Arterial stiffness is associated with cardiovascular and cancer mortality in cancer patients: Insight from NHANESIII

Shannon K Parr; Catherine C Steele; Stephen T Hammond; Vanessa Rose G Turpin; Carl J Ade

doi:10.1016/j.ijchy.2021.100085

Arterial stiffness is associated with cardiovascular and cancer mortality in cancer patients: Insight from NHANESIII

Int J Cardiol Hypertens. 2021 Apr 28:9:100085. doi: 10.1016/j.ijchy.2021.100085. eCollection 2021 Jun.

Authors

Shannon K Parr¹, Catherine C Steele², Stephen T Hammond¹, Vanessa Rose G Turpin¹, Carl J Ade^{1

3

4}

Affiliations

¹ Department of Kinesiology, College of Health and Human Sciences, Kansas State University, USA.
² Department of Psychology and Communication, College of Arts and Sciences, Texas A&M International University, USA.
³ Physician Assistant Studies, College of Health and Human Sciences, Kansas State University, USA.
⁴ Johnson Cancer Center, Kansas State University, USA.

Abstract

Background: Cancer survivors are at greater risk for cardiovascular disease (CVD) than second malignancy, resulting in a decreased quality of life and increased cost of care. Additional knowledge of CVD prevention by identifying possible risk factors has clinical relevance. Our main objective was to determine the relevance of a clinical index of arterial stiffness, pulse pressure, in predicting CVD mortality in cancer patients, with a second objective to examine its relationship with cancer mortality.

Methods: We retrospectively analyzed 781 cancer patients from Third National Health and Nutrition Examination Survey and Linked Mortality File, including demographic, anthropometric, blood pressure, and cause of death. Kaplan-Meier survival curve and Cox hazard regression analyses were performed to assess the relationship between pulse pressure and cardiovascular, cancer, and all-cause mortality.

Results: During a mean follow-up time of 8.1 years, 603 deaths, 257 cancer and 151 CVD, occurred. In unadjusted models, the risk of CVD, cancer, and all-cause mortality were 3.8-fold, 5.3-fold, and 1.6-fold higher, respectively, for pulse pressure ≥70 mmHg compared to <50 mmHg. Adjusted analyses revealed a higher CVD mortality in cancer patients <65 years with a pulse pressure 60-70 mmHg (adjusted hazard ratio, 5.26; 95%CI, 1.12-24.78) when compared to pulse pressure of <50 mmHg. Pulse pressure was not associated with risk of all-cause, CVD, or cancer in those ≥65 years.

Conclusion: Pulse pressure, an index of arterial stiffness, is predictive of CVD mortality in cancer patients. Our findings support non-invasive office-setting measurements of arterial stiffness to identify high risk patients.

Keywords: Arterial stiffness; BMI, Body mass index; CVD; CVD, Cardiovascular disease; Cardio-oncology; MAP, Mean arterial pressure; NDI, National Death Index; NHANES III, Third National Health and Nutrition Examination Survey; PP, Pulse Pressure.