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CVD mortality much higher among cancer patients

CVD mortality highest in first year from diagnosis; and also much higher for bladder, larynx, prostate and uterine cancers

Louise Prime

Tuesday, 26 November 2019

Cancer patients have on average a 2–6 times higher risk of dying from cardiovascular disease (CVD) than the general population, new research has confirmed – and it showed that more than one in 10 cancer patients die from CVD rather than from their cancer. An expert commentator on the study*, published in the European Heart Journal, called for a proactive approach that starts before any cancer therapy is given and continues for a lifetime thereafter, rather than watching and waiting for complications to arrive.

Researchers used data from the Surveillance, Epidemiology, and End Results program in the US to compare CVD mortality in the US general population with that in 3,234,256 US cancer survivors (1973–2012) – and to look at different cancer sites, and changes over time from cancer diagnosis, as well as differences by age, race and sex.

They reported that overall among 28 cancer types, 1,228,328 patients (38.0%) died from cancer and 365,689 patients (11.3%) died from CVD; and among CVD deaths, 76.3% were from heart disease. Risk of death from CVD causes in cancer survivors (all sites) gradually decreased with increasing age at cancer diagnosis (55-64 years of age, standardised mortality ratio (SMR), SMR 7.5; 65-74 years of age, SMR 3.8; 75-84 years of age, SMR 2.4).

They noted that cause of death varied greatly by cancer site – and for eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. They found that:

  • The proportion of cancer survivors dying from CVD was highest in bladder cancer (19% of patients), larynx (17%), prostate (17%), womb (16%), bowel (14%) and breast (12%).
  • Whereas patients who were more likely to die from cancer than from CVD were those with the most aggressive and hard-to-treat cancers, such as cancer of the lung, liver, brain, stomach, gallbladder, pancreas, oesophagus, ovary and multiple myeloma.

The study authors added that CVD mortality risk was highest (SMR 3.93) within the first year after cancer diagnosis; but it remained elevated throughout follow-up compared with the general population.

They concluded: “The majority of deaths from CVD occur in patients diagnosed with breast, prostate, or bladder cancer. We observed that from the point of cancer diagnosis forward into survivorship cancer patients (all sites) are at elevated risk of dying from CVDs compared to the general US population. In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, supporting early involvement of cardiologists in such patients.”

The author of an accompanying editorial** commented: “The important work by Sturgeon et al. confirms that cancer patients have an on average 2–6 times higher CVD mortality risk than the general population. This is a key message that every cardiologist needs to hear.

“Secondly, the CVD mortality risk is evident throughout the continuum of cancer care, and entails an acute phase (early risk) and a chronic phase (late risk). In view of such grave and persistent consequences, a reactive management approach that comes into play solely when clinical presentations and complications arise is no longer in order. Rather, one would advocate for a proactive approach that starts before any cancer therapy is given and continues for a lifetime thereafter.

“Thirdly, even with the best possible cardio-oncology care, no difference in population-based outcomes may be achieved in patients with relentless malignancies, while for others it is of increasing significance. Demonstrating improvement in outcomes and that cardio-oncology can, indeed, make a difference may address the sceptic and consolidate the movement.”

* Sturgeon KM, Deng L, Bluethmann SM, et al, A population-based study of cardiovascular disease mortality risk in US cancer patients. European Heart Journal, DOI:10.1093/eurheartj/ehz766

** Herrmann J. From trends to transformation: where cardio-oncology is to make a difference. European Heart Journal, DOI:10.1 093/eurheartj/ehz781

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