Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers

Tianwang Guan; Olivia Monteiro; Dongting Chen; Zehao Luo; Kaiyi Chi; Zhihao Li; Yinglan Liang; Zhenxing Lu; Yanting Jiang; Jinming Yang; Wenrui Lin; Min Yi; Kang Zhang; Caiwen Ou

doi:10.1016/j.jare.2024.03.017

Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers

J Adv Res. 2024 Mar 26:S2090-1232(24)00117-6. doi: 10.1016/j.jare.2024.03.017. Online ahead of print.

Authors

Tianwang Guan¹, Olivia Monteiro², Dongting Chen³, Zehao Luo³, Kaiyi Chi⁴, Zhihao Li⁵, Yinglan Liang³, Zhenxing Lu⁶, Yanting Jiang³, Jinming Yang³, Wenrui Lin³, Min Yi⁷, Kang Zhang⁸, Caiwen Ou⁹

Affiliations

¹ Cancer Center, The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China; Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China.
² Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China.
³ Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China.
⁴ Department of Clinical Medicine, Clinical Medical School, Guangzhou Medical University, Guangzhou 510180, China; Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China.
⁵ Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou 510515, China.
⁶ The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China.
⁷ Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou 510180, China.
⁸ Faculty of Medicine, Medical Sciences Division, Macau University of Science and Technology, Avenida da Harmonia, Praia Park, Coloane, Macao 999078, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China. Electronic address: kang.zhang@gmail.com.
⁹ Guangdong Provincial Key Laboratory of Cardiac Function and Microcirculation, Guangzhou 510515, China; The Tenth Affiliated Hospital, Southern Medical University (Dongguan People's Hospital), Dongguan 523059, China. Electronic address: oucaiwen@smu.edu.cn.

PMID: 38537701
DOI: 10.1016/j.jare.2024.03.017

Abstract

Introduction: Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers.

Objectives: To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites.

Methods: A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs).

Results: In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]-19·85[95 %CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]-19·25[95 %CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]-24·71[95 %CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group.

Conclusion: The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.

Keywords: Cardio-oncology; Cardiovascular disease death; Non-metastatic cancers; SEER.