Suboptimal Use of Cardioprotective Drugs in Patients with a History of Cancer

Abstract

Introduction: Success of modern cancer therapy leads to a decline in death rates for cancer patients. Cardiovascular disease (CVD) is now a leading cause of long-term morbidity and mortality among cancer survivors. There is increasing need to be more vigilant in the use of cardioprotective therapies for primary and secondary prevention of cardiovascular diseases in patients living with cancer. This study aims to examine the use of cardioprotective therapies in patients with or without previous history of cancer admitted to cardiology. Methods and Results: Patients (n = 333, mean age: 65 ± 13 yrs) who were admitted to cardiology unit at John Hunter Hospital for either acute or chronic CVD from July to November 2018. N = 76 (23%) of patients had a history of cancer (Hx Ca) as documented in case notes at the time of admission. There was no difference in the prevalence of cardiac ischaemia, hypertension, dyslipidaemia, diabetes, or heart failure, but significantly higher atrial fibrillation in patients with Hx Ca (26%) vs. those without (16%). There was under-use of cardiovascular medications in patients with Hx Ca vs those without: antiplatelets (53% vs. 73%, p < 0.01); β-blockers (61% vs 70%, p = 0.17), ACEi/ARB (50% vs 61%, p = 0.1), and statins (59% vs 78%, p < 0.01). On multivariate analysis, patients with Hx of Ca had significantly lower usage of statins adjusted for age, BMI, gender, and cardiovascular risk factors. Conclusions: Cardioprotective therapies appear to be under-utilised in patients with previous history of cancer with comparable CV risk factors. Strategies are required to increase cardioprotective pharmacotherapies in these patients.