Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Cardio-Oncology Program, Division of Cardiology, Ohio State University, Columbus, OH, USA.
Eur J Prev Cardiol. 2023 Sep 20;30(13):1325-1332. doi: 10.1093/eurjpc/zwad146.
This study aimed to characterize the influence of a cancer diagnosis on the use of preventive cardiovascular measures in patients with and without cardiovascular disease (CVD).
Data from the Behavioural Risk Factor Surveillance System Survey (spanning 2011-22) were used. Multivariable logistic regression models adjusted for potential confounders were applied to calculate average marginal effects (AME), the average difference in the probability of using a given therapy between patients with and without cancer. Outcomes of interest included the use of pharmacological therapies, physical activity, smoking cessation, and post-CVD rehabilitation. Among 5 012 721 respondents, 579 114 reported a history of CVD (coronary disease or stroke), and 842 221 reported a diagnosis of cancer. The association between cancer and the use of pharmacological therapies varied between those with vs. without CVD (P-value for interaction: <0.001). Among patients with CVD, a cancer diagnosis was associated with a lower use of blood pressure-lowering medications {AME: -1.46% [95% confidence interval (CI): -2.19% to -0.73%]}, lipid-lowering medications [AME: -2.34% (95% CI: -4.03% to -0.66%)], and aspirin [AME: -6.05% (95% CI: -8.88% to -3.23%)]. Among patients without CVD, there were no statistically significant differences between patients with and without cancer regarding pharmacological therapies. Additionally, cancer was associated with a significantly lower likelihood of engaging in physical activity in the overall cohort and in using post-CVD rehabilitation regimens, particularly post-stroke rehabilitation.
Preventive pharmacological agents are underutilized in those with cancer and concomitant CVD, and physical activity is underutilized in patients with cancer in those with or without CVD.
•This paper compared the use of preventive cardiovascular measures, both pharmaceutical and non-pharmaceutical, in patients with and without cancer.•In patients with cardiovascular disease and cancer, there is a lower use of preventive cardiovascular medications compared with those with cardiovascular disease but without cancer. This includes a lower utilization of blood pressure-lowering medications, cholesterol-lowering medications, and aspirin.•Patients with cancer reported lower levels of exercise but higher levels of smoking cessation compared with those without cancer.
本研究旨在描述癌症诊断对伴有和不伴有心血管疾病（CVD）的患者使用预防性心血管措施的影响。
使用了行为风险因素监测系统调查（2011-2022 年）的数据。应用多变量逻辑回归模型调整潜在混杂因素，计算平均边际效应（AME），即癌症患者和非癌症患者使用某种治疗方法的概率差异的平均值。感兴趣的结局包括药物治疗、体力活动、戒烟和 CVD 后康复的使用。在 5012721 名受访者中，579114 人报告有 CVD（冠心病或中风）病史，842221 人报告有癌症诊断。癌症与药物治疗使用之间的关联因伴有或不伴有 CVD 的患者而有所不同（交互作用检验 P 值：<0.001）。在伴有 CVD 的患者中，癌症诊断与降压药物的使用率较低相关[AME：-1.46%（95%CI：-2.19%至-0.73%）]、降脂药物[AME：-2.34%（95%CI：-4.03%至-0.66%）]和阿司匹林[AME：-6.05%（95%CI：-8.88%至-3.23%）]。在不伴有 CVD 的患者中，癌症患者与非癌症患者之间在药物治疗方面无统计学显著差异。此外，癌症与总体队列中体力活动的可能性显著降低以及 CVD 后康复方案的使用相关，尤其是中风后康复。
伴有 CVD 的癌症患者预防性药物治疗的使用率较低，而伴有或不伴有 CVD 的癌症患者体力活动的使用率较低。
