Risk of Ischemic Heart Disease and Stroke in Prostate Cancer Survivors: A Nationwide Study in South Korea

Abstract

In this study using national health insurance data, we investigated the risk of ischemic heart disease (IHD) and stroke among prostate cancer (PC) survivors compared with the general population, as well as the risk of cardiovascular disease (CVD) according to primary treatment. A total of 48,298 PC patients diagnosed from 2007 to 2013 were included and matched to non-cancer controls. Compared to the general population, PC survivors had a slightly lower risk of IHD (adjusted hazard ratio [aHR] = 0.89, 95% confidence interval [CI] 0.83-0.96) or stroke (aHR 0.90, 95% CI 0.87-0.95). Especially, survivors who underwent surgery had lower risks of IHD (aHR 0.70, 95% CI 0.61-0.80) or stroke (aHR 0.73, 95% CI 0.67-0.81). Compared to survivors in the active surveillance/watchful waiting group, the androgen deprivation therapy (ADT) group had a significantly greater risk of stroke (aHR 1.16, 95% CI 1.02-1.32), but the IHD risk was not significantly elevated (aHR 1.06, 95% CI 0.88-1.29). In conclusion, PC survivors had a slightly lower risk of CVD compared to the general population, which was attributable to self-selection for PSA screening, specifically in the surgery-only group. CVD risk was dependent on treatment received, and attention should be given to patients who receive ADT. Cancer survivor is defined as any person diagnosed with cancer, from the time of diagnosis until his or her death. With improved survival and the increased number of prostate cancer (PC) survivors 1 , management of comorbidities has become increasingly important for this population 2. Cardiovascular disease (CVD) is reported to be the main cause of mortality in PC survivors in the US, comprising 20% of overall mortality, and surpassing mortality from PC and second primary malignancies 3. In a Korean cohort study, CVD was responsible for 29.1% of non-PC mortality in long-term PC survivors 4. Many studies have analyzed the risk of CVD in PC patients treated with androgen deprivation therapy (ADT) 5-17 , but it is not certain whether PC survivors have a greater risk of CVD compared to the general population. To date, only a few studies have compared the CVD risk between PC survivors and the general population 18-20 , but the results were inconsistent: a Swedish study suggested elevated risk 18 , a UK study reported similar risk 19 , and a US study demonstrated lower risk 20. Among these studies, only the Swedish study analyzed the CVD risk according to treatment modality (i.e., surveillance, curative treatment, endocrine therapy) 18. Thus, the risk of CVD among PC survivors who underwent different types of treatment has not been assessed definitively. In addition, there are no reports from Asian countries, where practice patterns may differ from Western countries 21. To address these limitations, we used a Korean national healthcare database to investigate the CVD risk among PC survivors compared with general population controls, as well as the risk of CVD according to primary treatment. Methods Data Source: Korean national Health insurance Service...

Is stroke incidence increased in survivors of adult cancers? A systematic review and meta-analysis

“…Controls = mean 2.0 yr (SD 0.4) 0–2 yr Shin et al, 2018 [ 38 ] Korean National Health Insurance (KNHI) database; South Korea; Jan 2004–Dec 2011. Study follow-up until Dec 2013 Gastric cancer (requiring surgery) Cancer-free controls propensity score matched 1:1 by year of cancer diagnosis, age, sex, residence, income, disability, hypertension, diabetes, and dyslipidaemia Mean age (SD) 57.9 yr (± 11.7) Primary outcomes = coronary heart disease and Ischaemic stroke Age, sex, insurance premium level, hypertension, diabetes, dyslipidaemia, type of surgery, chemotherapy, smoking status, baseline BMI, and body weight change (decrease defined by > 5% reduction from baseline) Excluded 2 years 98,936 exposed; 98,936 controls Cancer population: mean = 5.3 yr. Control population: mean = 5.5 yr 0–10 yr from start of follow-up Shin et al, 2020 [ 39 ] Korean National Health Insurance (NHIS) database; South Korea; Jan 2007–Dec 2013. Study follow-up until Dec 2016 Prostate cancer Cancer-free controls matched 1:3 on the basis of age and sex Cancer population: mean age = 68.4 ± 8.7 yr .…”

“…A variety of cancer types were studied: four prostate [ 36 , 37 , 39 , 44 ], three cervical [ 19 , 33 , 43 ], three head and neck [ 23 , 26 , 27 ], three breast [ 12 , 28 , 45 ], two lung [ 21 , 46 ], two gastric [ 30 , 38 ], two ovarian [ 22 , 29 ], two nasopharyngeal [ 24 , 32 ], and one each of endometrial [ 40 ], oral [ 48 ], pancreatic [ 20 ], Hodgkin’s lymphoma [ 25 ], non-Hodgkin’s lymphoma [ 35 ], testicular [ 31 ], and thyroid [ 42 ]. Eight studies evaluated multiple cancer types [ 4 , 6 , 16 – 18 , 34 , 41 , 47 ].…”

“…Of the 28 studies looking at individual cancers and the incidence of stroke, 21 reported an increased incidence of stroke following cancer diagnosis compared to the control group. Seven studies reported a reduced incidence of stroke in individuals with cancer compared to controls (two studies of cervical cancer [ 19 , 33 ], two of prostate cancer [ 36 , 39 ], and one each of breast [ 28 ], gastric [ 38 ], and testicular cancers [ 31 ]).…”

“…Cisplatin-based and carboplatin-based chemotherapy regimes for ovarian cancer were independent risk factors for ischaemic stroke, whereas non-platinum-based regimens were not [ 29 ]. Those within a palliative treatment regimen for prostate cancer had increased risk for ischaemic stroke [ 36 ], whereas stroke incidence was higher in those treated with endocrine therapy for prostate cancer [ 39 , 44 ]. In one study for prostate cancer, only gonadotrophin-releasing hormone agonists resulted in an increased incidence of stroke [ 37 ].…”

Cardiovascular morbidities in postoperative colorectal cancer patients

“…CVD is emerging as a serious cause of death in many cancer survivors, rivaling cancer recurrence 5 . Although a few conflicting results have been published based on previous studies 6 , 7 , most cancers are associated with an increased risk of coronary heart disease (CHD), especially during the first 6 months after diagnosis 8 . Emerging evidence have suggested a relationship between CVD and cancer, in addition to simple collusion due to the sharing of common risk factors 9 , 10 .…”