Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia.
SA Pharmacy, SA Health, Adelaide, South Australia, Australia.
Cancer Med. 2024 Aug;13(15):e70057. doi: 10.1002/cam4.70057.
Cardiovascular disease (CVD) is the leading cause of non-cancer death in cancer survivors, but the risk of CVD varies between cancers.
To synthesise available evidence on patterns and magnitude of CVD mortality risk.
A systematic search of Medline (OVID), CINAHL and Scopus databases from 01-January-2000 to 16-July-2023 of studies of people with cancer, reporting CVD mortality in cancer population compared with a reference population (e.g. general population) as standardised mortality ratios (SMR). Meta-analysis of SMRs across cancer and CVD types were pooled using a random-effects model to allow for heterogeneity of the true effect size across studies.
We identified 136 studies from 16 countries. Sample sizes ranged from 157 to 7,529,481. The majority (n = 98; 72%) were conducted in the United States, followed by Europe (n = 22; 16%). The most common cancers studied were gastrointestinal (n = 34 studies), haematological (n = 31) and breast (n = 29). A total of 876 CVD SMRs were extracted across diverse CVD conditions. Of those, the majority (535; 61%) indicated an increased risk of CVD death (SMR >1), 109 (12%) a lower risk of CVD death (SMR <1) and 232 (27%) an equivalent risk (95% CI of SMR included 1) compared to the general population. The meta-analysis of all reported SMRs showed an increased risk of CVD death (SMR = 1.55, 95% CI = 1.40-1.72) in cancer survivors compared with the general population. The SMR varied between CVD conditions and ranged from 1.36 (95% CI = 1.29-1.44) for heart diseases to 1.56 (95% CI = 1.39-1.76) for cerebrovascular diseases. SMR varied across cancer types, ranging from 1.14 (95% CI = 1.04-1.25) for testicular/germ cell tumours to 2.82 (95% CI = 2.20-3.63) for brain/central nervous system tumours.
Cancer survivors are at increased risk of premature CVD mortality compared to the general population, but the risk varies by cancer type and CVD. Future research should focus on understanding mechanisms behind the increased CVD risk to develop appropriate interventions.
心血管疾病（CVD）是癌症幸存者非癌症死亡的主要原因，但不同癌症之间的 CVD 风险不同。
综合现有证据，探讨 CVD 死亡风险的模式和程度。
从 2000 年 1 月 1 日至 2023 年 7 月 16 日，系统检索 Medline（OVID）、CINAHL 和 Scopus 数据库，检索患有癌症的人群的研究，报告癌症人群的 CVD 死亡率与参考人群（如一般人群）的标准化死亡率比（SMR）。使用随机效应模型对癌症和 CVD 类型的 SMR 进行荟萃分析，以允许研究间真实效应大小的异质性。
我们从 16 个国家的 136 项研究中确定了样本量。样本量范围从 157 到 7529481。大多数（n=98；72%）在美国进行，其次是欧洲（n=22；16%）。研究中最常见的癌症是胃肠道（n=34 项）、血液学（n=31 项）和乳腺癌（n=29 项）。共提取了 876 项 CVD SMR，涉及多种 CVD 情况。其中，大多数（535；61%）表明 CVD 死亡风险增加（SMR >1），109（12%）表明 CVD 死亡风险降低（SMR <1），232（27%）表明风险相当（95%CI 的 SMR 包括 1）与一般人群相比。所有报告的 SMR 的荟萃分析显示，与一般人群相比，癌症幸存者的 CVD 死亡风险增加（SMR=1.55，95%CI=1.40-1.72）。SMR 因 CVD 情况而异，范围从心脏病的 1.36（95%CI=1.29-1.44）到脑血管病的 1.56（95%CI=1.39-1.76）。SMR 因癌症类型而异，范围从睾丸/生殖细胞肿瘤的 1.14（95%CI=1.04-1.25）到脑/中枢神经系统肿瘤的 2.82（95%CI=2.20-3.63）。
与一般人群相比，癌症幸存者发生 CVD 死亡的风险增加，但风险因癌症类型和 CVD 而异。未来的研究应侧重于了解 CVD 风险增加的背后机制，以开发适当的干预措施。
