Abstract 1819P
Background
Patients with cancer are predisposed to develop CVD. This real-world, population-based study aimed to assess the factors related with new onset CVD in cancer survivors.
Methods
We identified patients with stage I-III solid organ cancer in a large Canadian province from 2004 to 2017. Patients with a CVD prior to their cancer diagnosis were excluded. We linked administrative data sources to identify new onset CVD (cardiac arrhythmias, cerebrovascular accidents [CVAs], congestive heart failure [CHF], and myocardial infarctions [MIs]). We performed logistic regression analyses to examine the associations of clinical variables with the development of CVD.
Results
A total of 81,418 patients were identified, of whom 54.3% were women and median age was 62 years. Breast (28.6%), prostate (23.1%), and colorectal cancer (CRC) (15.0%) represented the three most common malignancies. The Charlson comorbidity index (CCI) score at diagnosis was 0,1 and >1 in 49.8%, 25.6 and 24.6%, respectively. At a median follow-up of 69 months, 29.5% of patients had developed CVD (11.7% arrhythmias, 7.0% CVAs, 5.3% CHF, and 3.7% MI). Patients with CRC were most predisposed to arrhythmias (15.4%) and CHF (7.2%) whereas those with prostate cancer were most at risk for MIs (6.3%) and CVAs (8.2%). The median time from diagnosis of cancer to CVD was 29.1 months. Advancing age, male sex, worse CCI score, prostate cancer and CRC and receipt of any cancer treatment were associated with a higher odd of CVD. Further, new-onset CVD in cancer survivors was associated with a higher likelihood of death (hazard ratio, 1.04; 95% confidence interval, 1.02-1,08; P=0.003) after adjusting for other prognostic factors. Table: 1819P
| Variable | Odds ratio | 95% confidence interval | P-value |
| Age at cancer diagnosis | 1.05 | 1.04-1.05 | <.001 |
| Sex | |||
| Female | Ref | ||
| Male | 1.30 | 1.24-1.36 | <.001 |
| Charlson comorbidity index | |||
| 0 | Ref | ||
| 1 | 1.30 | 1.26-1.35 | <.001 |
| 2 | 1.59 | 1.52-1.67 | <.001 |
| Tumor group | |||
| Breast | Ref | ||
| Prostate | 1.16 | 1.08-1.25 | .001 |
| Colorectal | 1.12 | 1.05-1.12 | .001 |
| Others | 1.02 | 0.96-1.08 | .496 |
| Chemotherapy | 1.18 | 1.13-1.22 | <.001 |
| Hormone therapy | 1.09 | 1.04-1.15 | <.001 |
| Surgery | 1.32 | 1.26-1.38 | <.001 |
| Radiotherapy | 1.07 | 1.04-1.12 | <.001 |
Conclusions
Approximately one-third of cancer patients develop new onset CVD during follow-up, with many of them experiencing worse survival outcomes. While routine cardiac surveillance and risk-reduction strategies are often implemented in young women with breast cancer, this same approach should be strongly considered in other tumor settings.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.