Relation Between Cancer and Atrial Fibrillation (from the REasons for Geographic And Racial Differences in Stroke Study)

Abstract

Atrial fibrillation (AF) is common in patients with life threatening cancer and those undergoing active cancer treatment. However, data from persons with a history of non-life threatening cancer and those who do not require active cancer treatment are lacking. A total of 15,428 (mean age: 66 ± 8.9 years; 47% women; 45% blacks) participants from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study with baseline data on prior cancer diagnosis and AF were included. Participants with life threatening cancer and active cancer treatment within 2 years of study enrollment were excluded. History of cancer was identified using computer-assisted telephone interviews. AF cases were identified from baseline electrocardiogram data and by a self-reported history of a previous diagnosis. Logistic regression was used to examine the cross-sectional association between cancer diagnosis and AF. A total of 2,248 (15%) participants had a diagnosis of cancer and 1,295 (8.4%) had AF. In a multivariable logistic regression model adjusted for socio-demographics (age, sex, race, education, income, and region of residence) and cardiovascular risk factors (systolic blood pressure, high-density lipoprotein cholesterol, total cholesterol, C-reactive protein, body mass index, smoking, diabetes, antihypertensive and lipid-lowering agents, left ventricular hypertrophy, and cardiovascular disease), those with cancer were more likely to have prevalent AF than those without cancer (OR=1.19, 95%CI=1.02, 1.38). Subgroup analyses by age, sex, race, cardiovascular disease, and C-reactive protein yielded similar results. In conclusion, AF was more prevalent in participants with a history of non-life threatening cancer and those who did not require active cancer treatment in REGARDS.

Efficacy and Safety of Edoxaban in Patients With Active Malignancy and Atrial Fibrillation: Analysis of the ENGAGE AF‐TIMI 48 Trial

“…Use of DOACs in patients with AF is increasing in clinical practice and the aging population 36, 37. Older patients receiving DOACs may develop a new or recurrent malignancy because of shared risk factors with aging 3, 4, 5, 6. We anticipate, therefore, an increase in use of DOACs in patients with cancer and a need for efficacy and safety data.…”

“…Although data on patients with AF with malignancy are limited, observational studies suggest an association between AF and cancer,2, 3, 4, 5 likely because of systemic inflammation, shared risk factors, and common disease states underlying both conditions in aging populations 4, 6. Although 20‐year incident malignancy in patients with new‐onset AF has been reportedly low at 10%,4 incident AF may occur in up to 30% of patients with certain types of malignancy (eg, thoracic) 6.…”

Pathophysiology of cancer therapy-provoked atrial fibrillation

“…AF was more prevalent in participants with a history of non-life-threatening cancer and those who did not need active cancer therapies [66]. Case-control studies in breast cancer and colon cancer support the claim that cancer affects AF development [13,29,[115][116][117].…”

“…Table 1 summarizes potential adverse heart-related effects of three kinds of anticancer drugs (e.g., alkylating agents, anthracycline agents, and cancer targeted therapies). Importantly, development of AF is also frequently observed in patients with life-threatening cancer and those undergoing active cancer therapies [66]. Drug-induced AF is considered an adverse effect of chemotherapeutic drugs, such as alkylating agents (e.g., cisplatin, melphalan, and cyclophosphamide (CTX)), anthracycline agents (e.g., doxorubicin), and cancer targeted therapies (e.g., trastuzumab, sorafenib, and sunitinib) [67].…”

Association of Atrial Fibrillation and Cancer

“…12 However, the prevalence of AF appears to be higher in patients with cancer at the time of diagnosis even before undergoing therapy. 16,17 Patients with cancer are also at increased risk of developing AF, particularly in the first 90 days after diagnosis suggesting an overlap in pathophysiological processes. 17,18 …”