School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Austin Health, Heidelberg, Victoria, Australia.
Cancer. 2024 Dec 1;130(23):4138-4148. doi: 10.1002/cncr.35503. Epub 2024 Sep 23.
Cancer survivors can be at risk of cardiovascular disease (CVD) because of either their malignancy or its treatment. Although studies linking cancer and CVD exist, few examine risk in older adults, the impact of cancer treatment, or the effect of aspirin on reducing risk in this cohort.
The authors conducted a secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the impact of cancer and cancer treatment on a composite CVD end point comprising hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.
Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis. Rates of CVD were greater in the cancer risk-set compared to the cancer-free risk-set (20.8 vs. 10.3 events per 1000 person-years; incidence rate ratio, 2.03; 95% confidence interval, 1.51-2.66), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke. Increased incidence remained after adjustment for clinically significant risk factors for CVD. Incidence was greatest in metastatic, hematological, and lung cancer. Chemotherapy was associated with increased risk of CVD. Similar rates of CVD were seen across aspirin and placebo groups.
Incidence of CVD, including MI, HHF, and ischemic stroke, was increased in older adults with cancer. Aspirin did not impact CVD incidence. Risk may be higher in those with metastatic, hematological, and lung cancer, and following chemotherapy.
癌症幸存者可能面临心血管疾病（CVD）的风险，原因可能是癌症本身或其治疗。尽管有研究将癌症与 CVD 联系起来，但很少有研究关注老年人的风险、癌症治疗的影响或阿司匹林在这一人群中降低风险的作用。
作者对阿司匹林减少老年人事件（ASPREE）试验进行了二次分析，以调查癌症及其治疗对包括心力衰竭（HHF）、心肌梗死（MI）和中风在内的复合 CVD 终点的影响。
在 15454 名澳大利亚和美国 ASPREE 参与者中，有 1392 人被诊断患有癌症。与无癌症风险组相比，癌症风险组的 CVD 发生率更高（20.8 比 10.3 例/1000人年；发病率比，2.03；95%置信区间，1.51-2.66），MI、HHF、总体中风和缺血性中风均有增加。在调整 CVD 的临床显著危险因素后，发病率仍有所增加。发病率在转移性、血液学和肺癌中最高。化疗与 CVD 风险增加有关。阿司匹林组和安慰剂组的 CVD 发生率相似。
在患有癌症的老年人中，CVD（包括 MI、HHF 和缺血性中风）的发病率增加。阿司匹林对 CVD 发病率没有影响。在转移性、血液学和肺癌患者以及接受化疗的患者中，风险可能更高。
