Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Division of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
JAMA Otolaryngol Head Neck Surg. 2023 Aug 1;149(8):717-725. doi: 10.1001/jamaoto.2023.1342.
Cardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited.
To define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023.
Demographic, cancer-specific, and treatment characteristics.
Prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death.
Of 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively.
The results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.
由于共同的风险因素和潜在的心脏毒性癌症治疗，心血管（CV）疾病是癌症发病率和死亡率的主要原因。然而，我们对头颈部鳞状细胞癌（HNSCC）患者的 CV 风险的了解有限。
定义 HNSCC 患者的 CV 风险概况、中风、心肌梗死（MI）和死亡率。
设计、设置和参与者：这是一项回顾性的基于人群的队列研究，纳入了 2000 年 1 月 1 日至 2020 年 12 月 31 日期间美国新诊断为 HNSCC 的 35897 名退伍军人。数据于 2022 年 5 月至 2023 年 1 月进行分析。
人口统计学、癌症特异性和治疗特征。
HNSCC 诊断时 CV 危险因素、药物使用和控制的患病率；中风和 MI 的累积发生率；以及全因死亡。
在 35857 名美国 HNSCC 退伍军人中（中位[IQR]年龄，63[58-69]岁；176[0.5%]美洲原住民或阿拉斯加原住民，57[0.2%]亚洲人，5321[16.6%]黑人，207[0.6%]夏威夷原住民或其他太平洋岛民，26277[82.0%]白人），有很高的吸烟率（16341[83%]）、高血压（24023[67%]）、糖尿病（7988[22%]）和血脂异常（18421[51%]）。尽管大多数患者正在服用降低风险的药物，但仍有 15941 人（47%）至少有 1 项未得到控制的 CV 危险因素。黑人种族与未得到控制的 CV 危险因素的风险增加有关（相对风险，1.06；95%CI，1.03-1.09），与其他癌症部位相比，患有喉癌的患者更常见存在现患和未得到控制的风险因素。考虑到死亡作为竞争风险，中风和 MI 的 10 年累积发生率分别为 12.5%和 8.3%。在特定原因的风险模型中，高血压、糖尿病、颈动脉狭窄、冠心病和存在未得到控制的 CV 危险因素与中风和 MI 显著相关。在扩展的 Cox 模型中，中风和 MI 与全因死亡的风险分别增加 47%（95%CI，41%-54%）和 71%（95%CI，63%-81%）有关。
这项队列研究的结果表明，在 HNSCC 中，CV 危险因素控制不佳和中风和 MI 发生率较高的负担很大。可改变的 CV 危险因素与不良 CV 事件的风险相关，这些事件与更高的死亡风险相关。这些发现确定了有风险的人群，并可能强调了控制可改变的 CV 危险因素的重要性，并激发了在 HNSCC 生存护理中降低 CV 风险的策略。
