Cardioprotective medications underused in patients with cancer
In a study of patients admitted to the cardiology unit at a single center, those with current or past cancer were less likely to be using certain cardioprotective medications than those without cancer, researchers reported.
Among 320 patients with an indication for cardioprotective medications (mean age, 65 years; 62% men) admitted to the cardiology unit at John Hunter Hospital in New Lambton Heights, New South Wales, Australia, between July 2018 and January 2019, those with a history of cancer were less likely to have been prescribed statins and antiplatelet therapies despite a similar CV risk profile to those without cancer, according to a research letter in JACC: CardioOncology.
“A history of cancer and cancer treatment are associated with an increased risk of cardiovascular disease and is an issue of substantial public health importance,” Doan T.M. Ngo, BPharm, B.Health Sc (Hons), PhD, of the School of Biomedical Sciences and Pharmacy at the University of Newcastle in Australia, said in a press release. “It is clear there are practice and policy gaps regarding the treatment of these patients, and it is vital to develop strategies to improve guideline-directed cardioprotective therapies in cardio-oncology.”
Of the 69 patients with a history of cancer, cancer predated admission to the cardiology unit by an average of 11 years, and 11 patients were receiving active cancer treatment. Those with a history of cancer were more likely to have HF as their reason for admission than those with no cancer history.
When the researchers performed a multivariable analysis adjusted for age, sex, BMI, hypertension, dyslipidemia, smoking status, diabetes and CVD, they found patients with a history of cancer were less likely to be taking statins (OR = 0.41; 95% CI, 0.22-0.77) or antiplatelet therapy (OR = 0.53; 95% CI, 0.29-1) compared with those with no cancer history.
However, there was no difference between the groups in use of ACE inhibitors and angiotensin receptor blockers (OR = 0.62; 95% CI, 0.34-1.12) and beta-blockers (OR = 0.63; 95% CI, 0.35-1.14).
Prescription of statins and antiplatelet therapy at the time of admission was also lower in those with a cancer history compared with those without one (OR for statins = 0.38; 95% CI, 0.2-0.7; OR for antiplatelet therapy = 0.43; 95% CI, 0.25-0.77), according to the researchers.
Among those with a history of cancer, the most common types were colorectal (20.3%), breast (13%) and melanoma (11.6%), and 36% had a CVD diagnosis before their cancer diagnosis, the researchers wrote.
“These results suggest that management of modifiable cardiovascular risk factors in patients with cancer is suboptimal compared with those without a history of cancer,” Ngo and colleagues wrote. “Given that cancer history is associated with an increased CVD risk, we believe that this issue is of substantial public health importance.”