Prevalence and prognosis significance of cardiovascular disease in cancer patients: a population-based study

Abstract

Background: Cardiovascular disease (CVD) is a heavy burden on cancer patients worldwide. This study aimed to evaluate the prevalence and influence of cardiovascular risk factors (CVRF) and CVD on the all-cause mortality among Chinese cancer patients.

Results: Overall, 13.0% of all cancer patients had at least one type of CVRFs and 5.0% with CVDs. Patients with CVRF or CVD presented more frequently at later stages and received higher percentage of oncotherapy. During 1,782,527 person-years of follow-up, the all-cause mortality in cancer patients with CVDs and with CVRFs was higher compared with those without (182.6/1000, 109.5/1000 and 93.3/1000 person-years, respectively). Cox regression analysis showed that patients with heart failure (HR 1.79, 95% CI 1.61-1.99), myocardial infarction (HR 1.50, 95% CI 1.16-1.95), atrial fibrillation (HR 1.30, 95% CI 1.09-1.53), stroke (HR 1.21, 95% CI 1.11-1.32), hypertension (HR 1.10, 95% CI 1.04-1.16) and diabetes (HR 1.16, 95% CI 1.08-1.24) had increased all-cause mortality, whereas dyslipidemia patients had better prognosis (HR 0.73, 95% CI 0.64-0.83). Stratified by cancer type, the prognostic impact of specific CVRF or CVD varied.

Methods: We consecutively recruited 710,170 cancer patients between Feb. 1995 and Jun. 2018. A stratified Cox proportional hazards model was used to analyze the effect of comorbidities on the overall survival of patients stratified by cancer type.

Conclusions: Cancer patients are vulnerable to comorbidity related to heart and cerebral disease. The influence of comorbidities on prognosis is noticeable and specific both for the type of cancer and comorbidities.

Keywords: cardiovascular disease; comorbidity; mortality; prevalence; tumor.

Figure 1

Prevalence of cardiovascular comorbid condition by type of malignancy. (A) Prevalence of cancer patients suffered from cardiovascular risk factors or cardiovascular diseases. (B) Cumulative percentage of cancer patients affected by individual comorbidities.

Figure 2

Prevalence of cardiovascular comorbid condition by age groups. Comparison among cancer patients (A) cardiovascular disease (CVD) and cardiovascular risk factor (CVRF); (B) CVRF; (C) CVD.

Figure 3

Overall survival calculated by Kaplan–Meier curves. Comparison of cumulative survival among cancer patients with (A) cardiovascular disease (CVD), cardiovascular risk factor (CVRF), (B) diabetes mellitus (DM), (C) hypertension, (D) dyslipidemia, (E) myocardial infarction (MI), (F) heart failure (HF), (G) atrial fibrillation (AF), (H) stroke and those without corresponding comorbidities.

Figure 4

Hazard ratios for all-cause mortality in top six cancer types patients with and without specific cardiovascular comorbidities. The impact of the specific CVRF or CVD on mortality for the general cancer patients, lung and bronchus, breast, cervix uterus, colon and rectum, esophagus and stomach cancer patients. Hazard ratios from Cox regression analysis were adjusted for age, gender, treatment, tumor stage and cardiovascular comorbidities.

Figure 5

Summary of the impact of the specific CVRF or CVD on mortality for the general cancer patients and the top six cancer types patients. HT, hypertension; DM, diabetes mellitus; MI, myocardial infarction; HF, heart failure; AF, atrial fibrillation.