Cardiovascular medication after cancer at a young age in Finland: A nationwide registry linkage study

Abstract

Despite improved survival rates, childhood and young adult (YA) cancer survivors face elevated risks for life-threatening morbidities, especially cardiovascular complications. Our nationwide Finnish registry study investigated the purchases of cardiovascular medication from 1993 to 2011 in patients diagnosed with cancer aged below 35 years (N 5 8,197) between 1993 and 2004 compared to siblings (N 5 29,974) via linkage to the drug purchase registry. The cumulative incidence for purchasing cardiovascular medications was higher in childhood and YA cancer patients compared to siblings with a rising trend over time. After childhood cancer, the highest hazard ratio (HR) was found for purchasing anticoagulants (HR 19.8,). The HRs for any cardiovascular medication (HR 7.2, 95% CI 5.1-10.1) and cardiac medication (HR 4.8, were markedly elevated after childhood cancer as well. Regarding YA cancer patients, the respective HRs were 2.5 (95% CI 2.0-3.2) for anticoagulants, HR 1.7 (95% CI 1.5-1.9) for any cardiovascular medication and HR 1.5 (95% CI 1.3-1.7) for cardiac medication. Among cancer patients, highest HRs for cardiovascular medication were observed after childhood acute lymphoblastic leukemia (ALL) and bone tumors (HR 10.2, 95% CI 6.8-15.5 and HR 7.4, 95% CI 4.0-13.7) and YA ALL and acute myeloid leukemia (HR 5.1, 95% CI 3.5-7.1 and HR 2.8, 95% CI 1.8-4.0). Our study demonstrated increased HRs for purchasing cardiovascular medication after early-onset cancer compared to siblings reflecting elevated cardiovascular morbidity. Thus, the implementation of long-term cardiovascular disease screening is imperative to prevent, detect and adequately treat cardiovascular late effects after cancer at a young age.At present, the diagnosis with childhood or young adult (YA) cancer is not an instantaneous death sentence anymore thanks to survival approaching 80%.1,2 However, virtually any organ system may be susceptible to adverse effects of cancer therapy involving chemotherapy, radiation or surgery. 3-5 Nearly twothirds of childhood cancer survivors have reported to experience health drawbacks after the initial defeat over malignancy: longterm morbidities that may eventually lead to a reduced life expectancy. 5 Late cardiovascular morbidity has been demonstrated to be the leading nonmalignant cause of death after childhood and YA cancer in patients aged below 34 years at cancer diagnosis. [6][7][8] Up to date, information on the use of cardiovascular medication after childhood and YA cancer remains limited. Only one study reported that childhood cancer survivors have more likely been treated for hypertension than their siblings. 9As a consequence of the great impact of cardiovascular adverse effects after cancer, a new clinical field has emerged to specifically deal with cardiovascular complications: cardiooncology.10 Cardio-oncology aims at reducing or preventing cardiovascular damage during cancer therapy, detecting cardiovascular late effects in early, reversible stages and treating cardiovascular complications effectively...

Challenges and opportunities in the care of survivors of adolescent and young adult cancers

“…36 The likelihood of purchasing cardiovascular medicines has been shown to be significantly higher in survivors of childhood (hazard ratio [HR] = 19.8) than AYA cancer (HR = 2.5). 43 These risks were more elevated than those observed in the Yorkshire…”

“…In the several reports from Finland comparing survivors of cancer diagnosed aged 0‐19 years to those diagnosed aged 20‐34 years, the risk of cardiovascular morbidity was 13.5 times and 3.6 times higher, respectively, than expected from sibling controls . The likelihood of purchasing cardiovascular medicines has been shown to be significantly higher in survivors of childhood (hazard ratio [HR] = 19.8) than AYA cancer (HR = 2.5) . These risks were more elevated than those observed in the Yorkshire Specialist Register of Cancer in Children and Young People and Danish Cancer Registry, where AYA aged 15‐39 years at diagnosis were only 1.3 times more at risk for hospitalisation for cardiovascular disease compared to the control group in the latter cohort .…”

Can biomarkers be used to improve diagnosis and prediction of metabolic syndrome in childhood cancer survivors? A systematic review

“… 74 , 75 , 82 , 83 , 167 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 226 This may limit applicability of results to the population of CCS, in which the prevalence of comorbidities is high. 3 , 25 , 256 , 270 This was taken into account when scoring the risk of bias. Additionally, childhood cancer (treatment)‐related long‐term side effects, such as altered fat distribution, sarcopenic obesity, and hormonal disbalances, may play a survivor specific role in the pathogenesis of MetS 11 ; development of future studies that apply the use of biomarkers in large cohorts of CCS is therefore important.…”

“… 3 , 10 One of these severe conditions is represented by cardiovascular disease (CVD), which is an important cause of premature death beyond 5 years cancer survival; the standardized mortality risk for CVD ranges from 1.9 to 12.7. 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 …”

Cardiovascular Complications of Cranial and Neck Radiation

“…As cancer survival improves, the long-term adverse consequences of cancer therapy are becoming more apparent. In particular, cancer survivors have an increased incidence of cardiovascular events compared to age-and gender-matched individuals in the general population [2]. Cardiovascular disease is not only a significant cause of morbidity but is also the largest cause of nonmalignancy-related mortality in cancer survivors [2].…”