Prevalence and prognosis in cancer therapy-related cardiovascular diseases from big data of electronic health record in Japan

Abstract

Abstract Background Recent advance in cancer therapy has improved the cancer prognosis, which also increased the number of elder cancer survivors. Yet the anticancer agents have some serious side effects on cardiovascular system. Although there have been previous studies regarding cancer-specific and/or therapeutic agents-specific cardiovascular side effects in the selected patients, real-world data of the epidemiology for the impact of cardiovascular diseases (CVD) in cancer survivors is still limited due to the lack of comprehensive dataset. In this regard, the electronic health record (EHR), a big data, from the National Health Insurance in Japan provides a unique opportunity to obtain the suitable dataset. Purpose The purpose of this study was to clarify the prevalence of various CVD after the use of anticancer agents and the prognosis in cancer survivors using EHR in Japan. Methods This study was a retrospective cohort study using the database of Medical Data Vision (MDV) Co., Ltd. (Tokyo, Japan). The database covered 129 hospitals of all of the Designated Cancer Hospitals in Japan. The total number of patients was 17.85 million, which covered 14% of the total Japanese population. We extracted 140,327 cancer patients who received anticancer agents between April 2008 to January 2017. We identified CVD as pulmonary thromboembolism (PTE), atrial fibrillation (AF), ischemic heart disease (IHD), ventricular arrhythmia, pericarditis patients after the use of anticancer agents, according to International Classification of Diseases, 10th revision (ICD-10) codes. Hypertension (HT) patients were also identified according to ICD-10 codes, with the use of one or more anti-HT drugs after the HT diagnosis. Results The mean follow-up period was 1.53 years and mean age (standard deviation) was 69.2 (11.6) years old. The population over 75 years old were 36.2%, while males were 59.0%. There were prostate cancer (28.3%), lung cancer (13.8%), and colon cancer (13.2%) in males, and breast cancer (43.1%), colon cancer (12.6%), and lung cancer (8.6%) in females. Among them, 3,371 patients (2.4%) were diagnosed as PTE, 2,193 patients (1.6%) as AF, 4,085 patients (2.9%) as stable coronary artery disease, 681 patients (0.5%) as acute myocardial infarction (AMI), 749 patients (0.5%) as ventricular arrhythmia, 238 patients (0.2%) as pericarditis, 7,693 patients (5.5%) as HT. The cumulative survival rate was 65.6% in all cancer patients, 50.7% in PTE, 53.4% in AF, 61.7% in stable coronary disease, 52.7% in AMI and 45.9% in HT after the use of anticancer agents. Conclusion This study indicated that the prevalence of each CVD was less than 10% after the use of anticancer agents, but that patients with cancer therapy-related CVD had worse prognosis. Funding Acknowledgement Type of funding source: None