Mukherjee Amrita, Wiener Howard W, Griffin Russell L, Lenneman Carrie, Chatterjee Arka, Nabell Lisle M, Lewis Cora E, Shrestha Sadeep
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States.
Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States.
Front Cardiovasc Med. 2023 Jan 12;9:1024846. doi: 10.3389/fcvm.2022.1024846. eCollection 2022.
Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis.
A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk.
In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older ( 0.006) and had a higher 5-year cumulative incidence of CVD ( 0.013) than HPV-positive patients.
Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.
头颈部鳞状细胞癌（HNSCC）患者发生心血管疾病（CVD）的风险报告不足。我们评估了HNSCC相关因素和传统风险因素与癌症诊断时无CVD病史的HNSCC患者1年和5年CVD风险的关联。
纳入了一个临床队列，该队列包括2012年至2018年间在一家美国国立癌症研究所（NCI）指定的癌症中心诊断出的1829例HNSCC患者。从肿瘤登记处提取有关HNSCC相关因素的信息[HNSCC解剖亚部位、诊断时的分期、治疗和肿瘤人乳头瘤病毒（HPV）状态]。在基线（HNSCC诊断）时从电子健康记录系统（EHR）中提取传统风险因素（高血压、血脂异常、糖尿病、吸烟状况和肥胖）的数据。缺血性心脏病、心力衰竭和缺血性中风的综合情况是事件发生时间分析中感兴趣的结果。报告了以死亡作为竞争风险的风险比（HR）（95%置信区间）。
在诊断为HNSCC的患者中，10.61%在癌症诊断后1年内发生了CVD事件。与无基线高血压的患者相比，基线时使用抗高血压药物的患者1年CVD风险较低[HR（95%置信区间）：0.41（0.24 - 0.61）]。接受HNSCC手术的患者1年CVD风险较高。接受放射治疗的患者5年CVD风险高于手术患者[HR（95%置信区间）：2.17（1.31 - 3.04）]。使用抗高血压药物的患者5年CVD风险低于无基线高血压的患者[HR（95%置信区间）：0.45（0.22 - 0.75）]。年龄较大和患有糖尿病与1年和5年CVD风险增加相关。HPV阴性患者比HPV阳性患者年龄更大（P < 0.006）且5年CVD累积发病率更高（P < 0.013）。
传统风险因素和癌症相关因素与HNSCC患者的CVD风险相关。未来的研究应调查抗高血压药物在降低HNSCC患者CVD风险中的作用。
