Predicting the risk of cardiovascular comorbidity in cancer survivors.

Abstract

9071 Background: Preventable conditions, such as heart disease and diabetes mellitus, represent a major threat to the life of many cancer survivors (CS). However, there are limited data on how to identify CS at the greatest risk who may benefit most from prevention. Our goals were to: 1) characterize the clinical factors associated with ischemic heart disease (IHD) and congestive heart failure (CHF) among CS; and 2) develop a stratification schema for predicting the risk of cardiovascular comorbidity in CS. Methods: CS and noncancer controls (NCC) were identified from the U.S. National Health and Nutrition Examination Survey. Multivariate logistic regression models were constructed to determine independent clinical factors associated with an increased relative risk (RR) for cardiovascular comorbid conditions. Based on a composite scoring system that assigned 1 point for each risk factor identified, a cardiovascular risk stratification schema was devised that correlated the risk score with the prevalence of cardiovascular comorbidity in CS. Results: A total of 2,734 CS and 23,832 NCC were included: mean age was 45.0 years (SD 17.4), 48.1 % were male, and 88.6% were White in the entire cohort. Baseline characteristics were similar between CS and NCC. When compared to NCC, CS were significantly more likely to report IHD (8.5 vs. 2.9%, p<0.01), CHF (7.1 vs. 2.0%, p<0.01), or both (3.2% vs. 0.67%, p<0.01). Based on multivariate analyses, risk factors for cardiovascular problems included: age ≥ 60 (RR 6.4, 95% CI 5.3-7.7); male gender (RR 1.8, 95% CI 1.6-2.1); racial minorities (RR 1.7, 95% CI 1.4-2.1); those who were separated or widowed (RR 2.4, 95% CI 1.8-3.4); less than high school education (RR 1.5, 95% CI 1.3-1.8); and an annual income less than $20,000 (RR 1.9, 95% CI 1.6-2.3). A cardiovascular risk stratification schema for IHD and CHF in CS was developed (Table). Conclusions: Independent risk factors for IHD and CHF in CS were identified. A risk stratification schema may be helpful in developing a risk-based approach to cardiovascular preventive strategies for CS. Prevalence of cardiovascular conditions based on risk score. Comorbidity Risk score ≤ 2 3 4 5+ IHD 0.8% 6.4% 13.6% 19.5% CHF 0.4% 6.2% 10.6% 16.7% IHD and CHF 0.2% 2.2% 3.2% 9.1%