Cancer survivors face elevated risk of cardiovascular disease over 10 years

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A study has found that about 35% of Americans with a cancer history had an elevated risk of atherosclerotic cardiovascular disease (ASCVD) in the next decade, compared with about 23% of those who didn't have cancer.

Based on a risk calculator that estimates a person's 10-year chances of developing heart disease or stroke, researchers from The Ohio State University found that the average estimated 10-year risk for a cancer survivor was about 8%, compared to 5% for those who didn't have a history of cancer.

"We know that obesity, cancer and cardiovascular disease share some common risk factors, and in addition to those shared risk factors, cancer patients also receive treatments including radiation and chemotherapy that can affect their cardiovascular health – we call that cardiotoxicity," said lead researcher Xiaochen Zhang, a PhD candidate in Ohio State's College of Public Health.

But those risks may be underestimated or poorly understood, leading Zhang and fellow researchers to urge steps to boost recognition among health care providers and their patients.

"The good news is that we're getting really good at treating cancer and we have more survivors, but we need to start thinking more carefully about the non-cancer risks following a diagnosis, one of which is cardiovascular disease," said study senior author Ashley Felix, an associate professor of epidemiology at Ohio State.

"We don't want people to survive cancer only to die prematurely of heart disease or stroke, so we need to make sure that cancer patients, and their health care team, are aware of this increased risk."

The data used in the study comes from the National Health and Nutrition Examination Survey conducted by the US Centres for Disease Control and Prevention. The nationally representative sample of people surveyed from 2007 to 2016 should provide a good picture of the elevated risk for cancer survivors in the US, the researchers said.

For this analysis, they examined data provided by 15,095 adults aged 40 to 79 years with no history of cardiovascular disease. Almost 13% reported a history of cancer. One of the strengths of this research is the large study size, which allowed for analysis based on type of cancer and by age group. Survivors of testicular, prostate, bladder and kidney cancers had particularly high 10-year cardiovascular disease risk, as did those in their 60s.

When the researchers compared individual cardiovascular disease risk factors by cancer status, they found that older age, higher systolic blood pressure and a personal history of diabetes were more common in the cancer survivors.

Looking forward, it's important that researchers and health care providers keep their eyes on the growing number of cancer survivors, including younger adults, Felix said.

Almost 17m Americans live with a cancer diagnosis, a number that is expected to grow to 26m by 2040.

"If we continue to see the increasing incidence of cancer among younger adults, we can expect to see a larger burden of cardiovascular disease among those individuals – our future studies need to go in that direction," she said.

Added Zhang, "The good news is that those younger individuals have a lot of time to make lifestyle changes that could move their cardiovascular risk in a positive direction.

"In addition to monitoring cancer survivors carefully for cardiovascular disease – and making them aware of the elevated risk – health care providers have the opportunity to guide patients toward interventions that can lower their risk," she said.

There's also potential for developing a risk-assessment tool that specifically takes cancer survivorship into account – which would allow for more precise assessments for that population, the researchers said.

The all-Ohio State research team also included Meghan Pawlikowski, Susan Olivo-Marston, Karen Patricia Williams and Julie Bower.

 

Study details
Ten-year cardiovascular risk among cancer survivors: The National Health and Nutrition Examination Survey

Xiaochen Zhang, Meghan Pawlikowski, Susan Olivo-Marston, Karen Patricia Williams, Julie K Bower, Ashley S Felix

Published in PLOS One on 4 March 2021

Abstract
Background
Cancer survivors have a higher risk of developing and dying from cardiovascular disease (CVD) compared to the general population. We sought to determine whether 10-year risk of atherosclerotic CVD (ASCVD) is elevated among those with vs. without a cancer history in a nationally representative U.S. sample.
Methods
Participants aged 40–79 years with no CVD history were included from the 2007–2016 National Health and Nutrition Examination Survey. Cancer history was self-reported and 10-year risk of ASCVD was estimated using Pooled Cohort Equations. We used logistic regression to estimate associations between cancer history and odds of elevated (≥7.5%) vs. low (<7.5%) 10-year ASCVD risk. An interaction between age and cancer history was examined.
Results
A total of 15,095 participants were included (mean age = 55.2 years) with 12.3% (n = 1,604) reporting a cancer history. Individuals with vs. without a cancer history had increased odds of elevated 10-year ASCVD risk (OR = 3.42, 95% CI: 2.51–4.66). Specifically, those with bladder/kidney, prostate, colorectal, lung, melanoma, or testicular cancer had a 2.72–10.47 higher odds of elevated 10-year ASCVD risk. Additionally, age was an effect modifier: a cancer history was associated with 1.24 (95% CI: 1.19–4.21) times higher odds of elevated 10-year ASCVD risk among those aged 60–69, but not with other age groups.
Conclusions
Adults with a history of self-reported cancer had higher 10-year ASCVD risk. ASCVD risk assessment and clinical surveillance of cardiovascular health following a cancer diagnosis could potentially reduce disease burden and prolong survival, especially for patients with specific cancers and high ASCVD risk.

 

Ohio State University material

 

PLOS One study (Open access)

 

 

See also MedicalBrief archives:

CVD risk for survivors of childhood cancer

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