Cleveland Clinic, OH, USA; Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Cleveland Clinic, OH, USA; Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cardiovasc Pathol. 2019 Nov-Dec;43:107147. doi: 10.1016/j.carpath.2019.08.001. Epub 2019 Aug 7.
We evaluated the risk of cardiac death in patients with prior cancer diagnoses and compared risk by cancer type and ethnicity in a large US population.
Utilizing the Surveillance, Epidemiology, and End Results database, data on patients with a cancer diagnosis between 2000 and 2014 were obtained. We calculated the standardized mortality ratio (SMR) of cardiac death after a cancer diagnosis and the excess risk per 10,000 person-years. We stratified the analysis according to the time interval between cancer and cardiac events, cancer site, cancer stage, and race.
A total of 4,671,989 patients with a cancer diagnosis were included, of which 163,255 died due to cardiac causes within 10 years of diagnosis. We found a significantly higher rate of cardiac death for cancer patients [SMR=1.16, 95% confidence interval (CI) 1.15-1.16] compared to the general population. When observed for each cancer site, the highest SMR was after a diagnosis of hepatocellular carcinoma (SMR=2.58, 95% CI 2.45-2.72), pancreatic cancer (SMR=2.36, 95% CI 2.25-2.47), and lung cancer (SMR=2.30, 95% CI 2.27-2.34). Patients with metastatic disease had a higher rate of cardiac death (SMR=2.16, 95% CI 2.13-2.19). When stratified by ethnicity, SMR for cardiac death was 1.76, 2.28, 3.68, 2.65, and 1.84 for whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and Hispanics, respectively.
Cancer patients are more vulnerable to cardiac death than the general population, especially those with nonwhite ethnicity; liver, lung, and pancreatic cancers; and history of metastasis. Healthcare providers should be aware of this risk and pay particular attention to the highest-risk groups.
我们评估了既往癌症诊断患者的心脏死亡风险，并在美国大型人群中按癌症类型和种族对风险进行了比较。
利用监测、流行病学和最终结果数据库，获取了 2000 年至 2014 年间患有癌症的患者数据。我们计算了癌症诊断后心脏死亡的标准化死亡率（SMR）和每 10000 人年的超额风险。我们根据癌症与心脏事件之间的时间间隔、癌症部位、癌症分期和种族对分析进行分层。
共纳入 4671989 例癌症诊断患者，其中 163255 例在诊断后 10 年内死于心脏原因。与一般人群相比，癌症患者的心脏死亡发生率明显更高[SMR=1.16，95%置信区间（CI）1.15-1.16]。观察每个癌症部位时，肝癌（SMR=2.58，95%CI 2.45-2.72）、胰腺癌（SMR=2.36，95%CI 2.25-2.47）和肺癌（SMR=2.30，95%CI 2.27-2.34）诊断后的 SMR 最高。患有转移性疾病的患者心脏死亡发生率更高（SMR=2.16，95%CI 2.13-2.19）。按种族分层时，白人、黑人、美国印第安人/阿拉斯加原住民、亚洲/太平洋岛民和西班牙裔的心脏死亡 SMR 分别为 1.76、2.28、3.68、2.65 和 1.84。
与一般人群相比，癌症患者更容易发生心脏死亡，尤其是非白种人、患有肝癌、肺癌和胰腺癌以及有转移病史的患者。医疗保健提供者应意识到这种风险，并特别关注风险最高的群体。
