Prospective cohort study of air pollution and cardiac remodeling and function in patients with breast cancer receiving anthracyclines or trastuzumab

The relationship between air pollution and cardiac remodeling in patients with cancer treated with cardiotoxic therapy is unclear. A longitudinal prospective cohort study evaluated the associations between air pollutants and changes in cardiac function, structure, and remodeling in patients with breast cancer treated with anthracylines and/or trastuzumab. The study included patients enrolled at multiple sites of a quaternary health care system. Across 580 patients, 3642 echocardiograms were obtained at standardized time intervals over a median of 3.1 years. Greater exposure to fine particulate matter with diameter of 2.5 μm or less and ozone was associated with worse cardiac remodeling and function and greater risk of therapy-related cardiac dysfunction, while exposure to particulate matter with diameter of 10 μm or less and nitrogen dioxide showed limited associations. The authors conclude that these data support the critical need for strategies to reduce fine particulate matter and ozone exposure, particularly in patients with breast cancer.