Incidence of cardiovascular disease up to 13 year after cancer diagnosis: A matched cohort study among 32 757 cancer survivors

Abstract

We examined the incidence of cardiovascular disease (CVD) among 32 757 cancer survivors and age-, gender-, and geographically matched cancer-free controls during a follow-up period of 1-13 years, and explored whetherCVD incidence differed by received cancer treatment, traditional cardiovascular risk factors, age, or gender. Adult 1-year cancer survivors without a history ofCVD diagnosed with breast (n = 6762), prostate (n = 4504), non-Hodgkin (n = 1553), Hodgkin (n = 173), lung and trachea (n = 2661), basal cell carcinoma (BCC; n = 12 476), and colorectal (n = 4628) cancer during 1999-2011 were selected from the Netherlands Cancer Registry and matched to cancer-free controls without a history ofCVD. Drug dispenses and hospitalizations from thePHARMO Database Network were used as proxy forCVD. Data were analyzed using Cox regression analyses. Prostate (HR: 1.17; 95%CI: 1.01-1.35) and lung and trachea (HR: 1.48; 95%CI: 1.10-1.97) cancer survivors had an increased risk for developingCVD compared to cancer-free controls. This increased risk among lung and trachea cancer survivors remained statistically significant after including traditional cardiovascular risk factors and cancer treatment information (HR: 1.41; 95%CI: 1.06-1.89). Among prostate cancer survivors, the increased risk of incidentCVD was limited to those who received hormones and those without traditional cardiovascular risk factors. Breast, non-Hodgkin,BCC, and colorectal cancer survivors showed no increasedCVD risk compared to cancer-free controls. There was an increased risk of incidentCVD among prostate, and lung and trachea cancer survivors compared to age-, gender- and geographically matched cancer-free controls. Studies including longer follow-up periods are warranted to examine whether cancer survivors are at increased risk of long-term incidentCVD.

Keywords: cancer survivors; cardiotoxic treatment; cardiovascular disease; matched cohort study.

Figure 1

Flow chart of the sample selection of the seven cohorts of cancer survivors and their age‐, gender and geographically matched cancer‐free controls. Note: ⱡ = Initial study population of all adult patients who were diagnosed between 1999 and 2011 with one of the seven most common incident malignancies (i.e. breast; prostate, non‐Hodgkin; Hodgkin; lung & trachea; BCC = basal cell carcinoma; and colorectal cancer) as a primary cancer diagnosis, who were 18 years or older and had a malignancy with stage 1 or higher were selected from the Southern Region of the Netherlands Cancer Registry. CVD = cardiovascular disease.