Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients

Amrita Mukherjee; Howard W Wiener; Russell L Griffin; Carrie Lenneman; Arka Chatterjee; Lisle M Nabell; Cora E Lewis; Sadeep Shrestha

doi:10.3389/fcvm.2022.1024846

Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients

Front Cardiovasc Med. 2023 Jan 12:9:1024846. doi: 10.3389/fcvm.2022.1024846. eCollection 2022.

Authors

Amrita Mukherjee^{1

2}, Howard W Wiener¹, Russell L Griffin¹, Carrie Lenneman³, Arka Chatterjee⁴, Lisle M Nabell⁵, Cora E Lewis¹, Sadeep Shrestha¹

Affiliations

¹ Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States.
² Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
³ Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.
⁴ Department of Medicine, Sarver Heart Center, University of Arizona Health Sciences, Tucson, AZ, United States.
⁵ Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.

Abstract

Background: Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis.

Methods: A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk.

Results: In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older (p 0.006) and had a higher 5-year cumulative incidence of CVD (p 0.013) than HPV-positive patients.

Conclusion: Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.

Keywords: cardiovascular disease; electronic health records; head and neck cancer; hypertension; traditional risk factors.

Grants and funding

This study was funded by the American Heart Association Predoctoral Fellowship Award (AHA award: 20PRE35180040). Mining and processing of hospital data was supported by the NIH/NCATS CTSA grant UL1TR001417 funded Informatics for Integrating Biology and the Bedside (i2b2) and the Quetelet Endowed Professorship Research Fund.