a Survivorship , Danish Cancer Society Research Center , Copenhagen , Denmark.
b Department of Oncology , Rigshospitalet Copenhagen University Hospital , Copenhagen , Denmark.
Acta Oncol. 2019 May;58(5):715-721. doi: 10.1080/0284186X.2019.1572924. Epub 2019 Feb 13.
High socioeconomic position is associated with better prognosis in prostate cancer patients but it is unknown if part of this association may be explained by socioeconomic differences in severe late effects. We investigated the association between education as an indicator for socioeconomic position and cardiovascular events after prostate cancer and if such associations were mediated by differences in lifestyle, cardiovascular risk factors and prostate cancer treatment. We identified 1980 men diagnosed with prostate cancer from 1993 to 2014 among participants in the Danish Diet, Cancer and Health study. Individual level information on education, lifestyle, cardiovascular risk factors and prostate cancer clinical information were obtained from questionnaires, registries and medical records. The Cox proportional hazards models were used to evaluate the risk of incident acute myocardial infarction, ischemic stroke and heart failure during up to 18 years of follow-up for men with short (<9 years) or medium (9-12 years) compared with long education (>12 years). Compared to men with long education, we found an increased risk of acute myocardial infarction in men with medium and short education (HR 3.14, 95% CI 1.53-6.47 and HR 2.14, 95% CI 0.82-5.58, respectively). Adjusting for stage, first-line treatment, lifestyle and cardiovascular risk factors did not change the HRs substantially (adjusted HRs 3.04, 95% CI 1.47-6.31 and 2.07, 95% CI 0.78-5.53, respectively). There were no educational differences in risk for ischemic stroke or heart failure. The risk of acute myocardial infarction was increased in prostate cancer patients with short or medium education compared with long education. Although the educational inequality did not seem to be explained by differences in treatment, lifestyle or cardiovascular risk factors, monitoring of cardiovascular health and health promotion should involve all prostate cancer patients regardless of social position to ensure best prognosis for all.
高社会经济地位与前列腺癌患者的预后较好相关，但尚不清楚这种相关性的一部分是否可以通过严重晚期影响方面的社会经济差异来解释。我们研究了教育作为社会经济地位的指标与前列腺癌后心血管事件之间的关系，以及这种关联是否通过生活方式、心血管危险因素和前列腺癌治疗方面的差异来介导。我们从丹麦饮食、癌症和健康研究的参与者中确定了 1993 年至 2014 年间诊断出的 1980 名前列腺癌男性。个体水平的教育、生活方式、心血管危险因素和前列腺癌临床信息均来自问卷、登记册和病历。我们使用 Cox 比例风险模型评估了急性心肌梗死、缺血性卒中和心力衰竭的风险，这些风险在长达 18 年的随访期间发生在教育程度较短（<9 年）或中等（9-12 年）的男性与教育程度较长（>12 年）的男性。与具有长期教育程度的男性相比，我们发现中短期教育程度的男性发生急性心肌梗死的风险增加（HR 3.14，95%CI 1.53-6.47 和 HR 2.14，95%CI 0.82-5.58）。调整分期、一线治疗、生活方式和心血管危险因素并没有实质性改变 HR（调整后的 HR 3.04，95%CI 1.47-6.31 和 2.07，95%CI 0.78-5.53，分别）。在缺血性卒中和心力衰竭的风险方面没有教育差异。与具有长期教育程度的男性相比，短期或中等教育程度的前列腺癌患者发生急性心肌梗死的风险增加。尽管教育不平等似乎不能通过治疗、生活方式或心血管危险因素方面的差异来解释，但监测心血管健康和促进健康应包括所有前列腺癌患者，无论其社会地位如何，以确保所有患者的最佳预后。
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