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. 2025 Mar:69:215-224.
doi: 10.1016/j.jare.2024.03.017. Epub 2024 Mar 26.

Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers

Tianwang Guan  1 , Olivia Monteiro  2 , Dongting Chen  3 , Zehao Luo  3 , Kaiyi Chi  4 , Zhihao Li  5 , Yinglan Liang  3 , Zhenxing Lu  6 , Yanting Jiang  3 , Jinming Yang  3 , Wenrui Lin  3 , Min Yi  7 , Kang Zhang  8 , Caiwen Ou  9
Affiliations

Long-term and short-term cardiovascular disease mortality among patients of 21 non-metastatic cancers

Tianwang Guan et al. J Adv Res. 2025 Mar.

Abstract

Introduction: Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers.

Objectives: To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites.

Methods: A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975-2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs).

Results: In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]-19·85[95 %CI, 16·69-23·44]; AER 5·77-210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]-19·25[95 %CI, 15·76-23·29]; AER 4·36-159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]-24·71[95 %CI, 16·28-35·96]; AER 1·01-37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group.

Conclusion: The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.

Keywords: Cardio-oncology; Cardiovascular disease death; Non-metastatic cancers; SEER.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

None
Graphical abstract
Fig. 1
Fig. 1
The proportion of death in patients with non-metastatic cancer. A. All causes of deaths; B. Causes of CVD deaths; C.Causes of non-neoplasms deaths. Abbreviations: CVD, cardiovascular disease.
Fig. 2
Fig. 2
The cumulative mortality in patients with localized cancer based on cancer sites (high competing risk group). Abbreviations: CVD, cardiovascular disease.
Fig. 3
Fig. 3
The risk of cardiovascular death by competing risk and years after diagnosis in patients with non-metastatic cancer (localized stage and AJCC I). The resulting SMR from the two staging systems follows the same trend: (A and B) SEER stage from 1975 to 2018 (SEER-9); (C and D) AJCC stage from 2004 to 2015 (SEER-18). The data from 1975 to 2018 contributed to observing long-term outcomes (A and B), while the data from 2004 to 2015 reflected modern medical practices (C and D).The time interval does not include the upper limit.
Fig. 4
Fig. 4
Cause-specific hazard ratios by 21 cancer sites with localized stage. Abbreviations: CVD, cardiovascular disease
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References

    1. Miller K.D., Nogueira L., Mariotto A.B., Rowland J.H., Yabroff K.R., Alfano C.M., et al. Cancer treatment and survivorship statistics, 2019. CA Cancer J Clin. 2019;69(5):363–385. - PubMed
    1. Siegel R.L., Miller K.D., Fuchs H.E., Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33. - PubMed
    1. Siegel R.L., Miller K.D., Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30. - PubMed
    1. Zaorsky N.G., Churilla T.M., Egleston B.L., Fisher S.G., Ridge J.A., Horwitz E.M., et al. Causes of death among cancer patients. Ann Oncol. 2017;28(2):400–407. - PMC - PubMed
    1. Roth G.A., Forouzanfar M.H., Moran A.E., Barber R., Nguyen G., Feigin V.L., et al. Demographic and epidemiologic drivers of global cardiovascular mortality. N Engl J Med. 2015;372(14):1333–1341. - PMC - PubMed

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