Department of Preventive Medicine, School of Public Health, North China University of Science and Technology, Tangshan, China.
Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China.
Curr Probl Cardiol. 2023 Jul;48(7):101693. doi: 10.1016/j.cpcardiol.2023.101693. Epub 2023 Mar 15.
The long-term risk of incident atherosclerotic cardiovascular diseases (ASCVD) among cancer patients remains incompletely defined. This study aimed to evaluate the long-term ASCVD risk in cancer patients compared with the noncancer population. This was a prospective population-based study using data from the Kailuan cohort, 6204 individuals with newly diagnosed cancer, free of ASCVD, were matched in a 1:1 ratio to noncancer controls for age (±1) and sex, from June 2006 to December 2020. Multivariable competing risk analyses were performed to evaluate the association between cancer diagnosis and risk of incident ASCVD events (including myocardial infarction, ischemic stroke, heart failure, and revascularization with coronary artery bypass graft surgery or percutaneous coronary intervention). During a median follow-up of 5.3 (1.7, 9.7) years, 1019 incident ASCVD events were observed. Compared to participants without cancer, there was a similar risk for incident ASCVD events among cancer patients within the first few years after cancer diagnosis, and the risk declined over time. Overall, cancer patients showed lower risks of incident ASCVD compared to the noncancer patients over the long term, with a hazard ratio (95% confidence interval) of 0.52 (0.45-0.60) for composite ASCVD events, 0.43 (0.35-0.53) for ischemic stroke, 0.63 (0.42-0.95) for myocardial infarction, 0.63 (0.48-0.83) for heart failure, and 0.82 (0.60-1.11) for coronary revascularization. Baseline level of low-density lipoprotein cholesterol, fasting blood glucose, blood pressure, and high-sensitivity C-reactive protein could independently predict the incident ASCVD among the study population. Subgroup analyses according to cancer types revealed a significantly lower risk of ASCVD events among patients with digestive cancer or respiratory cancer compared with noncancer controls, but not for urologic or genital cancer. Multiple sensitivity analyses yielded similar results to the primary analysis. Long-term ASCVD risk among cancer survivors is not increased compared with the noncancer individuals, probably driven by a favorable profile of baseline risk factor in cancer population.
癌症患者新发动脉粥样硬化性心血管疾病（ASCVD）的长期风险仍不完全明确。本研究旨在评估癌症患者与非癌症人群相比的长期 ASCVD 风险。这是一项前瞻性基于人群的研究，使用了来自开滦队列的数据，该队列纳入了 6204 例新发癌症且无 ASCVD 的个体，按照年龄（±1 岁）和性别，以 1:1 的比例与非癌症对照进行匹配，随访时间从 2006 年 6 月至 2020 年 12 月。采用多变量竞争风险分析评估癌症诊断与 ASCVD 事件（包括心肌梗死、缺血性卒中和心力衰竭以及经皮冠状动脉介入治疗或冠状动脉旁路移植术血运重建）发生风险之间的关联。中位随访 5.3（1.7，9.7）年后，观察到 1019 例 ASCVD 事件。与无癌症的参与者相比，癌症患者在诊断后最初几年内发生 ASCVD 事件的风险相似，且该风险随时间推移而降低。总体而言，与非癌症患者相比，癌症患者在长期内发生 ASCVD 的风险较低，复合 ASCVD 事件的风险比（95%置信区间）为 0.52（0.45-0.60），缺血性卒中和心力衰竭的风险比分别为 0.43（0.35-0.53）、0.63（0.42-0.95）和 0.63（0.48-0.83），经皮冠状动脉介入治疗和冠状动脉旁路移植术血运重建的风险比分别为 0.82（0.60-1.11）。研究人群中，基线时的低密度脂蛋白胆固醇、空腹血糖、血压和高敏 C 反应蛋白水平可独立预测 ASCVD 事件的发生。根据癌症类型进行的亚组分析显示，与非癌症对照组相比，消化道癌或呼吸道癌患者的 ASCVD 事件风险显著降低，但泌尿系统或生殖系统癌症患者则不然。多次敏感性分析得出的结果与主要分析一致。与非癌症个体相比，癌症幸存者的长期 ASCVD 风险并未增加，这可能是由于癌症患者的基线风险因素特征良好所致。
