Cardiovascular Disease Among Survivors of Adult-Onset Cancer: A Community-Based Retrospective Cohort Study
Cardiovascular Disease Among Survivors of Adult-Onset Cancer: A Community-Based Retrospective Cohort Study
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DOI：
10.1200/jco.2015.64.0409
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发表时间：
2016-04-01
影响因子：
45.3
通讯作者：
Chao, Chun
中科院分区：
文献类型：
--
作者：
Armenian, Saro H.;Xu, Lanfang;Chao, Chun
目的
心血管疾病（CVD），包括缺血性心脏病、中风和心力衰竭，是儿童及年轻成人（诊断时<40岁）癌症幸存者中已明确的治疗晚期效应；对于成年发病（≥40岁）癌症的长期幸存者中的心血管疾病了解较少。
方法
采用回顾性队列研究设计，在一个大型综合管理式医疗组织内，描述36232名成年发病癌症的≥2年幸存者与匹配（年龄、性别和居住邮政编码）的非癌症对照者（n = 73545）相比的心血管疾病风险程度。采用多变量回归分析心血管危险因素（CVRF；高血压、糖尿病、血脂异常）对癌症幸存者长期心血管疾病风险的影响。
结果
多发性骨髓瘤（发病率比[IRR]，1.70；P <.01）、肺/支气管癌（IRR，1.58；P <.01）、非霍奇金淋巴瘤（IRR，1.41；P <.01）和乳腺癌（IRR，1.13；P <.01）的幸存者与非癌症对照者相比，心血管疾病风险显著更高。相反，前列腺癌幸存者与对照者相比心血管疾病风险较低（IRR，0.89；P <.01）。与具有少于两个CVRF的非癌症对照者相比，具有两个或更多CVRF的癌症幸存者心血管疾病风险最高（IRR，1.83 - 2.59；P <.01）。发生心血管疾病的癌症幸存者的8年总生存率（60%）与未发生心血管疾病的癌症幸存者（81%；P <.01）相比显著更差。
结论
后续心血管疾病风险的程度因癌症亚型以及心血管危险因素的存在而异。发生心血管疾病的幸存者的总体生存率较差，强调了对心血管疾病发生风险最高的个体制定针对性预防策略的必要性。
PurposeCardiovascular diseases (CVDs), including ischemic heart disease, stroke, and heart failure, are well-established late effects of therapy in survivors of childhood and young adult (< 40 years at diagnosis) cancers; less is known regarding CVD in long-term survivors of adult-onset (>= 40 years) cancer.MethodsA retrospective cohort study design was used to describe the magnitude of CVD risk in 36,232 >= 2-year survivors of adult-onset cancer compared with matched (age, sex, and residential ZIP code) noncancer controls (n = 73,545) within a large integrated managed care organization. Multivariable regression was used to examine the impact of cardiovascular risk factors (CVRFs; hypertension, diabetes, dyslipidemia) on long-term CVD risk in cancer survivors.ResultsSurvivors of multiple myeloma (incidence rate ratio [IRR], 1.70; P < .01), carcinoma of the lung/bronchus (IRR, 1.58; P < .01), non-Hodgkin lymphoma (IRR, 1.41; P < .01), and breast cancer (IRR, 1.13; P < .01) had significantly higher CVD risk when compared with noncancer controls. Conversely, prostate cancer survivors had a lower CVD risk (IRR, 0.89; P < .01) compared with controls. Cancer survivors with two or more CVRFs had the highest risk of CVD when compared with noncancer controls with less than two CVRFs (IRR, 1.83 to 2.59; P < .01). Eight-year overall survival was significantly worse among cancer survivors who developed CVD (60%) when compared with cancer survivors without CVD (81%; P < .01).ConclusionThe magnitude of subsequent CVD risk varies according to cancer subtype and by the presence of CVRFs. Overall survival in survivors who develop CVD is poor, emphasizing the need for targeted prevention strategies for individuals at highest risk of developing CVD.