medwireNews: Survivors of the 20 most common site-specific cancers, including lung and prostate, are at increased risk for cardiovascular disease in the years that follow diagnosis and treatment, show data published in The Lancet.
Krishnan Bhaskaran (London School of Hygiene & Tropical Medicine, UK) and colleagues believe their findings highlight the need for “more tailored strategies to minimise and manage cardiovascular risk” among people who survive cancer.
Bhaskaran and team used data from multiple linked UK electronic health record databases to identify 108,215 adult survivors of the 20 most common cancers as well as 523,541 controls with no history of cancer, matched for age, sex, and general practice.
They found that the risk for venous thromboembolism (VTE) was significantly elevated among survivors of 90% of the cancer types they studied, with hazard ratios (HRs) ranging from 1.72 for prostate cancer to 9.72 for pancreatic cancer.
Survivors of lung cancer had a 5.24-fold increased risk for VTE relative to controls, and they were also at increased risk for heart failure or cardiomyopathy (HR=1.82), coronary artery disease (HR=1.42), arrhythmia (HR=1.85), stroke (HR=1.51), peripheral vascular disease (HR=1.44), and pericarditis (HR=6.27).
The only outcome studied that did not have an elevated risk among lung cancer survivors was valvular heart disease. Only survivors of liver (HR=2.97) and bladder (HR=1.16) cancer were at increased risk for this complication.
Bladder cancer survivors also had increased risks for VTE (HR=2.01), heart failure or cardiomyopathy (HR=1.19), coronary artery disease (HR=1.25), arrhythmia (HR=1.14), and peripheral vascular disease (HR=1.19).
Survivors of both kidney and prostate cancer had increased risks for heart failure or cardiomyopathy (HR=1.73 and 1.12, respectively) and arrythmia (HR=1.28 and 1.07, respectively), while prostate cancer survivors were also at increased risk for coronary artery disease (HR=1.09).
The researchers note that the associations between cancer and cardiovascular risk did not appear to be explained by shared risk factors, such as smoking, BMI, and comorbidity, but exploratory analyses suggested that the risks for each of the outcomes were most pronounced among patients who had received chemotherapy.
They also found that the risk for cardiovascular disease decreased with time since diagnosis, but for VTE in particular remained elevated for at least 5 years.
In an accompanying comment, Anne Blaes and Chetan Shenoy, both from the University of Minnesota in Minneapolis, USA, say that the study “shows that cancer therapies, particularly chemotherapy, play a prominent role in cardiovascular risk, a risk that might be similar to that of tobacco use and increased body-mass index.”
However, they also point out that tools such as the Framingham risk prediction score and the Pooled Cohort Equations, used to identify individuals at high short-to-medium term risk for developing cardiovascular disease, do not include cancer as one of the risk factors.
Blaes and Shenoy therefore say that there is a “strong case for research into whether the inclusion of cancer in these risk prediction tools, beyond the traditional risk factors for the prediction of cardiovascular disease risk, would add incremental value in the general population.”
They conclude: “In the meantime, clinicians should account for cancer, and especially chemotherapy, as a risk factor for cardiovascular disease when discerning individual patient risks to guide preventive interventions.”
By Laura Cowen
medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group
Lancet 2019; doi:10.1016/S0140-6736(19)31674-5
Lancet 2019; doi:10.1016/S0140-6736(19)31886-0