Prevalence and incidence of various cancer subtypes in patients with heart failure vs matched controls.
Prevalence and incidence of various cancer subtypes in patients with heart failure vs matched controls.
复制标题
心力衰竭患者与匹配对照患者中各种癌症亚型的患病率和发病率。
DOI：
10.1016/j.ijcard.2020.10.072
复制
发表时间：
2021-03-01
影响因子：
3.5
通讯作者：
Andersson C
中科院分区：
文献类型：
--
作者：
Schwartz B;Schou M;Gislason GH;Køber L;Torp-Pedersen C;Andersson C
背景心力衰竭患者患癌症的风险可能增加，但各种癌症亚型的风险大小尚未得到充分的研究。方法利用1997至2017年间的丹麦全国行政数据库，我们估计了新诊断的心力衰竭患者与年龄和性别匹配的对照组(每个心力衰竭病例最多5名对照)在调整合并症前后的全因癌症的患病率、发病率和相对风险。结果在心衰组的167,633人和对照组的837,126人中，心力衰竭组的几种并发症的患病率较高，包括癌症(17%对10%)；优势比1.72(1.70-1.75)。心力衰竭患者的癌症发病率(癌症发病率3.02[2.97-3.07]/100人年)也高于对照组(癌症发病率1.89[1.88-1.90])，危险比1.38(1.36-1.40)。然而，在对合并症进行调整后，增加的恶性肿瘤风险大大减弱(对于发生的全因癌症，风险比为1.14[1.12-1.16])，而在对药物进行额外调整后完全消失(对于全因癌症，多变量调整后的风险比为0.93[0.91-0.96])。在相同的缺血性心脏病患者队列中，调整了基线合并症(风险比1.05[1.02-1.08])后，全因癌症风险的增加仅略有增加。结论心力衰竭患者患各种癌症亚型的风险略有增加，但风险主要由合并症驱动。
BackgroundPatients with heart failure (HF) may be at increased risks of cancer, but the magnitude of risk for various cancer subtypes is insufficiently investigated.MethodUsing the Danish Nationwide administrative databases between 1997 and 2017, we estimated the prevalence, incidence and relative risk for all-cause cancer in new-diagnosed HF vs. age and sex-matched controls (up to 5 controls per HF case) before and after adjustment for comorbidities.ResultsAmong the 167,633 people in the heart failure group and 837,126 individuals in the control group, there was a higher prevalence of several comorbidities, including cancer (17% vs. 10%) in the HF group; odds ratio 1.72 (1.70–1.75). Patients with heart failure also had higher cancer incidence (cancer incidence rate 3.02 [2.97–3.07] per 100 person-years), compared with controls (cancer incidence rate 1.89 [1.88–1.90]); hazards ratio 1.38 (1.36–1.40). However, after adjustment for comorbidities the increased risk of malignancy was greatly attenuated (hazards ratio 1.14 [1.12–1.16] for incident all-cause cancer) and dissipated altogether after additional adjustment for medications (multivariable adjusted hazards ratio 0.93 [0.91–0.96] for all-cause cancer). In a homogeneous cohort of patients with ischemic heart disease, the increased risk of all-cause cancer was only marginally increased after adjustment for baseline comorbidities (hazards ratio 1.05 [1.02–1.08]).ConclusionPatients with heart failure had a slightly increased risk of various cancer subtypes, but the risks were mainly driven by comorbidities.