Incident Cardiovascular Diseases Among Survivors of High-Risk Stage II–III Colorectal Cancer: A Cluster-Wide Cohort Study

Abstract

Background: The incidence and survival of colorectal cancer (CRC) are increasing. There is an increasing number of long-term survivors, many of whom are elderly and have comorbidities. We conducted a population-based study in Hong Kong to assess the long-term cardiovascular disease (CVD) incidence associated with adjuvant fluoropyrimidine-based chemotherapy among CRC survivors. Patients and Methods: Using the population-based electronic medical database of Hong Kong, we identified adults who were diagnosed with high-risk stage II–III CRC and treated with radical surgery followed by adjuvant fluoropyrimidine-based chemotherapy between 2010 and 2019. We evaluated the cause-specific cumulative incidence of CVD (including ischemic heart disease, heart failure, cardiomyopathy, and stroke) using the flexible parametric competing risk modeling framework. The control group without a history of CVD was selected from among a noncancer random sample from primary care clinics in the same geographic area. Results: We analyzed 1,037 treated patients with CRC and 5,078 noncancer controls. The adjusted cause-specific hazard ratio (HR) for CVD in the cancer cohort compared with the control group was 2.11 (95% CI, 1.39–3.20). The 1-, 5-, and 10-year cause-specific cumulative incidences were 2.0%, 4.5%, and 5.4% in the cancer cohort versus 1.2%, 3.0%, and 3.8% in the control group, respectively. Age at cancer diagnosis (HR per 5-year increase, 1.16; 95% CI, 1.08–1.24), male sex (HR, 1.40; 95% CI, 1.06–1.86), comorbidity (HR, 1.88; 95% CI, 1.36–2.61 for 1 comorbidity vs none, and HR, 6.61; 95% CI, 4.55–9.60 for ≥2 comorbidities vs none), diabetes (HR, 1.38; 95% CI, 1.04–1.84), hypertension (HR, 3.27; 95% CI, 2.39–4.50), and dyslipidemia/hyperlipidemia (HR, 2.53; 95% CI, 1.68–3.81) were associated with incident CVD. Conclusions: Exposure to adjuvant fluoropyrimidine-based chemotherapy was associated with an increased risk of CVD among survivors of high-risk stage II–III CRC. Cardiovascular risk monitoring of this group throughout cancer survivorship is advisable.

A Retrospective Clinical Study on Cardiovascular Complications from Colorectal Cancer

“…The findings highlight the importance of age, LDL-C, and serum CRP level as independent risk factors for cardiovascular complications in such patients. The incidence rate was found to be 15.8%, which is lower than the rate reported in a previous study [33]. This difference may be due to differences in patient characteristics and in the duration of follow-up.…”

Chemotherapy for elderly Stage II colorectal cancer patients with primary cardiovascular diseases: less is more?

“…For illustration, Kelly et al reported the increased risk of new cardiovascular diseases and congestive heart failure in elderly CRC patients, reminding that elderly patients with a history of chemotherapy should be closely monitored in clinical work [14] . A population-based study in South Korea also noted that 5-FU chemotherapy for CRC patients was associated with an increased risk of CVD [15] . Previous studies only discussed the incidence of CVD in chemotherapy patients, but rarely compared the prognosis of patients.…”

Health Literacy, Individual and Community Engagement, and Cardiovascular Risks and Disparities

“…In the United States, research on disparities in common cancers with elevated cardiovascular risk, including lung, 66 , 67 , 68 colorectal, 69 , 70 , 71 , 72 bladder, 73 , 74 endometrial, 75 , 76 and hematologic malignancies, 77 , 78 , 79 , 80 , 81 is still underway. Understanding the shared risk factors between these cancers and CVDs, combined with recent treatment advancements, underscores the need to address social disparities in this space.…”