Department of Oncology, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, 225000 Yangzhou, Jiangsu, China.
Department of Oncology, Medical College of Yangzhou University, 225000 Yangzhou, Jiangsu, China.
Heart Surg Forum. 2023 Dec 26;26(6):E780-E790. doi: 10.59958/hsf.6733.
To investigate the incidence and risk factors of cardiovascular complications amongst patients with colorectal cancer (CRC).
A retrospective cohort study was conducted on 2085 patients diagnosed with CRC in two tertiary hospitals in China between 2015 and 2020. The patients' medical records were reviewed to identify cardiovascular complications, including myocardial infarction, heart failure, stroke, hypertension, coronary heart disease, heart failure, and arrhythmia. The incidence rate of cardiovascular complications was calculated, and Cox proportional hazards regression analysis was used to identify risk factors.
Of the 2085 CRC patients, 329 (15.8%) experienced cardiovascular complications during the follow-up period, with an incidence rate of 17.4 cases per 1000 person-years. The risk was significantly higher in patients who were older than 60 years (adjusted hazard ratio [HR] 2.04, 95% confidence interval [CI] 1.22-3.41), had a higher level of low-density lipoprotein cholesterol (LDL-C) (adjusted HR 2.32, 95% CI 1.31-4.10), had higher levels of serum C-reactive protein (CRP) (adjusted HR 1.57, 95% CI 1.21-2.04), or who underwent chemotherapy or radiotherapy. CRC patients with cardiovascular complications had significantly higher levels of oxidative stress markers, including malondialdehyde (MDA) (5.8 ± 1.2 μmol/L vs. 3.4 ± 0.9 μmol/L, p < 0.001), lower levels of superoxide dismutase (SOD) (85.2 ± 15.6 U/mg protein vs. 112.5 ± 21.3 U/mg protein, p < 0.001), and lower levels of glutathione peroxidase (GPx) (15.6 ± 3.2 U/mg protein vs. 20.4 ± 4.1 U/mg protein, p < 0.001) compared to those without complications. A progressive increase was observed in the proportion of CRC patients with cardiovascular complications over time, rising from 10% in the first year to 38% by the tenth year of follow-up.
Cardiovascular complications pose a high risk in CRC patients, particularly amongst older patients and those with higher levels of LDL-C or CRP. Regular monitoring of cardiovascular function should be considered in the management of patients with CRC.
探讨结直肠癌（CRC）患者心血管并发症的发生率和危险因素。
本研究采用回顾性队列研究，纳入 2015 年至 2020 年期间在中国两家三级医院诊断为 CRC 的 2085 例患者。回顾患者病历，以识别心血管并发症，包括心肌梗死、心力衰竭、中风、高血压、冠心病、心力衰竭和心律失常。计算心血管并发症的发生率，并采用 Cox 比例风险回归分析确定危险因素。
在 2085 例 CRC 患者中，329 例（15.8%）在随访期间发生心血管并发症，发生率为每 1000 人年 17.4 例。年龄大于 60 岁的患者（校正后风险比[HR]2.04，95%置信区间[CI]1.22-3.41）、低密度脂蛋白胆固醇（LDL-C）水平较高（校正 HR 2.32，95% CI 1.31-4.10）、血清 C 反应蛋白（CRP）水平较高（校正 HR 1.57，95% CI 1.21-2.04）或接受化疗或放疗的患者风险显著增加。发生心血管并发症的 CRC 患者的氧化应激标志物水平显著升高，包括丙二醛（MDA）（5.8±1.2 μmol/L 比 3.4±0.9 μmol/L，p<0.001）、超氧化物歧化酶（SOD）（85.2±15.6 U/mg 蛋白比 112.5±21.3 U/mg 蛋白，p<0.001）和谷胱甘肽过氧化物酶（GPx）（15.6±3.2 U/mg 蛋白比 20.4±4.1 U/mg 蛋白，p<0.001）。与无并发症的患者相比，发生心血管并发症的 CRC 患者的比例随时间呈渐进性增加，从第 1 年的 10%上升到第 10 年的 38%。
心血管并发症是 CRC 患者的高风险因素，特别是在老年患者和 LDL-C 或 CRP 水平较高的患者中。在 CRC 患者的管理中应考虑定期监测心血管功能。
