Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers

Abstract

IntroductionPrevious studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers. ObjectivesTo assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites. MethodsA total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975–2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs). ResultsIn patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]–19·85[95 %CI, 16·69-23·44]; AER 5·77–210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]–19·25[95 %CI, 15·76-23·29]; AER 4·36–159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]–24·71[95 %CI, 16·28-35·96]; AER 1·01–37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group. ConclusionThe CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.