.lastname: Vrieling
authors.forename: Petra
authors.initials: P
authors.lastname: Seibold
authors.forename: Jenny
authors.initials: J
authors.lastname: Chang-Claude
authors.forename: Dieter
authors.initials: D
authors.lastname: Flesch-Janys
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D047072:Aromatase Inhibitors / Q000009:adverse effects; D015992:Body Mass Index; D001943:Breast Neoplasms / Q000150:complications / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D017741:Survivors; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D047072:Aromatase Inhibitors; D000068878:Trastuzumab