Cardiovascular disease and stroke following cancer and cancer treatment in older adults.
cancer
cardiovascular disease
elderly
stroke
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
23 Sep 2024
23 Sep 2024
Historique:
revised:
30
04
2024
received:
28
02
2024
accepted:
13
05
2024
medline:
23
9
2024
pubmed:
23
9
2024
entrez:
23
9
2024
Statut:
aheadofprint
Résumé
Cancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort. The authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke. Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk-set compared to the cancer-free risk-set (20.8 vs. 10.3 events per 1000 person-years; incidence rate ratio, 2.03; 95% confidence interval, 1.51-2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups. Incidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.
Sections du résumé
BACKGROUND
BACKGROUND
Cancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort.
METHODS
METHODS
The authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.
RESULTS
RESULTS
Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk-set compared to the cancer-free risk-set (20.8 vs. 10.3 events per 1000 person-years; incidence rate ratio, 2.03; 95% confidence interval, 1.51-2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups.
CONCLUSIONS
CONCLUSIONS
Incidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : National Health and Medical Research Council
ID : 1127060
Organisme : National Health and Medical Research Council
ID : 334047
Organisme : NIH HHS
ID : 3U19 AG062682-02S1
Pays : United States
Organisme : NIH HHS
ID : P30 CA047904
Pays : United States
Organisme : NIH HHS
ID : U01 AG029824
Pays : United States
Organisme : NIH HHS
ID : U19 AG062682
Pays : United States
Organisme : Victorian Cancer Agency
Organisme : Monash University
Informations de copyright
© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.
Références
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394‐424. doi:10.3322/caac.21492
Australian Cancer Incidence and Mortality (ACIM) books. Australian Institute of Health and Welfare; 2018.
Howlander N, Noone A, Krapcho M, et al. SEER Cancer Statistics Review, 1975‐2016; 2018. Accessed June 22, 2023. https://seer.cancer.gov/csr/1975_2016/
Muhandiramge J, Orchard S, Haydon A, Zalcberg J. The acceleration of ageing in older patients with cancer. J Geriatr Oncol. 2021;12(3):343‐351. doi:10.1016/j.jgo.2020.09.010
Muhandiramge J, Zalcberg JR, van Londen GJ, et al. Cardiovascular disease in adult cancer survivors: a review of current evidence, strategies for prevention and management, and future directions for cardio‐oncology. Curr Oncol Rep.2022;24(11):1579‐1592. doi:10.1007/s11912‐022‐01309‐w
Strongman H, Gadd S, Matthews A, et al. Medium and long‐term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population‐based cohort study using multiple linked UK electronic health records databases. Lancet. 2019;394(10203):1041‐1054. doi:10.1016/S0140‐6736(19)31674‐5
Zoller B, Ji J, Sundquist J, Sundquist K. Risk of coronary heart disease in patients with cancer: a nationwide follow‐up study from Sweden. Eur J Cancer. 2012;48(1):121‐128. doi:10.1016/j.ejca.2011.09.015
Paterson DI, Wiebe N, Cheung WY, et al. Incident cardiovascular disease among adults with cancer: a population‐based cohort study. J Am Coll Cardiol. 2022;4(1):85‐94. doi:10.1016/j.jaccao.2022.01.100
Zoller B, Ji J, Sundquist J, Sundquist K. Risk of haemorrhagic and ischaemic stroke in patients with cancer: a nationwide follow‐up study from Sweden. Eur J Cancer. 2012;48(12):1875‐1883. doi:10.1016/j.ejca.2012.01.005
Zhang F, Wang K, Du P, et al. Risk of stroke in cancer survivors: a meta‐analysis of population‐based cohort studies. Neurology. 2021;96(4):e513‐e526. doi:10.1212/WNL.0000000000011264
Dardiotis E, Aloizou AM, Markoula S, et al. Cancer‐associated stroke: Pathophysiology, detection and management (Review). Int J Oncol. 2019;54(3):779‐796. doi:10.3892/ijo.2019.4669
Blaes AH, Thavendiranathan P, Moslehi J. Cardiac toxicities in the era of precision medicine: underlying risk factors, targeted therapies, and cardiac biomarkers. Am Soc Clin Oncol Educ Book. 2018;38:764‐774. doi:10.1200/EDBK_208509
Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation. 2016;133(11):1104‐1114. doi:10.1161/CIRCULATIONAHA.115.020406
Saynak M, Cosar‐Alas R, Yurut‐Caloglu V, Caloglu M, Kocak Z, Uzal C. Chemotherapy and cerebrovascular disease. J BUON. 2008;13(1):31‐36.
Koutroumpakis E, Palaskas NL, Lin SH, et al. Modern radiotherapy and risk of cardiotoxicity. Chemotherapy. 2020;65(3‐4):65‐76. doi:10.1159/000510573
Ramin C, Schaeffer ML, Zheng Z, et al. All‐cause and cardiovascular disease mortality among breast cancer survivors in CLUE II, a long‐standing community‐based cohort. J Natl Cancer Inst. 2021;113(2):137‐145. doi:10.1093/jnci/djaa096
Stoltzfus KC, Zhang Y, Sturgeon K, et al. Fatal heart disease among cancer patients. Nat Commun. 2020;11(1):2011. doi:10.1038/s41467‐020‐15639‐5
Epping‐Jordan JE, Galea G, Tukuitonga C, Beaglehole R. Preventing chronic diseases: taking stepwise action. Lancet. 2005;366(9497):1667‐1671. doi:10.1016/S0140‐6736(05)67342‐4
Bansal N, Adams MJ, Ganatra S, et al. Strategies to prevent anthracycline‐induced cardiotoxicity in cancer survivors. Cardiooncology. 2019;5:18. doi:10.1186/s40959‐019‐0054‐5
Curigliano G, Lenihan D, Fradley M, et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Ann Oncol. 2020;31(2):171‐190. doi:10.1016/j.annonc.2019.10.023
Scott JM, Zabor EC, Schwitzer E, et al. Efficacy of exercise therapy on cardiorespiratory fitness in patients with cancer: a systematic review and meta‐analysis. J Clin Oncol. 2018;36(22):2297‐2305. doi:10.1200/JCO.2017.77.5809
McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509‐1518. doi:10.1056/NEJMoa1805819
McNeil JJ, Gibbs P, Orchard SG, et al. Effect of aspirin on cancer incidence and mortality in older adults. J Natl Cancer Inst. 2021;113(3):258‐265. doi:10.1093/jnci/djaa114
Orchard SG, Lockery JE, Gibbs P, et al. Cancer history and risk factors in healthy older people enrolling in the ASPREE clinical trial. Contemp Clin Trials. 2020;96:106095. doi:10.1016/j.cct.2020.106095
McNeil JJ, Woods RL, Nelson MR, et al. Baseline characteristics of participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study. J Gerontol A Biol Sci Med Sci. 2017;72(11):1586‐1593. doi:10.1093/gerona/glw342
Muhandiramge J, Warner ET, Zalcberg JR, et al. Cancer treatment patterns and factors affecting receipt of treatment in older adults: results from the ASPREE cancer treatment substudy (ACTS). Cancers. 2023(4):15. doi:10.3390/cancers15041017
ASPREE Investigator Group. Study design of ASPirin in Reducing Events in the Elderly (ASPREE): a randomized, controlled trial. Contemp Clin Trials. 2013;36(2):555‐564. doi:10.1016/j.cct.2013.09.014
van de Poll‐Franse LV, Kwan L, Reiter RE, Lee SP, Litwin MS. The influence of cardiovascular disease on health related quality of life in men with prostate cancer: a 4‐year followup study. J Urol. 2008;179(4):1362‐1367. doi:10.1016/j.juro.2007.11.086
Paterson DI, Wiebe N, Cheung WY, et al. Incident cardiovascular disease among adults with cancer: a population‐based cohort study. JACC CardioOncol. 2022;4(1):85‐94. doi:10.1016/j.jaccao.2022.01.100
Schoormans D, Vissers PAJ, van Herk‐Sukel MPP, et al. Incidence of cardiovascular disease up to 13 year after cancer diagnosis: a matched cohort study among 32 757 cancer survivors. Cancer Med. 2018;7(10):4952‐4963. doi:10.1002/cam4.1754
Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420(6917):860‐867. doi:10.1038/nature01322
Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;140(11):e596‐e646. doi:10.1161/CIR.0000000000000678
Smith CL, Kasza J, Woods RL, et al. Compliance‐adjusted estimates of aspirin effects in older persons in the ASPREE randomized trial. Am J Epidemiol. 2023;192(12):2063‐2074. doi:10.1093/aje/kwad168
Rugbjerg K, Mellemkjaer L, Boice JD, Kober L, Ewertz M, Olsen JH. Cardiovascular disease in survivors of adolescent and young adult cancer: a Danish cohort study, 1943‐2009. J Natl Cancer Inst. 2014;106(6):dju110. doi:10.1093/jnci/dju110
Greenlee H, Iribarren C, Rana JS, et al. Risk of cardiovascular disease in women with and without breast cancer: the Pathways heart study. J Clin Oncol. 2022;40(15):1647‐1658. doi:10.1200/JCO.21.01736
Elshanbary AA, Zaazouee MS, Abdelmonem M, Mohammed YA, Abdel‐Aziz W. Risk factors for cardiovascular mortality and melanoma‐specific mortality among patients with melanoma: a SEER based study. Eur J Cancer Prev. 2022;31(3):293‐300. doi:10.1097/CEJ.0000000000000690
Florido R, Daya NR, Ndumele CE, et al. Cardiovascular disease risk among cancer survivors: the Atherosclerosis Risk In Communities (ARIC) study. J Am Coll Cardiol. 2022;80(1):22‐32. doi:10.1016/j.jacc.2022.04.042
Okwuosa TM, Morgans A, Rhee JW, et al. Impact of hormonal therapies for treatment of hormone‐dependent cancers (breast and prostate) on the cardiovascular system: effects and modifications: a scientific statement from the American Heart Association. Circ Genom Precis Med. 2021;14(3):e000082. doi:10.1161/HCG.0000000000000082
Navi BB, Reiner AS, Kamel H, et al. Association between incident cancer and subsequent stroke. Ann Neurol. 2015;77(2):291‐300. doi:10.1002/ana.24325
Pai VB, Nahata MC. Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf. 2000;22(4):263‐302. doi:10.2165/00002018‐200022040‐00002
Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15‐year survival: an overview of the randomised trials. Lancet. 2005;366(9503):2087‐2106. doi:10.1016/S0140‐6736(05)67887‐7
Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin's disease. JAMA. 1993;270(16):1949‐1955.
Bradley JD, Paulus R, Komaki R, et al. Standard‐dose versus high‐dose conformal radiotherapy with concurrent and consolidation carboplatin plus paclitaxel with or without cetuximab for patients with stage IIIA or IIIB non‐small‐cell lung cancer (RTOG 0617): a randomised, two‐by‐two factorial phase 3 study. Lancet Oncol. 2015;16(2):187‐199. doi:10.1016/S1470‐2045(14)71207‐0