Saifei Liu, John D Horowitz, Bogda Koczwara, Aaron L Sverdlov, Natalie Packer, Robyn A Clark
{"title":"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。","authors":"Saifei Liu, John D Horowitz, Bogda Koczwara, Aaron L Sverdlov, Natalie Packer, Robyn A Clark","doi":"10.1186/s40959-024-00269-3","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Aim: </strong>To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD<sub>A</sub>); (b) The rates of patient admission with subsequent development of CVD (CVD<sub>S</sub>) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD<sub>A</sub> and CVD<sub>S</sub> on mortality rates relative to those seen in patients without overt CVD (CVD<sup>-</sup>) and (d) The time course of mortality in CVD<sup>-</sup> versus CVD<sub>S</sub> patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Of the total 17,389 patients, there were 2,159 with CVD<sub>A</sub>. Over a median follow-up time of 4.6 years, CVD<sub>S</sub> admissions (n = 8,529) occurred more commonly in the presence of CVD<sub>A</sub> (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD<sub>S</sub> cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD<sub>A</sub>, 64.7% for CVD<sub>S</sub>, and 40.8% for CVD<sup>-</sup> (p < 0.001). Development of CVD<sub>S</sub> 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).</p><p><strong>Conclusions: </strong>Approximately 50% of patients assigned to cancer chemotherapy developed CVD<sub>S</sub>, heralding a particularly high risk of mortality over the next 12 months. Both CVD<sub>A</sub> and CVD<sub>S</sub> are associated with substantial increases in mortality rates relative to those in CVD<sup>-</sup> patients. This increased risk merits close individual monitoring.</p>","PeriodicalId":9804,"journal":{"name":"Cardio-oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481733/pdf/","citationCount":"0","resultStr":"{\"title\":\"Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications.\",\"authors\":\"Saifei Liu, John D Horowitz, Bogda Koczwara, Aaron L Sverdlov, Natalie Packer, Robyn A Clark\",\"doi\":\"10.1186/s40959-024-00269-3\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Aim: </strong>To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD<sub>A</sub>); (b) The rates of patient admission with subsequent development of CVD (CVD<sub>S</sub>) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD<sub>A</sub> and CVD<sub>S</sub> on mortality rates relative to those seen in patients without overt CVD (CVD<sup>-</sup>) and (d) The time course of mortality in CVD<sup>-</sup> versus CVD<sub>S</sub> patients.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>Of the total 17,389 patients, there were 2,159 with CVD<sub>A</sub>. Over a median follow-up time of 4.6 years, CVD<sub>S</sub> admissions (n = 8,529) occurred more commonly in the presence of CVD<sub>A</sub> (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD<sub>S</sub> cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD<sub>A</sub>, 64.7% for CVD<sub>S</sub>, and 40.8% for CVD<sup>-</sup> (p < 0.001). Development of CVD<sub>S</sub> 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).</p><p><strong>Conclusions: </strong>Approximately 50% of patients assigned to cancer chemotherapy developed CVD<sub>S</sub>, heralding a particularly high risk of mortality over the next 12 months. Both CVD<sub>A</sub> and CVD<sub>S</sub> are associated with substantial increases in mortality rates relative to those in CVD<sup>-</sup> patients. This increased risk merits close individual monitoring.</p>\",\"PeriodicalId\":9804,\"journal\":{\"name\":\"Cardio-oncology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-10-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11481733/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardio-oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1186/s40959-024-00269-3\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardio-oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1186/s40959-024-00269-3","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications.
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 (CVDA); (b) The rates of patient admission with subsequent development of CVD (CVDS) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVDA and CVDS on mortality rates relative to those seen in patients without overt CVD (CVD-) and (d) The time course of mortality in CVD- versus CVDS 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 CVDA. Over a median follow-up time of 4.6 years, CVDS admissions (n = 8,529) occurred more commonly in the presence of CVDA (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVDS cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVDA, 64.7% for CVDS, and 40.8% for CVD- (p < 0.001). Development of CVDS 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 CVDS, heralding a particularly high risk of mortality over the next 12 months. Both CVDA and CVDS 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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