Abstract
BackgroundCancer survivors may be at increased risk of cardiovascular diseases, but little is known about whether prescribing guidelines for the primary prevention of cardiovascular disease are adequately implemented in these patients. We compared levels of statin initiation and cessation among cancer survivors compared to the general population to determine differences in uptake of pharmaceutical cardiovascular risk prevention measures in these groups.MethodsThe study population included individuals aged ≥40 during 2005–13 within the UK Clinical Practice Research Datalink primary care database. Within this population we identified cancer survivors who were alive and under follow-up at least 1 year after diagnosis, and controls with no cancer history. Follow-up time prior to cancer diagnosis was included in the control cohort. Using logistic regression, we compared these groups with respect to uptake of statins within 1 month of a first high recorded cardiovascular risk score. Then, we used Cox modelling to compare persistence on statin therapy (time to statin cessation) between cancer survivors and controls from the main study population who had initiated on a statin.ResultsAmong 4202 cancer survivors and 113,035 controls with a record indicating a high cardiovascular risk score, 23.0% and 23.5% respectively initiated a statin within 1 month (adjusted odds ratio 0.98 [91.8–1.05], p = 0.626). Cancer survivors appeared more likely to discontinue statin treatment than controls (adjusted hazard ratio 1.07 [1.01–1.12], p = 0.02). This greater risk of discontinuing was only evident after the first year of therapy (p-interaction < 0.001).InterpretationAlthough cardiovascular risk is thought to be higher in cancer survivors compared to the general population, cancer survivors were no more likely to receive statins, and marginally more likely to cease long-term therapy, than general population controls. There may be an opportunity to mitigate the suspected higher cardiovascular risk in the growing population of cancer survivors by improving uptake of lipid-lowering treatment and persistence on therapy.
Highlights
Advances in cancer detection and treatment over the past 20 years have led to considerable improvements in cancer survival [1, 2]
Recent evidence has demonstrated that cancer survivors are at increased risk of cardiovascular disease (CVD) compared to the general population [7] and that in certain populations CVD competes with cancer as the leading cause of death [8, 9]
We described the proportion of patients with at least one measurement recorded in the past 5 years for each of: blood pressure, lipids (total cholesterol and/or high-density lipoprotein cholesterol (HDL) and/or cholesterol/High-density lipoprotein (HDL) ratio), and 10 year predicted cardiovascular risk score (Framingham, QRisk, ASSIGN, Joint British Society (JBS), or unspecified; Read terms used to identify cardiovascular risk scores are included in Additional file 3: Table S3)
Summary
Advances in cancer detection and treatment over the past 20 years have led to considerable improvements in cancer survival [1, 2]. Recent evidence has demonstrated that cancer survivors are at increased risk of cardiovascular disease (CVD) compared to the general population [7] and that in certain populations (e.g. breast cancer survivors) CVD competes with cancer as the leading cause of death [8, 9]. This is likely to be due to shared risk factors (e.g. obesity and tobacco use) and potential cardiotoxic effects of systemic therapies and radiotherapy [10, 11]. We compared levels of statin initiation and cessation among cancer survivors compared to the general population to determine differences in uptake of pharmaceutical cardiovascular risk prevention measures in these groups
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
