“Improvements in cancer survival in the past few decades have resulted in a large and growing population of long-term cancer survivors; about half of patients diagnosed with cancer in high-income settings are now expected to survive for 10 years or longer,” wrote the researchers, whose work was published in The Lancet. “However, significant concerns exist that there might be increased medium-term to long-term risks of cardiovascular diseases after cancer diagnosis, driven by cardiotoxic treatment effects, mechanisms directly related to cancer biology, and shared risk factors.”
The researchers used UK Clinical Practice Research Datalink data tied to primary care, hospital, and cancer registry data for information on cancer survivors of the 20 most common cancers. Patients had to be aged ≥ 18 years.
“The outcomes of the study were fatal or non-fatal coronary artery disease (angina, myocardial infarction, revascularisation procedures, and sudden cardiac arrest), stroke (haemorrhagic and ischaemic stroke), arrhythmia, venous thromboembolism (deep vein thrombosis and pulmonary embolism), heart failure and cardiomyopathy combined, pericarditis, valvular heart disease, and peripheral vascular disease,” the authros wrote. “Component outcomes within coronary artery disease, venous thromboembolism, and heart failure or cardiomyopathy were also analysed separately.”
Final analysis included a total of 108,215 cancer survivors who were matched to 523,541 controls. Patients with 18 of the 20 cancers evaluated had a higher risk of venous thromboembolism compared to controls, with adjusted hazard ratios (HRs) ranging from 1.72 (95% confidence interval [CI] 1.57–1.89) for prostate cancer survivors to 9.72 (5.50–17.18) for pancreatic cancer survivors. HRs were still increased more than five years after diagnosis but went down overtime. Heart failure or cardiomyopathy risks were significantly increased in patients with 10 of the 20 evaluated cancers, including hematological (adjusted HR 1.94, 1.66–2.25, with non-Hodgkin lymphoma; 1.77, 1.50–2.09, with leukemia; and 3.29, 2.59–4.18, with multiple myeloma), esophageal (1.96, 1.46–2.64), lung (1.82, 1.52–2.17) kidney (1.73, 1.38–2.17) and ovarian (1.59, 1.19–2.12). Several cancers, including hematological malignancies, were associated with increased risks of arrhythmia, pericarditis, coronary artery disease, stroke, and valvular heart disease. Patients who were younger and did not have a history of heart disease had higher HRs for heart failure or cardiomyopathy and venous thromboembolism, but “absolute excess risks were generally greater with increasing age,” the authors noted. “Increased risks of these outcomes seemed most pronounced in patients who had received chemotherapy.”
The authors concluded by recommending, “Strategies to minimise and manage cardiovascular risk are needed for the growing population of cancer survivors.”