Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications.

IF 3.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS Cardio-oncology Pub Date : 2024-10-16 DOI:10.1186/s40959-024-00269-3

Saifei Liu, John D Horowitz, Bogda Koczwara, Aaron L Sverdlov, Natalie Packer, Robyn A Clark

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Abstract

Background: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD).

Aim: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD_A); (b) The rates of patient admission with subsequent development of CVD (CVD_S) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD_A and CVD_S on mortality rates relative to those seen in patients without overt CVD (CVD^-) and (d) The time course of mortality in CVD^- versus CVD_S patients.

Methods: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined.

Results: Of the total 17,389 patients, there were 2,159 with CVD_A. Over a median follow-up time of 4.6 years, CVD_S admissions (n = 8,529) occurred more commonly in the presence of CVD_A (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD_S cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD_A, 64.7% for CVD_S, and 40.8% for CVD^- (p < 0.001). Development of CVD_S was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001).

Conclusions: Approximately 50% of patients assigned to cancer chemotherapy developed CVD_S, heralding a particularly high risk of mortality over the next 12 months. Both CVD_A and CVD_S are associated with substantial increases in mortality rates relative to those in CVD^- patients. This increased risk merits close individual monitoring.

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接受癌症化疗的 17,389 名患者中发生的心脏事件：短期和长期影响。

背景：心血管疾病与癌变之间的关系是双向的，且已得到证实。此外，癌症治疗可提高患者的总体生存率，但可能以增加致命性心血管疾病（CVD）为代价。目的：评估(a)在真实世界的队列中，接受癌症化疗的患者中患有先兆心血管疾病（CVDA）的比例；(b)接受化疗后，因心血管疾病（CVDS）而需要入院治疗的患者比例；(c)相对于无明显心血管疾病（CVD-）的患者，心血管疾病（CVDA）和心血管疾病（CVDS）对死亡率的影响；(d)心血管疾病（CVD-）患者与心血管疾病（CVDS）患者的死亡率时间变化：方法：在去标识化的关联健康数据集中进行了回顾性分析。死亡率的相关因素通过 Cox 比例危险评估进行评估。确定了心血管疾病作为主要死因的相对和绝对时间可变性：在总共 17,389 名患者中，有 2,159 人患有心血管疾病。中位随访时间为 4.6 年，CVDS 入院病例（n = 8,529 例）更常见于存在 CVDA 的患者（70.0% vs. 46.1%，p S 例发生在随访的前 12 个月。CVDA的5年死亡率为71.5%，CVDS为64.7%，心血管疾病为40.8%。与非心血管疾病相比，心血管疾病的发生也与心血管疾病死亡风险的增加有关（7.1% 对 1.6%，p 结论）：在接受癌症化疗的患者中，约有50%的患者出现了心血管疾病，这预示着他们在未来12个月内的死亡风险特别高。与心血管疾病患者相比，CVDA 和 CVDS 都会导致死亡率大幅上升。这种风险的增加值得密切监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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