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Eur Heart J. 2019 Dec 21;40(48):3889-3897. doi: 10.1093/eurheartj/ehz766.

A population-based study of cardiovascular disease mortality risk in US cancer patients.

Author information

1
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
2
Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
3
Department of Radiation Oncology, Mayo Clinic, Jacksonville, FL, USA.
4
Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, New York City, NY, USA.
5
Division of Cancer Epidemiology and Genetics, National Institutes of Health, Bethesda, MD, USA.
6
Department of Radiation Oncology, Penn State Cancer Institute, Hershey, PA, USA.

Abstract

AIMS:

This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis.

METHODS AND RESULTS:

The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3 234 256 US cancer survivors (1973-2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1 228 328 patients (38.0%) died from cancer and 365 689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at <35 years of age. Further, CVD mortality risk is highest (SMR 3.93, 95% confidence interval 3.89-3.97) within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population.

CONCLUSION:

The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.

KEYWORDS:

Cardio-oncology; Epidemiology; Heart disease; Neoplasm; SEER

PMID:
31761945
PMCID:
PMC6925383
[Available on 2020-12-21]
DOI:
10.1093/eurheartj/ehz766

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