17389名接受癌症化疗患者队列中的心脏事件：短期和长期影响

Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications.

作者信息

Liu Saifei, Horowitz John D, Koczwara Bogda, Sverdlov Aaron L, Packer Natalie, Clark Robyn A

机构信息

Cardiovascular Pathophysiology & Therapeutics Group, The Basil Hetzel Institute for Translational Research, University of Adelaide, Adelaide, SA, Australia.

Caring Futures Institute, Flinders University, Southern Adelaide Local Health Network, Adelaide, SA, Australia.

出版信息

Cardiooncology. 2024 Oct 16;10(1):72. doi: 10.1186/s40959-024-00269-3.

DOI:10.1186/s40959-024-00269-3

PMID:39415228

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11481733/

Abstract

BACKGROUND

The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD).

AIM

To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD); (b) The rates of patient admission with subsequent development of CVD (CVD) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD and CVD on mortality rates relative to those seen in patients without overt CVD (CVD) and (d) The time course of mortality in CVD versus CVD patients.

METHODS

Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined.

RESULTS

Of the total 17,389 patients, there were 2,159 with CVD. Over a median follow-up time of 4.6 years, CVD admissions (n = 8,529) occurred more commonly in the presence of CVD (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD, 64.7% for CVD, and 40.8% for CVD (p < 0.001). Development of CVD was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001).

CONCLUSIONS

Approximately 50% of patients assigned to cancer chemotherapy developed CVD, heralding a particularly high risk of mortality over the next 12 months. Both CVD and CVD are associated with substantial increases in mortality rates relative to those in CVD patients. This increased risk merits close individual monitoring.

摘要

背景

心血管疾病与癌症发生之间的关联是双向的且已得到充分证实。此外，癌症治疗可提高患者总体生存率，但可能以增加致命性心血管疾病（CVD）为代价。

目的

评估（a）在一个真实世界队列中，接受癌症化疗且有既往心血管疾病（CVD）的患者比例；（b）在分配接受化疗后因后续发生心血管疾病（CVD）而需要住院的患者入院率；（c）心血管疾病（CVD）和心血管疾病（CVD）相对于无明显心血管疾病（CVD）患者的死亡率影响；以及（d）心血管疾病（CVD）与心血管疾病（CVD）患者的死亡时间进程。

方法

对去识别化的关联健康数据集进行回顾性分析。通过Cox比例风险评估来评估死亡率的相关因素。确定心血管疾病（CVD）作为主要死亡原因的相对和绝对时间变异性。

结果

在总共17389例患者中，有2159例患有心血管疾病（CVD）。在中位随访时间4.6年期间，心血管疾病（CVD）入院（n = 8529）在患有心血管疾病（CVD）的情况下更为常见（70.0%对46.1%，p < 0.001），且超过50%的心血管疾病（CVD）病例发生在随访的前12个月内。心血管疾病（CVD）患者的5年死亡率为71.5%，心血管疾病（CVD）患者为64.7%，无心血管疾病（CVD）患者为40.8%（p < 0.001）。心血管疾病（CVD）的发生与未来12个月内死亡率大幅增加相关。心血管疾病（CVD）的发生也与心血管疾病死亡率增加相关，而非心血管疾病死亡率（7.1%对1.6%，p < 0.001）。