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Abstract
Data on how to identify cancer survivors (css) at the greatest risk for cardiovascular conditions are limited. We aimed to characterize the clinical factors associated with ischemic heart disease (ihd) and congestive heart failure (chf) in css and to develop a stratification schema for predicting the risk of cardiovascular comorbidities in css. Cancer survivors and non-cancer controls (nccs) were identified from the U.S. National Health and Nutrition Examination Survey. Independent factors associated with increased relative risk (rr) for cardiovascular conditions were determined. A risk stratification schema was devised that correlated risk score with the prevalence of cardiovascular comorbidities in cs. Baseline characteristics were similar for the 1869 css and 24,337 nccs included in the study. Compared with nccs, css were more likely to report ihd (13.7% vs. 5.2%), chf (7.9% vs. 2.1%), or both (4.2% vs. 1.2%; all p < 0.01). Based on multivariate analyses, risk factors for cardiovascular problems included ages 40-60 years (rr: 3.66; 95% ci: 1.87 to 7.17), 60-80 years (rr: 14.18; 95% ci: 7.65 to 26.30), and 80 years or older (rr: 25.34; 95% ci: 13.16 to 48.78); male sex (rr: 2.25; 95% ci: 1.72 to 2.94); U.S. citizenship (rr: 2.10; 95% ci: 1.08 to 4.08); annual incomes of $20,000-$45,000 (rr: 1.81; 95% ci: 1.21 to 2.70) and less than $20,000 (rr: 3.05; 95% ci: 1.81 to 5.14); comorbid diabetes mellitus (rr: 2.97; 95% ci: 2.05 to 4.32); and physical inactivity (rr: 1.98; 95% ci: 1.41 to 2.79). Independent risk factors for ihd and chf in css were identified. The risk stratification schema presented here may be helpful in developing a risk-based approach to preventive cardiovascular strategies for css.
Highlights
The incidence of cancer increases with advancing age
A risk stratification schema was devised that correlated risk score with the prevalence of cardiovascular comorbidities in cs
The risk stratification schema presented here may be helpful in developing a risk-based approach to preventive cardiovascular strategies for css
Summary
The incidence of cancer increases with advancing age. Cancer survivors are more likely to develop second malignancies and other medical conditions such as cardiovascular disease (cvd) and diabetes mellitus[2,3,4], partly because of their age, and because of late effects from prior cancer therapies. These associations are concerning, because comorbidities can worsen long-term outcomes in css, independent of the stage of their primary disease and the type of prior treatment[5]
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