Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Coll Cardiol. 2022 Jul 5;80(1):22-32. doi: 10.1016/j.jacc.2022.04.042.
More than 80% of adult patients diagnosed with cancer survive long term. Long-term complications of cancer and its therapies may increase the risk of cardiovascular disease (CVD), but prospective studies using adjudicated cancer and CVD events are lacking.
The aim of this study was to assess the risk of CVD in cancer survivors in a prospective community-based study.
We included 12,414 ARIC (Atherosclerosis Risk In Communities) study participants. Cancer diagnoses were ascertained via linkage with state registries supplemented with medical records. Incident CVD outcomes were coronary heart disease (CHD), heart failure (HF), stroke, and a composite of these. We used multivariable Poisson and Cox regressions to estimate the association of cancer with incident CVD.
Mean age was 54 years, 55% were female, and 25% were Black. A total of 3,250 participants (25%) had incident cancer over a median 13.6 years of follow-up. Age-adjusted incidence rates of CVD (per 1,000 person-years) were 23.1 (95% CI: 24.7-29.1) for cancer survivors and 12.0 (95% CI: 11.5-12.4) for subjects without cancer. After adjustment for cardiovascular risk factors, cancer survivors had significantly higher risks of CVD (HR: 1.37; 95% CI: 1.26-1.50), HF (HR: 1.52; 95% CI: 1.38-1.68), and stroke (HR: 1.22; 95% CI: 1.03-1.44), but not CHD (HR: 1.11; 95% CI: 0.97-1.28). Breast, lung, colorectal, and hematologic/lymphatic cancers, but not prostate cancer, were significantly associated with CVD risk.
Compared with persons without cancer, adult cancer survivors have significantly higher risk of CVD, especially HF, independent of traditional cardiovascular risk factors. There is an unmet need to define strategies for CVD prevention in this high-risk population.
超过 80%的成年癌症患者能够长期生存。癌症及其治疗的长期并发症可能会增加心血管疾病（CVD）的风险，但缺乏使用裁定的癌症和 CVD 事件的前瞻性研究。
本研究旨在通过一项前瞻性社区研究评估癌症幸存者的 CVD 风险。
我们纳入了 12414 名 ARIC（社区动脉粥样硬化风险）研究参与者。癌症诊断通过与州登记处的链接确定，并辅以病历。新发 CVD 结局为冠心病（CHD）、心力衰竭（HF）、中风和这些疾病的综合表现。我们使用多变量泊松和 Cox 回归来估计癌症与新发 CVD 的关联。
平均年龄为 54 岁，55%为女性，25%为黑人。在中位 13.6 年的随访期间，共有 3250 名参与者（25%）发生了癌症。癌症幸存者的 CVD（每 1000 人年）年龄调整发生率为 23.1（95%CI：24.7-29.1），而无癌症的参与者为 12.0（95%CI：11.5-12.4）。在调整心血管风险因素后，癌症幸存者 CVD（HR：1.37；95%CI：1.26-1.50）、HF（HR：1.52；95%CI：1.38-1.68）和中风（HR：1.22；95%CI：1.03-1.44）的风险显著升高，但 CHD（HR：1.11；95%CI：0.97-1.28）的风险没有显著升高。乳腺癌、肺癌、结直肠癌和血液/淋巴癌，而非前列腺癌，与 CVD 风险显著相关。
与无癌症的人相比，成年癌症幸存者 CVD 的风险显著升高，尤其是 HF，独立于传统心血管风险因素。在这个高危人群中，需要确定 CVD 预防策略。
