December 29, 2019
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Cancer survivors may have increased CVD mortality risk

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Nicholas G. Zaorsky

Patients who survived cancer have an increased risk for mortality from CHD and stroke compared with the general population, according to a study published in the European Heart Journal.

“The majority of cardiovascular disease deaths occur in patients diagnosed with breast, prostate or bladder cancer,” Nicholas G. Zaorsky, MD, assistant professor in the departments of radiation oncology, radiology and public health sciences at Penn State College of Medicine and Penn State Cancer Institute, told Healio. “Thus, clinics that aim to open ‘cardio-oncology’ centers should likely focus on the inclusion of these sites, followed by other sites. Additionally, primary care physicians and cardiologists may seek to more aggressively control cardiovascular diseases in cancer survivors.”

Surveillance, Epidemiology and End Results data

Kathleen M. Sturgeon, PhD, MTR , assistant professor in public health sciences at Penn State College of Medicine and Penn State Cancer Institute, and colleagues analyzed data from 3,234,256 patients from the Surveillance, Epidemiology and End Results program who survived 28 types of cancer between 1973 and 2012.

The study focused on several objectives, including the characterization of CVD mortality risk by cancer type, describing the risk for CVD death as a function of age at cancer diagnosis and follow-up after cancer diagnosis. Causes of CVD risk included in these analyses were hypertension, heart disease, atherosclerosis, cerebrovascular disease and aortic aneurysm/dissection.

Of the patients in the study, 38% died of cancer and 11.3% died of CVD. Heart disease was the major cause of CVD death for 76.3% of patients. The risk for CVD mortality surpassed the risk for index cancer mortality in at least one calendar year for eight cancer sites.

Patients younger than 35 years who survived cancer had the highest CVD mortality risk. The risk for CVD mortality was 10-fold greater in patients who survived a cancer that was diagnosed before age 55 years compared with the general population. CVD mortality risk was highest in patients within the first year after a cancer diagnosis (standardized mortality ratio = 3.93; 95% CI, 3.89-3.97), which remained elevated throughout follow-up vs. the general population.

“The current analysis is a broad overview spanning over 40 years,” Zaorsky said in an interview. “In the future, we hope to find patient-specific factors that may increase the risk for particular CVDs (eg, stroke or MI) or focus on specific populations like women with breast cancer receiving radiation therapy.”

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‘Proactive approach’

Joerg Herrmann, MD, consultant in the division of ischemic heart disease and critical care and director of the Cardio Oncology Clinic at Mayo Clinic, wrote a related editorial, in which he said, “In view of such grave and persistent consequences, a reactive management approach that comes into play solely when clinical presentations and complications arise is no longer in order. Rather, one would advocate for a proactive approach that starts before any cancer therapy is given and continues for a lifetime thereafter.” – by Darlene Dobkowski

For more information:

Nicholas G. Zaorsky, MD, can be reached at nzaorsky@pennstatehealth.psu.edu; Twitter: @nicholaszaorsky.

Disclosures: Zaorsky, Sturgeon and Herrmann report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.