Incidence and risk of arterial thromboembolism in cancer patients from a safety-net healthcare system

Abstract

Background

The incidence of and risk factors for arterial thromboembolism (ATE) in patients with cancer, particularly in those with low socioeconomic status, remains understudied.

Objectives

We aimed to report the association between cancer-related and cardiovascular (CV) risk factors and the development of ATE.

Methods

We performed a retrospective cohort study of patients with newly diagnosed invasive cancer from 2011 to 2021 at a safety-net hospital system. We ascertained ATE outcomes using validated inpatient billing diagnosis codes for myocardial infarction and ischemic stroke. We examined the incidence of ATE after cancer diagnosis using the cumulative incidence competing risk method to account for early mortality and estimated subdistribution hazard ratios for ATE using multivariable Fine-Gray models.

Results

Among 17 236 patients (45.4% male, median 56 years), the ATE incidence was 1.5% (95% CI, 1.3%-1.6%) at 1 year and 2.8% (95% CI, 2.5%-3%) at 5 years after cancer diagnosis. In unadjusted analysis, the 5-year ATE incidence was highest in hematologic malignancies, such as multiple myeloma (8.6%) and acute leukemia (7.8%), among patients receiving immune checkpoint inhibitors (8.3% vs 2.7%), those with poor Eastern Cooperative Oncology Group performance status (5.4% performance status 4 vs 2.2% performance status 0), and advanced stage (3.1% IV vs 1.9% I). After multivariable adjustment, only cancer type remained significantly associated with ATE along with known CV risk factors, including advanced age, smoking, diabetes, hypertension, history of myocardial infarction, and history of ischemic stroke.

Conclusion

Both cancer type and traditional CV risk factors are independently associated with the development of ATE in patients with cancer.