William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
Heart. 2023 Jun 14;109(13):1007-1015. doi: 10.1136/heartjnl-2022-321888.
OBJECTIVES: To evaluate incident cardiovascular outcomes and imaging phenotypes in UK Biobank participants with previous cancer. METHODS: Cancer and cardiovascular disease (CVD) diagnoses were ascertained using health record linkage. Participants with cancer history (breast, lung, prostate, colorectal, uterus, haematological) were propensity matched on vascular risk factors to non-cancer controls. Competing risk regression was used to calculate subdistribution HRs (SHRs) for associations of cancer history with incident CVD (ischaemic heart disease (IHD), non-ischaemic cardiomyopathy (NICM), heart failure (HF), atrial fibrillation/flutter, stroke, pericarditis, venous thromboembolism (VTE)) and mortality outcomes (any CVD, IHD, HF/NICM, stroke, hypertensive disease) over 11.8±1.7 years of prospective follow-up. Linear regression was used to assess associations of cancer history with left ventricular (LV) and left atrial metrics. RESULTS: We studied 18 714 participants (67% women, age: 62 (IQR: 57-66) years, 97% white ethnicities) with cancer history, including 1354 individuals with cardiovascular magnetic resonance. Participants with cancer had high burden of vascular risk factors and prevalent CVDs. Haematological cancer was associated with increased risk of all incident CVDs considered (SHRs: 1.92-3.56), larger chamber volumes, lower ejection fractions, and poorer LV strain. Breast cancer was associated with increased risk of selected CVDs (NICM, HF, pericarditis and VTE; SHRs: 1.34-2.03), HF/NICM death, hypertensive disease death, lower LV ejection fraction, and lower LV global function index. Lung cancer was associated with increased risk of pericarditis, HF, and CVD death. Prostate cancer was linked to increased VTE risk. CONCLUSIONS: Cancer history is linked to increased risk of incident CVDs and adverse cardiac remodelling independent of shared vascular risk factors.
目的:评估英国生物库参与者既往癌症的心血管事件和影像学表型。
方法:通过健康记录链接确定癌症和心血管疾病(CVD)的诊断。对有癌症史(乳腺癌、肺癌、前列腺癌、结直肠癌、子宫癌、血液癌)的参与者进行血管危险因素的倾向匹配,与无癌症对照组进行匹配。使用竞争风险回归计算癌症史与新发 CVD(缺血性心脏病(IHD)、非缺血性心肌病(NICM)、心力衰竭(HF)、心房颤动/扑动、中风、心包炎、静脉血栓栓塞症(VTE))和 11.8±1.7 年前瞻性随访期间的死亡率(任何 CVD、IHD、HF/NICM、中风、高血压疾病)的事件相关风险比(SHR)。使用线性回归评估癌症史与左心室(LV)和左心房指标的相关性。
结果:我们研究了 18714 名参与者(67%为女性,年龄:62(IQR:57-66)岁,97%为白种人)有癌症史,其中 1354 名参与者进行了心血管磁共振检查。有癌症史的参与者具有较高的血管危险因素和常见 CVD 的负担。血液系统癌症与所有考虑的新发 CVD 风险增加相关(SHR:1.92-3.56),心室腔容积增大,射血分数降低,LV 应变恶化。乳腺癌与特定 CVD(NICM、HF、心包炎和 VTE;SHR:1.34-2.03)、HF/NICM 死亡、高血压疾病死亡、LV 射血分数降低和 LV 整体功能指数降低相关。肺癌与心包炎、HF 和 CVD 死亡风险增加相关。前列腺癌与 VTE 风险增加相关。
结论:癌症史与新发 CVD 和不良心脏重塑风险增加相关,而与共同的血管危险因素无关。
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