Jaidyn Muhandiramge BMedSc(Hons), MD, John R. Zalcberg MBBS, PhD, Erica T. Warner ScD, MPH, Galina Polekhina PhD, Peter Gibbs MBBS, MD, G. J. van Londen MD, MS, Wendy B. Bernstein MD, Finlay Macrae MBBS, MD, Andrew Haydon MBBS, PhD, Jeanne Tie MBChB, MD, Jeremy L. Millar MBChB, BMedSc, Victoria J. Mar MBBS, PhD, Lucy Gately MBBS, PhD, Andrew Tonkin MBBS, MD, Leslie Ford MD, Asad Umar DVM, PhD, Andrew T. Chan MD, MPH, Robyn L. Woods BSc(Hons), PhD, Suzanne G. Orchard BSc(Hons), PhD
{"title":"老年人癌症和癌症治疗后的心血管疾病和中风。","authors":"Jaidyn Muhandiramge BMedSc(Hons), MD, John R. Zalcberg MBBS, PhD, Erica T. Warner ScD, MPH, Galina Polekhina PhD, Peter Gibbs MBBS, MD, G. J. van Londen MD, MS, Wendy B. Bernstein MD, Finlay Macrae MBBS, MD, Andrew Haydon MBBS, PhD, Jeanne Tie MBChB, MD, Jeremy L. Millar MBChB, BMedSc, Victoria J. Mar MBBS, PhD, Lucy Gately MBBS, PhD, Andrew Tonkin MBBS, MD, Leslie Ford MD, Asad Umar DVM, PhD, Andrew T. Chan MD, MPH, Robyn L. Woods BSc(Hons), PhD, Suzanne G. Orchard BSc(Hons), PhD","doi":"10.1002/cncr.35503","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Cancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>The authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk-set compared to the cancer-free risk-set (20.8 vs. 10.3 events per 1000 person-years; incidence rate ratio, 2.03; 95% confidence interval, 1.51–2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Incidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.</p>\n </section>\n </div>","PeriodicalId":138,"journal":{"name":"Cancer","volume":"130 23","pages":"4138-4148"},"PeriodicalIF":6.1000,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11560579/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cardiovascular disease and stroke following cancer and cancer treatment in older adults\",\"authors\":\"Jaidyn Muhandiramge BMedSc(Hons), MD, John R. Zalcberg MBBS, PhD, Erica T. Warner ScD, MPH, Galina Polekhina PhD, Peter Gibbs MBBS, MD, G. J. van Londen MD, MS, Wendy B. Bernstein MD, Finlay Macrae MBBS, MD, Andrew Haydon MBBS, PhD, Jeanne Tie MBChB, MD, Jeremy L. Millar MBChB, BMedSc, Victoria J. Mar MBBS, PhD, Lucy Gately MBBS, PhD, Andrew Tonkin MBBS, MD, Leslie Ford MD, Asad Umar DVM, PhD, Andrew T. 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引用次数: 0
摘要
背景：癌症幸存者可能因恶性肿瘤或治疗而面临心血管疾病（CVD）风险。尽管存在将癌症和心血管疾病联系起来的研究，但很少有研究探讨老年人的风险、癌症治疗的影响或阿司匹林对降低该人群风险的作用：作者对阿司匹林减少老年人心血管事件（ASPREE）试验进行了二次分析，研究癌症和癌症治疗对心血管疾病综合终点（包括心力衰竭（HHF）住院、心肌梗死（MI）和中风）的影响：在 15454 名澳大利亚和美国 ASPREE 参与者中，有 1392 人被诊断为癌症。与无癌症风险组相比，癌症风险组的心血管疾病发病率更高（每千人年20.8例 vs. 10.3例；发病率比为2.03；95%置信区间为1.51-2.66），心肌梗死、HHF、总体中风和缺血性中风的发病率均有所上升。在对心血管疾病的临床重要风险因素进行调整后，发病率仍会增加。转移癌、血癌和肺癌的发病率最高。化疗与心血管疾病风险增加有关。阿司匹林组和安慰剂组的心血管疾病发病率相似：结论：患有癌症的老年人心血管疾病（包括心肌梗死、HHF 和缺血性中风）的发病率增加。阿司匹林不会影响心血管疾病的发病率。转移癌、血癌、肺癌患者和化疗后患者的风险可能更高。
Cardiovascular disease and stroke following cancer and cancer treatment in older adults
Background
Cancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort.
Methods
The authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.
Results
Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk-set compared to the cancer-free risk-set (20.8 vs. 10.3 events per 1000 person-years; incidence rate ratio, 2.03; 95% confidence interval, 1.51–2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups.
Conclusions
Incidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.
期刊介绍：
The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society.
CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research
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