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Methods We conducted a population-based case–control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart. Results The overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P.
Figure 1 Rate of Major Coronary Events According to Mean Radiation Dose to the Heart, as Compared with the Estimated Rate with No Radiation Exposure to the Heart. Major coronary events included myocardial infarction, coronary revascularization, and death from ischemic heart disease. Milton Piano Serial Numbers. The values for the solid line were calculated with the use of dose estimates for individual women.
The circles show values for groups of women, classified according to dose categories; the associated vertical lines represent 95% confidence intervals. All estimates were calculated after stratification for country and for age at breast-cancer diagnosis, year of breast-cancer diagnosis, interval between breast-cancer diagnosis and first major coronary event for case patients or index date for controls (all in 5-year categories), and presence or absence of a cardiac risk factor. The radiation categories were less than 2, 2 to 4, 5 to 9, and 10 Gy or more, and the overall averages of the mean doses to the heart of women in these categories were 1.4, 3.4, 6.5, and 15.8 Gy, respectively. Figure 2 Cumulative Risks of Death from Ischemic Heart Disease and of at Least One Acute Coronary Event. In Panel A, rates of death from ischemic heart disease and from all causes in the underlying population were assumed to be equal to the most recent values available (mostly for the year 2010) for the 15 westernmost countries of the European Union (Table S11 in the ).
In Panel B, the rates of acute coronary events in women in the underlying population who were younger than 50, 50 to 59, 60 to 69, and 70 to 79 years of age were assumed to be 6 times, 5 times, 3 times, and 2 times the rate of death from ischemic heart disease, respectively. In both panels, results are shown for a woman who was 50 years old at the time of breast-cancer diagnosis who received either no radiotherapy or radiotherapy with a mean dose to the heart of 3 Gy or 10 Gy. Results are shown for women with no cardiac risk factors and for those with one or more cardiac risk factors. In both panels, the distribution of cardiac risk factors in the population was assumed to be equal to that in the present study. Cumulative risks for other mean doses of radiation to the heart and for different ages at irradiation are provided in Tables S12 and S13 in the.