TY - JOUR
T1 - Cardiovascular Disease Risk Among Cancer Survivors
T2 - The Atherosclerosis Risk In Communities (ARIC) Study
AU - Florido, Roberta
AU - Daya, Natalie R.
AU - Ndumele, Chiadi E.
AU - Koton, Silvia
AU - Russell, Stuart D.
AU - Prizment, Anna
AU - Blumenthal, Roger S.
AU - Matsushita, Kunihiro
AU - Mok, Yejin
AU - Felix, Ashley S.
AU - Coresh, Josef
AU - Joshu, Corinne E.
AU - Platz, Elizabeth A.
AU - Selvin, Elizabeth
N1 - Publisher Copyright:
© 2022 American College of Cardiology Foundation
PY - 2022/7/5
Y1 - 2022/7/5
N2 - Background: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking. Objectives: The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study. Methods: We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD. Results: Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk. Conclusions: Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.
AB - Background: More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking. Objectives: The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study. Methods: We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD. Results: Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk. Conclusions: Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.
KW - cancer
KW - cardio-oncology
KW - cardiovascular disease
KW - epidemiology
KW - heart failure
KW - prevention
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U2 - 10.1016/j.jacc.2022.04.042
DO - 10.1016/j.jacc.2022.04.042
M3 - Article
C2 - 35772913
AN - SCOPUS:85132240080
SN - 0735-1097
VL - 80
SP - 22
EP - 32
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 1
ER -