Study examines increased CVD mortality in patients with cancer

By Rebecca Jenkins
Patients with cancer are more likely to die from cardiovascular disease (CVD) than the general population, a large study has found, underscoring the importance of multidisciplinary care with ongoing GP surveillance.

Cardiovascular mortality risk was highest in the first year after cancer diagnosis but remained elevated throughout follow up, according to researchers who compared the general US population with more than 3.2 million patients with cancer recorded in the US National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.

More than one million patients (38%) died from cancer but more than 350,000 patients with cancer died from CVD (11%) from 1973 to 2012, they found.

The data encompassed patients with 28 different types of cancer, with most CVD deaths (absolute numbers) occurring in people diagnosed with breast, prostate or bladder cancer.

‘In endometrial cancer, the first year after diagnosis poses a very high risk of dying from CVDs, which remains elevated compared to other cancer sites, supporting early involvement of cardiologists in such patients,’ the researchers noted in the European Heart Journal.

‘Our observations highlight the need for earlier and more aggressive cardiovascular care in cancer patients which may require enhanced coordinated care between oncologists, cardiologists, and PCPs [primary care physicians].’

Consistent with previous reports, younger age of cancer diagnosis was associated with higher CVD standardised mortality ratios, the researchers added.

In an accompanying editorial, Dr Joerg Herrmann, a cardiologist at the Department of Cardiovascular Diseases at the Mayo Clinic in Minnesota, USA, noted some limitations with the data, including that the analysis probably missed key developments in the era of immunotherapies.

But he called the study findings important, particularly the recognition of the acute phase of increased CVD mortality risk alongside an ongoing elevated risk.

‘Recognizing this chronic phase of persistent risk is equally important and again has not been worked out this clearly from one data set for a variety of cancers,’ he wrote.

Given the ‘grave and persistent consequences’ outlined in the study, clinicians must adopt a proactive cardiovascular management approach ‘that starts before any cancer therapy is given and continues for a lifetime thereafter’.

‘In summary, (the study)... confirms that cancer patients have on average 2-6 times higher CVD mortality risk than the general population,’ Dr Herrmann wrote.
Eur Heart J 2019; 0, 1-9; doi:10.1093/eurheartj/ehz766.
Eur Heart J 2019; 1-3; doi:10.1093/eurheartj/ehz781.