Danish Study Shows Increased Risk of Cardiovascular Disease Throughout Life in Survivors of Adolescent and Young Adult Cancer
In a Danish cohort study reported in the Journal of the National Cancer Institute, Rugbjerg and colleagues found that survivors of adolescent and young adult cancer are at increased risk of cardiovascular disease throughout life, with cardiovascular disease profiles differing according to cancer type.
Study Details
In the study, 43,153 1-year survivors of cancers diagnosed between 1943 and 2009 at ages 15 to 39 years who were alive in 1977 were identified from the Danish Cancer Registry. An age- and sex-matched cohort was randomly selected from the Danish Civil Registration System for comparison. Subjects were linked to the Danish Patient Register and observed numbers of first hospitalizations for cardiovascular disease were compared with expected numbers from the comparison cohort.
Overall Increased Risk
During follow-up, 10,591 cancer survivors (24.5%) were hospitalized with cardiovascular disease compared with an expected 8,124 (rate ratio [RR] = 1.30, P < .001). For each additional year of follow-up, one cardiovascular disease attributable to status as a cancer survivor was diagnosed in an average of 4 of 1,000 survivors.
Increase Across Age Groups
The hospitalization rate for cardiovascular disease among survivors was higher than expected in all age groups, indicating that risk remains elevated throughout life. Rate ratios decreased with increasing age from 6.7 among survivors aged 16 to 19 years at follow-up to 1.1 among those aged 70 to 79 years, reflecting the increase in background disease rates with increasing age. However, the absolute excess burden of disease remained high, at 800, 400, and 350 excess hospitalizations per 100,000 person-years in those aged 16 to 19, 20 to 59, and 60 to 79 years, respectively.
Risks by Cancer Type
Survivors were at increased risk for hospitalization for nearly all of the 26 cardiovascular disease diagnoses included in the analysis, with risk being particularly high for endocarditis, pericarditis, myocarditis, arterial thrombosis, and cerebral hemorrhage and extremely high for lymphedema and other lymphatic disease. Venous and lymphatic disease was the leading cause of hospitalization; together, venous and lymphatic disease, cardiomyopathy, and arrhythmia accounted for 35% of all cardiovascular hospitalizations.
Survivors of each of the 10 most common adolescent and young adult cancers had a markedly increased risk for a subsequent hospital diagnosis of cardiovascular disease. Survivors of leukemia had the highest risk (absolute excess risk [AER] per 100,000 person-years of 1,244), followed by Hodgkin lymphoma (AER of 666), brain tumors (AER of 602), and breast cancers (AER of 594).
Risk for lymphedema was high in survivors of breast cancer (RR = 63.3), cervical cancer (RR = 21.5), malignant melanoma (RR = 15.9), Hodgkin lymphoma (RR = 5.8), and brain tumors (RR = 5.1). Risk for cardiomyopathy was high in survivors of leukemia (RR = 8.6), non-Hodgkin lymphoma (RR = 6.5), breast cancer (RR = 5.3), and Hodgkin lymphoma (RR = 4.8). Hodgkin lymphoma survivors were also at increased risk for valvular disease (RR = 12.2, P < .001), and leukemia survivors were also at increased risk of cerebral hemorrhage (RR = 10.3, P < .001; estimate based on only 10 patients).
Survivors were also at increased risk for diabetes (RR = 1.23, 95% confidence interval [CI] = 1.17–1.30), chronic obstructive pulmonary disease (RR = 1.24, 95% CI = 1.17–1.31), and chronic kidney disease (RR = 2.30, 95% CI = 2.04–2.60).
The investigators concluded, “Survivors of adolescent and young adult cancer are at increased risk for cardiovascular disease throughout life, although each main type of adolescent and young adult cancer had its own risk profile.”
Kathrine Rugbjerg, MSc, PhD, of the Danish Cancer Society Research Center, Copenhagen, is the corresponding author for the Journal of the National Cancer Institute article.
The study was supported by a grant from the Danish Cancer Society Scientific Committee. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
