Investigators have uncovered a higher risk for strokes, heart attacks, and hospital admissions for heart failure in older cancer survivors, according to a recent study published by Muhandiramge et al in Cancer.
Background
Although advances in cancer treatment have led to decreased mortality rates over the past decade, a growing number of cancer survivors may experience long-term effects of cancer and anticancer therapies. For instance, the heart may be especially vulnerable to inflammation triggered by cancer as well as the toxic effects of chemotherapy and radiation.
Previous studies have observed cerebrovascular diseases such as stroke and heart attack following cancer treatment but have not explored the effects of individual treatment modalities on different cancer types or the impact of aspirin on the rates of cerebrovascular diseases.
Study Methods and Results
In the recent study, the investigators analyzed data from the ASPREE trial involving 15,454 patients aged 70 years and older residing in Australia and the United States. The goal was to determine the incidence of cardiovascular disease in older cancer survivors and the impact of specific cancer treatments on cardiovascular health.
The investigators noted that 1,392 of the patients developed cancer over an average follow-up of 4.6 years. After assessing which patients experienced a cardiovascular disease event—including stroke, heart attack, or hospital admission for heart failure—they found the rate was twice as high in those who developed cancer compared with those who were cancer free (20.8 vs 10.3 events per 1,000 person-years, respectively). This elevated risk, which was seen across the different cardiovascular outcomes, remained even after accounting for traditional cardiovascular disease risk factors.
Further, the incidence of cardiovascular disease events was highest in patients with metastatic, hematologic, and lung cancers. Chemotherapy was associated with a two times greater likelihood of experiencing cardiovascular disease events. Analyses were inconclusive regarding other systemic therapies, such as hormonal therapy, targeted therapy, immunotherapy, and radiation therapy; however, thoracic radiation is known to confer an elevated risk. Aspirin did not appear to impact cardiovascular disease incidence.
Conclusions
The investigators stressed the importance of early screening and preventive measures and the need for continued research to further protect cancer survivors’ cardiovascular health.
“Our research contributes to the growing body of work indicating that cancer- and treatment-related cardiovascular disease is a very real risk in cancer survivors,” underscored senior study author Suzanne Orchard, BSc (Hons), PhD, of Monash University. “Cardiovascular disease can have a significant impact on both quality of life and survival for patients with cancer. Fortunately, with early screening and preventative measures, some of the cancer-related risks can be mitigated,” she concluded.
Disclosure: For full disclosures of the study authors, visit acsjournals.onlinelibrary.wiley.com.
