Survivors of adult-onset cancers associated with increased incidence of cardiovascular disease

1. In a retrospective review of over 100 000 adult-onset cancer survivors and aged-matched controls, there was a significantly higher risk of cardiovascular diseases (CVD) in adult-onset cancer survivors compared to aged-matched controls.

2. Survivors of multiple myeloma, lung, non-Hodgkin’s lymphoma, and breast cancer had the highest associated risk with CVD compared with controls.

Evidence Rating Level: 3 (Average)

Study Rundown: As the population of long-term cancer survivors grows, their primary care management has become an increasingly significant issue. CVD remains the leading cause of morbidity and mortality in the general population in the United States and previous population-based studies have demonstrated that survivors of childhood and young adult-onset cancers are at increased risk for CVD. However, there is a paucity of research on the CVD risk among survivors of adult-onset (>40 years old) cancers, who represent the majority of new cancer diagnoses in the United States. The purpose of this retrospective cohort study was to evaluate the long-term incidence of CVD in this population.

The study retrospectively reviewed the health outcomes data of over 35 000 adult-onset cancer survivors and compared them with over 75 000 aged-matched controls. At the conclusion of the trial, survivors of adult-onset cancers were significantly more likely to have cardiovascular risk factors compared to controls. Specifically, survivors of multiple myeloma, non-Hodgkin’s lymphoma, as well as lung, ovarian, and kidney cancers demonstrated significantly higher risk of CVD compared to age-matched controls. Finally, cancer survivors who developed CVD demonstrated significantly higher mortality rate than cancer survivors without CVD. This study is strengthened by the large study population. However, the study is limited by the retrospective nature of the study, which may result in screening bias within the cancer survivor population. The results of this study supports an increased emphasis on CVD prevention and management in adult-onset cancer survivors.

Click to read the study in JCO

Relevant Reading: Long-term cardiovascular toxicity in children, adolescents, and young adults who receive cancer therapy: pathophysiology, course, monitoring, management, prevention, and research directions: a scientific statement from the American Heart Association

In-Depth [retrospective cohort]: This was a retrospective review of patient outcomes data from the Kaiser Permanente Southern California (KPSC) cancer registry. Inclusion criteria included age at cancer diagnosis of 40 years or older and survival for at least 2 years after diagnosis. Key exclusion criteria included diagnosis of a rare (<1% prevalence) cancer or the development of CVD prior to the index date. Patients were matched 1:2 to KPSC member controls without a history of cancer or CVD by age, sex, and residential ZIP code. The composite primary outcome was clinically overt CVD, defined as ischemic heart disease, stroke, and heart failure/cardiomyopathy. Overall, a total of 36 232 cancer survivors and 73 545 controls were enrolled. At the conclusion of the study, survivors of adult-onset cancers were more likely to develop hypertension (65.9% vs 59.5%; p < 0.01), diabetes (23.4% vs 21.5%; p < 0.01), dyslipidemia (57.9% vs 55.9%; p < 0.01), obesity (43.4% vs 35.4%; p < 0.01) and to have a history of smoking (32.7% vs 21.1%; p < 0.01) compared to controls. On multivariable regression analysis, survivors of multiple myeloma (incident rate ratio [IRR]: 1.7; p < 0.01), lung/bronchus carcinoma (IRR: 1.59; p < 0.01), non-Hodgkin lymphoma (IRR: 1.41; p < 0.01), and breast cancer (IRR: 1.13; p < 0.01) demonstrated a higher incidence of CVD compared to controls. Five and 8-year survival was worse among survivors who developed CVD compared to those who did not (75% and 60% vs. 87% and 81%, respectively). After multivariable regression analysis adjusting for age, ethnicity, sex, cancer stage, and CVD risk factors, overall mortality still remained higher in cancer survivors with CVD versus those who did not (IRR: 1.65; 95% CI: 1.55 to 1.75; p < 0.01).

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