Abstract
As the overlap between heart disease and cancer patients increases as cancer-specific mortality is decreasing and the surviving population is aging, it is necessary to identify cancer patients who are at an increased risk of death from heart disease. The purpose of this study is to identify cancer patients at highest risk of fatal heart disease compared to the general population and other cancer patients at risk of death during the study time period. Here we report that 394,849 of the 7,529,481 cancer patients studied died of heart disease. The heart disease-specific mortality rate is 10.61/10,000-person years, and the standardized mortality ratio (SMR) of fatal heart disease is 2.24 (95% CI: 2.23–2.25). Compared to other cancer patients, patients who are older, male, African American, and unmarried are at a greatest risk of fatal heart disease. For almost all cancer survivors, the risk of fatal heart disease increases with time.
Highlights
As the overlap between heart disease and cancer patients increases as cancer-specific mortality is decreasing and the surviving population is aging, it is necessary to identify cancer patients who are at an increased risk of death from heart disease
This has led to the development of the field of cardiooncology, which refers to the treatment of cardiovascular disease in cancer patients[5,6], with particular focus on the adverse effects of cancer therapy[7]
Cardiotoxicity in cancer patients became more prevalent as drugs such as anthracyclines and targeted kinase inhibitors were linked to unexpected cardiovascular outcomes, such as heart failure[8,9]
Summary
As the overlap between heart disease and cancer patients increases as cancer-specific mortality is decreasing and the surviving population is aging, it is necessary to identify cancer patients who are at an increased risk of death from heart disease. While small advancements have been made to address the overlapping fields of heart disease and cancer care, there is currently no comprehensive resource to assist clinicians, including primary care physicians, oncologists, and cardiologists, in identifying cancer patients at highest risk of fatal heart disease International organizations, such as the European Society for Cardiology, recognize the need for such guidelines due to the complex nature of the relationship between cancer and cardiovascular health, and have published materials to assist clinicians in the care of this patient population until formal guidelines are available[12]. Our objectives are to identify cancer patients at highest risk of fatal heart disease compared to (1) the general population, using standardized mortality ratios (SMRs), and (2) other cancer patients at risk of death during the study time period, using odds ratios (ORs) and hazard ratios (HRs). These findings should be used to develop comprehensive guidelines regarding the prevention and care of heart disease in cancer survivors
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