Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies: A National Registry Dataset Analysis

Abstract

Background: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer.

Objectives: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence.

Methods: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined.

Results: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients.

Conclusions: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes.

Keywords: CVD, cardiovascular disease; DLBCL, diffuse large B-cell lymphoma; HES, Hospital Episode Statistics; ICD-10, International Statistical Classification of Diseases and Related Health Problems-10th Revision; NCRD, National Cancer Registration Dataset; NICOR, National Institute for Cardiovascular Outcomes Research; NSCLC, non-small-cell lung cancer; breast cancer; colorectal cancer; lung cancer; lymphoma; prostate cancer.

Graphical abstract

Figure 1

Consolidated Standards of Reporting Trials Diagram The diagram shows the selection of cancer diagnoses included in the analysis. NCRAS = National Cancer Registration and Analysis Service; NHS = National Health Service.

Figure 2

Patients With Prevalent Cardiovascular Disease According to Tumor Type and Age Patients with prevalent cardiovascular disease according to tumor type (A) and age (B). The figure shows the proportion of patients with diagnoses of cardiovascular disease in each tumor cohort and according to age group. CVD = cardiovascular disease; DLBCL, diffuse large B-cell lymphoma; HL = Hodgkin lymphoma; NSCLC = non-small-cell lung cancer.

Figure 3

Prevalence of Cardiovascular Disease Before Cancer Diagnosis by Cancer Site The figure shows the observed and standardized prevalence of cardiovascular disease in Hospital Episode Statistics by cancer site. Prevalence is standardized by the age– and sex stratum–specific 2016 Office for National Statistics population estimates. MI = myocardial infarction; other abbreviations as in Figure 2.

Figure 4

Associations Between Prevalent Cardiovascular Disease and Cancer Site The figure shows the progressively adjusted logistic regression analysis reporting odds ratios of associations between cardiovascular disease recorded in Hospital Episode Statistics and/or National Institute for Cardiovascular Outcomes Research and cancer site. The reference is the breast cancer cohort. CCI = Charlson comorbidity index; IMD = Index of Multiple Deprivation; other abbreviations as in Figure 2.

Central Illustration

Study Design and Key Findings The figure shows the design of the analysis and the key findings. CVD = Cardiovascular Disease; NSCLC = Non-small-cell lung cancer.