Fatal heart disease among cancer patients

Stoltzfus, Kelsey C.; Zhang, Ying; Sturgeon, Kathleen M.; Sinoway, Lawrence I.; Trifiletti, Daniel M.; Chinchilli, Vernon M.; Zaorsky, Nicholas G.

doi:10.1038/s41467-020-15639-5

Cited by 133 publications

(116 citation statements)

References 29 publications

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“…We observed that CVD mortality risk declined over the decades studied. Similar trends have been reported in CVD mortality risk among patients from other non-CNS cancers 8,23 . This may reflect contemporary efforts to minimise exposure to cardiovascular adverse effects from chemotherapy in cancer patients, as well as improvements in CVD preventive treatments more broadly 24 .…”

Section: Discussionsupporting

confidence: 84%

“…Another limitation is the use of death certificate information to classify cause of death, which may have limited accuracy. However, international studies have reported acceptable validity (83-98%) of case of death using such data 23,31 . Lastly, we did not have detailed data in SEER to classify all stroke outcomes as ischaemic or haemorrhagic.…”

Section: Discussionmentioning

confidence: 99%

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Raised cardiovascular disease mortality after central nervous system tumour diagnosis: analysis of 171 926 patients from UK and USA

Jin

Poon

Brennan

et al. 2021

Preprint

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Background Patients with central nervous system (CNS) tumours have significant morbidity and mortality. Some studies showed CNS tumours patients may be at risk for cardiovascular disease (CVD) mortality. The magnitude of CVD risk among CNS tumours patients has not been comprehensively assessed. If CVD mortality is elevated in this population, there may be a potential for risk reduction to improve outcomes. We examined CVD mortality risk in patients with malignant and non-malignant CNS tumours. Methods We conducted analyses using UK (Wales)-based Secure Anonymised Information Linkage (SAIL) for 8743 CNS tumour patients diagnosed in 2000-2015 (54.9% of whom died) and US-based National Cancer Institutes Surveillance, Epidemiology, and End Results (SEER) for 163183 patients in 2005-2015 (39.6% of whom died). We calculated age-, sex-, and calendar-year- adjusted standardised mortality ratios (SMRs) for CVD death in CNS tumour patients compared to Welsh and US residents. We used multivariable cause-specific Cox regression models to examine factors associated with CVD mortality among CNS tumour patients. We stratified all analyses by malignancy and main histological types. Results CVD was the second commonest cause of death for CNS tumour patients in SAIL (UK) and SEER (US) (9.5% & 11.7%, respectively). Patients with CNS tumours had higher CVD mortality than the general population (SAIL SMR=2.64, 95% CI=2.39-2.90; SEER SMR=1.38, 95% CI=1.35-1.42). Malignant CNS tumour patients had over 2-fold higher CVD mortality risk in both US and UK cohorts. SMRs for non-malignant tumours were almost 2-fold higher in SAIL than in SEER (SAIL SMR=2.73, 95% CI=2.46-3.02; SEER SMR=1.30, 95% CI=1.26-1.33). The greatest magnitude of excess CVD mortality risk, particularly from cerebrovascular disease, was substantially greater in patients diagnosed at age younger than 50 years and within the first year after their cancer diagnosis (SAIL SMR=2.98, 95% CI=2.39-3.66; SEER SMR=2.14, 95% CI=2.03-2.25). Age, sex, race/ethnicity in USA, deprivation in UK and no surgery were associated with CVD mortality. Discussion CVD mortality is high among patients diagnosed with both malignant and non-malignant CNS tumours compared to the general population. Targeted interventions and risk stratification tools might improve survival.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Raised cardiovascular disease mortality after central nervous system tumour diagnosis: analysis of 171 926 patients from UK and USA

Jin

Poon

Brennan

et al. 2021

Preprint

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“…To conclude, in our study of men undergoing RP, diabetes was associated with an increased risk of PCSM and progression in obese but not in nonobese men. Our results highlight the need to aggressively curtail and reverse the increasing prevalence of obesity to avert a potential increase in the morbidity and mortality of prostate cancer survivors known to be at risk of secondary malignancies ( 46 ) and cardiovascular disease ( 47 ).…”

Section: Discussionmentioning

confidence: 82%

Diabetes and Prostate Cancer Outcomes in Obese and Nonobese Men After Radical Prostatectomy

Kelkar¹,

Oyekunle

Eisenberg

et al. 2021

JNCI Cancer Spectrum

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Background The link between diabetes and prostate cancer progression is poorly understood and complicated by obesity. We investigated associations between diabetes and prostate cancer-specific mortality (PCSM), castrate-resistant prostate cancer (CRPC), and metastases in obese and nonobese men undergoing radical prostatectomy (RP). Methods We included 4,688 men from SEARCH, a cohort of men undergoing RP from 1988 to 2017. Diabetes prior to RP, anthropometric and clinical data were abstracted from six Veterans Affairs Medical Centers electronic medical records. Primary and secondary outcomes were PCSM and metastases and CRPC, respectively. Multivariable-adjusted hazard ratios (adj-HRs) and 95% confidence intervals (CIs) were estimated for diabetes and PCSM, CRPC and metastases. Adj-HRs were also estimated in analyses stratified by obesity (BMI: nonobese <30 kg/m2; obese ≥30 kg/m2. All statistical tests were two-sided. Results Diabetes was not associated with PCSM (adj-HR=1.38; 95% CI = 0.86-2.24), CRPC (adj-HR=1.05; 95% CI = 0.67-1.64), or metastases (adj-HR=1.01; 95% CI = 0.70-1.46), among all men. Interaction terms for diabetes and obesity were statistically significant in multivariable models for PCSM, CRPC and metastases (P≤0.04). In stratified analyses, in obese men, diabetes was associated with PCSM (adj-HR=3.06; 95%CI = 1.40-6.69), CRPC (adj-HR=2.14; 95%CI = 1.11-4.15), and metastases (adj-HR=1.57; 95%CI = 0.88-2.78), though not statistically significant for metastases. In nonobese men, inverse associations were suggested for diabetes and prostate cancer outcomes without reaching statistical significance. Conclusions Diabetes was associated with increased risks of prostate cancer progression and mortality among obese, but not among nonobese men, highlighting the importance of aggressively curtailing the increasing prevalence of obesity in prostate cancer survivors.

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“…Patients with lung cancer represent a distinctly high cardiovascular risk group: More than 40% have preexisting cardiovascular disease (CVD), and the risk of fatal heart disease is significantly elevated even within the first year after diagnosis. 7,8 This excess cancer therapyerelated cardiac risk may be partially attributed to thoracic radiation therapy, based on several studies demonstrating the association between cardiac radiation dose exposure and early-onset cardiac events and mortality. [9][10][11] However, early data have shown that less than half of these patients are on optimal guideline-based medical therapy as recommended by the American Heart Association/American College of Cardiology.…”

Section: Introductionmentioning

confidence: 99%

Statin Use, Heart Radiation Dose, and Survival in Locally Advanced Lung Cancer

Atkins

Bitterman

Chaunzwa

et al. 2021

Practical Radiation Oncology

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Patients with locally advanced non-small cell lung cancer (LA-NSCLC) have a high prevalence of pre-existing coronary heart disease and face excess cardiac risk after thoracic radiation therapy. We sought to assess whether statin therapy is a predictor of overall survival (OS) after thoracic radiation therapy. Methods and Materials: We performed a retrospective analysis of 748 patients with LA-NSCLC treated with thoracic radiation therapy, using Kaplan-Meier OS estimates and Cox regression. Results: Statin use among high cardiac risk patients (Framingham risk !20% or pre-existing coronary heart disease; n Z 496) was 51.2%. After adjustment for baseline cardiac risk and other prognostic factors, statin therapy was associated with a significantly increased risk of all-cause mortality (adjusted hazard ratio, 1.39; 95% confidence interval [CI], 1.00-1.91; P Z .048) but not major adverse cardiac events (adjusted hazard ratio, 1.18; 95% CI, 0.52-2.68; P Z .69). Among statin-naïve patients, mean heart dose !10 Gy versus <10 Gy was associated with a significantly increased risk of all-cause mortality (hazard ratio, 1.32; 95% CI, 1.04-1.68; P Z .022), with 2-year OS estimates of 46.9% versus 60.0%, respectively. However, OS did not differ by heart dose among patients on statin therapy (hazard ratio, 1.00; 95% CI, 0.76-1.32; P Z 1.00; P-interaction Z .031), with 2-year OS estimates of 46.9% versus 50.3%, respectively.

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Fatal heart disease among cancer patients

Cited by 133 publications

References 29 publications

Raised cardiovascular disease mortality after central nervous system tumour diagnosis: analysis of 171 926 patients from UK and USA

Raised cardiovascular disease mortality after central nervous system tumour diagnosis: analysis of 171 926 patients from UK and USA

Diabetes and Prostate Cancer Outcomes in Obese and Nonobese Men After Radical Prostatectomy

Statin Use, Heart Radiation Dose, and Survival in Locally Advanced Lung Cancer

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