Adult-Onset Cancer Survivor Cardiovascular Disease Risks Revealed

The risk of cardiovascular disease in patients following adult-onset cancer varies by tumour type and presence of cardiovascular risk factors

medwireNews: The burden of cardiovascular disease (CVD) among survivors of adult-onset cancer is highlighted in the Journal of Clinical Oncology, with research showing both an increased risk of events and associated mortality for patients with a range of tumour types.

“Thefindings fromthe current study speak to the importance of strategies to improvecardiovascular health in at-risk survivors long after completion ofcancer therapy”, saySaro Armenian, from City of Hope Comprehensive Cancer Center in Duarte, California, USA, and co-authors.

The team compared CVD rates in 36,232 patients who were diagnosed with cancer at age 40 years or later and had survived for at least 2 years, and 73,545 individuals without cancer who were matched by age, gender and residence.

Cancer survivors had significantly higher rates than controls for a range of CVD risk factors including hypertension, diabetes, dyslipidaemia, obesity and smoking.

After adjusting for these CVD markers and age, gender and race,the incidence rate ratios (IRR) versus controls for CVD in the survivors of breast cancer, non-Hodgkin lymphoma, ovarian cancer, lung cancer and multiple myeloma were a significant 1.13, 1.41, 1.41, 1.58 and 1.70, respectively.

As well as tumour type, exploratory analysis suggested that the magnitude of CVD risk was significantly associated with the number of CVD risk factors; for example, the risk was highest when comparing survivors of multiple myeloma or ovarian cancer with two or more CVD risk factors versus controls with less than two such markers, with IRRs of 2.74 and 2.83, respectively.

By contrast, patients with prostate cancer had a significantly lower risk of CVD than controls, with an IRR of 0.89, which the researchers say is “counterintuitive” as androgen deprivation therapy is associated with metabolic disturbances and an increased risk of CVD within 2 years of treatment.

The team notes, however, that their findings support the previously reported finding that CVD risk does not increase after 2 years of ADT and hypothesise that the current low CVD risk prostate cancer patients may represent a “subset of individuals who are more likely to undergoroutine screening for early detection of prostate cancer and hencemore likely to be engaged with the health care system for preventivecare”.

Compared with controls, CVD risk was not significantly different for survivors of many tumours, including cancers of the bladder and thyroid, colorectal cancer, uterine cancer and chronic lymphocytic leukaemia.

Of concern, the 5- and 8-year rates of overall survival were significantly poorer in survivors who developed CVD than those who did not, at 75% versus 87% and 60% versus 81%, respectively.

Saro Armenian and co-authors therefore conclude:“Outcomes after onset of CVD in long-term cancer survivors seem to be especially poor, emphasizing the need for additional studies to characterize the treatment-specific associations with long-term CVD risk as well as the effect of therapeutic strategies to mitigate this risk.”

Reference

Armenian SH, Xu L, Ky B, et al. Cardiovascular disease among survivors of adult-onset cancer: A community-based retrospective cohort study. J Clin Oncol 2016; Advance online publication 1 February. doi: 10.1200/JCO.2015.64.0409

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