Incident Cardiovascular Disease Among Adults With Cancer

Paterson, Ian; Wiebe, Natasha; Cheung, Winson Y.; Mackey, John R.; Pituskin, Edith; Reiman, Anthony; Tonelli, Marcello

doi:10.1016/j.jaccao.2022.01.100

Cited by 103 publications

(90 citation statements)

References 28 publications

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“…In this issue of JACC: CardioOncology , Paterson et al 13 present a detailed population-based retrospective cohort study of the incidence of CVD in adult patients with cancer using an administrative medical database of 4,519,243 adults living in Alberta, Canada. Participants newly diagnosed with cancer during the study period were compared with those without cancer to determine the risk for subsequent cardiovascular events (cardiovascular death, myocardial infarction, stroke, heart failure, and pulmonary embolism) using a time-to-event survival model after adjusting for sociodemographic data and comorbidities.…”

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confidence: 99%

“…The work by Paterson et al 13 has remarkable strengths, including large administrative databases with validated risk factors and outcome indicators. The investigators hypothesized that cardiovascular risk increases in all cancer types and is not restricted to heart failure, because excess cardiovascular morbidity due to cancer treatment results from direct myocardial and vascular damage and indirect adverse lifestyle effects.…”

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confidence: 99%

“…First, the investigators acknowledge that data on cancer therapies, patient ethnicity, and some risk factors for atherosclerosis—such as smoking and physical activity—were not available. 13 Therefore, unmeasured confounders remain in 2 key elements: CVD risk factors and CTRCD. Second, although the investigators tried to minimize bias, the effect of the sharp difference between groups (median age 56 years [IQR: 43-67 years] vs 34 years [IQR: 23-49 years]) (see Table 1 of Paterson et al 13 ) remains even after age and sex adjustments, including >10% differences in hypertension, obesity, diabetes, and peripheral arterial disease (see Supplemental Table 6 of Paterson et al 13 ).…”

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confidence: 99%

“… 13 Therefore, unmeasured confounders remain in 2 key elements: CVD risk factors and CTRCD. Second, although the investigators tried to minimize bias, the effect of the sharp difference between groups (median age 56 years [IQR: 43-67 years] vs 34 years [IQR: 23-49 years]) (see Table 1 of Paterson et al 13 ) remains even after age and sex adjustments, including >10% differences in hypertension, obesity, diabetes, and peripheral arterial disease (see Supplemental Table 6 of Paterson et al 13 ). Third, a population-based analysis has limitations from several perspectives, including strength, consistency, specificity, temporality, biological gradient, and validity.…”

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confidence: 99%

“…Third, a population-based analysis has limitations from several perspectives, including strength, consistency, specificity, temporality, biological gradient, and validity. 6 , 14 For example, the HRs of cancer for CVD death (1.33; 95% CI: 1.29-1.37) 13 may be weaker than the HR of smoking for lung cancer (19.11; 95% CI: 15.8-23.18). 6 The broad definition of exposure (cancer) and outcome (CVD) may have lowered the specificity of the association.…”

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confidence: 99%

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Association of Preexisting Heart Failure With Outcomes in Older Patients With Diffuse Large B-Cell Lymphoma

et al. 2023

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ImportanceAnthracycline-containing regimens are highly effective for diffuse large B-cell lymphoma (DLBCL); however, patients with preexisting heart failure (HF) may be less likely to receive anthracyclines and may be at higher risk of lymphoma mortality.ObjectiveTo assess the prevalence of preexisting HF in older patients with DLBCL and its association with treatment patterns and outcomes.Design, Setting, and ParticipantsThis longitudinal cohort study used data from the Surveillance, Epidemiology, and End Results (SEER)–Medicare registry from 1999 to 2016. The SEER registry is a system of population-based cancer registries, capturing more than 25% of the US population. Linkage to Medicare offers additional information from billing claims. This study included individuals 65 years and older with newly diagnosed DLBCL from 2000 to 2015 with Medicare Part A or B continuously in the year prior to lymphoma diagnosis. Data were analyzed from September 2020 to December 2022.ExposuresPreexisting HF in the year prior to DLBCL diagnosis ascertained from billing codes required one of the following: (1) 1 primary inpatient discharge diagnosis, (2) 2 outpatient diagnoses, (3) 3 secondary inpatient discharge diagnoses, (4) 3 emergency department diagnoses, or (5) 2 secondary inpatient discharge diagnoses plus 1 outpatient diagnosis.Main Outcomes and MeasuresThe primary outcome was anthracycline-based treatment. The secondary outcomes were (1) cardioprotective medications and (2) cause-specific mortality. The associations between preexisting HF and cancer treatment were estimated using multivariable logistic regression. The associations between preexisting HF and cause-specific mortality were evaluated using cause-specific Cox proportional hazards models with adjustment for comorbidities and cancer treatment.ResultsOf 30 728 included patients with DLBCL, 15 474 (50.4%) were female, and the mean (SD) age was 77.8 (7.2) years. Preexisting HF at lymphoma diagnosis was present in 4266 patients (13.9%). Patients with preexisting HF were less likely to be treated with an anthracycline (odds ratio, 0.55; 95% CI, 0.49-0.61). Among patients with preexisting HF who received an anthracycline, dexrazoxane or liposomal doxorubicin were used in 78 of 1119 patients (7.0%). One-year lymphoma mortality was 41.8% (95% CI, 40.5-43.2) with preexisting HF and 29.6% (95% CI, 29.0%-30.1%) without preexisting HF. Preexisting HF was associated with higher lymphoma mortality in models adjusting for baseline and time-varying treatment factors (hazard ratio, 1.24; 95% CI, 1.18-1.31).Conclusions and RelevanceIn this study, preexisting HF in patients with newly diagnosed DLBCL was common and was associated with lower use of anthracyclines and lower use of any chemotherapy. Trials are needed for this high-risk population.

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Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

Viamonte,

Joaquim,

Alves

et al. 2023

JAMA Cardiol

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ImportanceCardiovascular disease is a leading cause of morbidity in cancer survivors, which makes strategies aimed at mitigating cardiovascular risk a subject of major contemporary importance.ObjectiveTo assess whether a center-based cardiac rehabilitation (CBCR) framework compared with usual care encompassing community-based exercise training (CBET) is superior for cardiorespiratory fitness improvement and cardiovascular risk factor control among cancer survivors with high cardiovascular risk.Design, Setting, and ParticipantsThis prospective, single-center, randomized clinical trial (CORE trial) included adult cancer survivors who had exposure to cardiotoxic cancer treatment and/or previous cardiovascular disease. Enrollment took place from March 1, 2021, to March 31, 2022. End points were assessed at baseline and after the 8-week intervention.InterventionsParticipants were randomly assigned in a 1:1 ratio to 8 weeks of CBCR or CBET. The combined aerobic and resistance exercise sessions were performed twice a week.Main Outcomes and MeasuresThe powered primary efficacy measure was change in peak oxygen consumption (V̇o2) at 2 months. Secondary outcomes included handgrip maximal strength, functional performance, blood pressure (BP), body composition, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), lipid profile, plasma biomarker levels, physical activity (PA) levels, psychological distress, quality of life (QOL), and health literacy.ResultsA total of 75 participants completed the study (mean [SD] age, 53.6 [12.3] years; 58 [77.3%] female), with 38 in the CBCR group and 37 in the CBET group. Participants in CBCR achieved a greater mean (SD) increase in peak V̇o2 than those in CBET (2.1 [2.8] mL/kg/min vs 0.8 [2.5] mL/kg/min), with a between-group mean difference of 1.3 mL/kg/min (95% CI, 0.1-2.6 mL/kg/min; P = .03). Compared with the CBET group, the CBCR group also attained a greater mean (SD) reduction in systolic BP (−12.3 [11.8] mm Hg vs −1.9 [12.9] mm Hg; P &lt; .001), diastolic BP (−5.0 [5.7] mm Hg vs −0.5 [7.0] mm Hg; P = .003), and BMI (−1.2 [0.9] vs 0.2 [0.7]; P &lt; .001) and greater mean (SD) improvements in PA levels (1035.2 [735.7] metabolic equivalents [METs]/min/wk vs 34.1 [424.4] METs/min/wk; P &lt; .001), QOL (14.0 [10.0] points vs 0.4 [12.9] points; P &lt; .001), and health literacy scores (2.7 [1.6] points vs 0.1 [1.4] points; P &lt; .001). Exercise adherence was significantly higher in the CBCR group than in the CBET group (mean [SD] sessions completed, 90.3% [11.8%] vs 68.4% [22.1%]; P &lt; .001).Conclusion and RelevanceThe CORE trial showed that a cardio-oncology rehabilitation model among cancer survivors with high cardiovascular risk was associated with greater improvements in peak V̇o2 compared with usual care encompassing an exercise intervention in a community setting. The CBCR also showed superior results in exercise adherence, cardiovascular risk factor control, QOL, and health literacy.Trial RegistrationClinicalTrials.gov Identifier: NCT05132998

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Incident Cardiovascular Disease Among Adults With Cancer

Cited by 103 publications

References 28 publications

Real-World Evidence in Cardio-Oncology

Real-World Evidence in Cardio-Oncology

Association of Preexisting Heart Failure With Outcomes in Older Patients With Diffuse Large B-Cell Lymphoma

Cardio-Oncology Rehabilitation for Cancer Survivors With High Cardiovascular Risk

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