Incidence of cardiovascular disease up to 13 year after cancer diagnosis: A matched cohort study among 32 757 cancer survivors

Abstract

We examined the incidence of cardiovascular disease (CVD) among 32 757 cancer survivors and age‐, gender‐, and geographically matched cancer‐free controls during a follow‐up period of 1‐13 years, and explored whetherCVD incidence differed by received cancer treatment, traditional cardiovascular risk factors, age, or gender. Adult 1‐year cancer survivors without a history ofCVD diagnosed with breast (n = 6762), prostate (n = 4504), non‐Hodgkin (n = 1553), Hodgkin (n = 173), lung and trachea (n = 2661), basal cell carcinoma (BCC; n = 12 476), and colorectal (n = 4628) cancer during 1999‐2011 were selected from the Netherlands Cancer Registry and matched to cancer‐free controls without a history ofCVD. Drug dispenses and hospitalizations from thePHARMO Database Network were used as proxy forCVD. Data were analyzed using Cox regression analyses. Prostate (HR: 1.17; 95%CI: 1.01‐1.35) and lung and trachea (HR: 1.48; 95%CI: 1.10‐1.97) cancer survivors had an increased risk for developingCVD compared to cancer‐free controls. This increased risk among lung and trachea cancer survivors remained statistically significant after including traditional cardiovascular risk factors and cancer treatment information (HR: 1.41; 95%CI: 1.06‐1.89). Among prostate cancer survivors, the increased risk of incidentCVD was limited to those who received hormones and those without traditional cardiovascular risk factors. Breast, non‐Hodgkin,BCC, and colorectal cancer survivors showed no increasedCVD risk compared to cancer‐free controls. There was an increased risk of incidentCVD among prostate, and lung and trachea cancer survivors compared to age‐, gender‐ and geographically matched cancer‐free controls. Studies including longer follow‐up periods are warranted to examine whether cancer survivors are at increased risk of long‐term incidentCVD.

The risk of developing cardiovascular disease is increased for patients with prostate cancer who are pharmaceutically treated for depression

“…Hence, these men had a relatively lower a priori risk for developing CVD, which means there was room for the increased risk of developing CVD by being pharmaceutically treated for depression. As previously demonstrated in this patient sample, there is an increased risk of receiving hormone treatment for incident CVD . The present results show that there might be an additive effect, as pharmaceutically treated depression increases the risk of CVD only amongst men who are treated with hormones.…”

“…First, traditional CVD risk factors such as hypertension, hypercholesterolaemia, and diabetes mellitus, are known to play an important role in the pathogenesis of CVD . The involvement of these risk factors has been confirmed to play a role in incident CVD among various malignancies as well . More recently, several studies have shown that psychological distress, such as being anxious or depressed, also increases the risk of the development and progression of CVD among non‐cancer populations, independent of traditional biomedical risk factors .…”

“…A considerable proportion of prostate cancer survivors experience late effects from the cancer itself and its treatment, such as co‐morbid cardiovascular disease (CVD) and psychological distress . A recent case‐control study by our group concluded that prostate cancer survivors have an increased risk of incident CVD compared to their age‐matched cancer‐free controls . This increased risk may be the result of cardiotoxic cancer treatment, as several chemotherapeutic agents and hormone treatments can lead to a heterogeneous group of CVDs .…”

“…The incidence rate of cardiac co‐morbidity in prostate cancer survivors who received cardiotoxic treatment is ~3% . This suggests that there are additional factors involved in the pathogenesis of incident CVD amongst prostate cancer survivors.…”

NCCN Guidelines Insights: Survivorship, Version 2.2020

“…1 Fox Chase Cancer Center; 2 Yale Cancer Center/Smilow Cancer Hospital; 3 Vanderbilt-Ingram Cancer Center; 4 University of Colorado Cancer Center; 5 City of Hope National Medical Center; 6 Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance; 7 Mayo Clinic Cancer Center; 8 O'Neal Comprehensive Cancer Center at UAB; 9 UCSF Helen Diller Family Comprehensive Cancer Center; 10 University of Michigan Rogel Cancer Center; 11 Abramson Cancer Center at the University of Pennsylvania; 12 St. Jude Children's Research Hospital/The University of Tennessee Health Science Center; 13 Moffitt Cancer Center; 14 UC San Diego Moores Cancer Center; 15 Massachusetts General Hospital Cancer Center; 16 Huntsman Cancer Institute at the University of Utah; 17 Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute; 18 Memorial Sloan Kettering Cancer Center; 19 Roswell Park Comprehensive Cancer Center; 20 The Ohio State University Comprehensive Cancer Center -James Cancer Hospital and Solove Research Institute; 21 Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine; 22 Dana-Farber/Brigham and Women's Cancer Center; 23 The University of Texas MD Anderson Cancer Center; 24 The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; 25 Duke Cancer Institute; 26 University of Wisconsin Carbone Cancer Center; 27…”