Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases
Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases
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DOI：
10.1016/s0140-6736(19)31674-5
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发表时间：
2019-09-21
期刊：
影响因子：
168.9
通讯作者：
Bhaskaran, Krishnan
中科院分区：
文献类型：
--
作者：
Strongman, Helen;Gadd, Sarah;Bhaskaran, Krishnan
在过去的几十年里，癌症患者的生存率有了很大的提高，但仍然存在对幸存者长期心血管疾病风险的担忧。关于各种癌症幸存者患特定心血管疾病的风险的证据很少，无法为预防和管理提供信息。在这项研究中，我们使用了来自多个链接的英国数据库的大规模电子健康记录数据来解决这些证据缺口。和来自英国临床实践研究数据链的癌症登记数据，以确定20种最常见癌症的幸存者队列，这些患者年龄在18岁或以上，在诊断和控制后存活12个月没有癌症史，年龄，性别和一般医疗条件相匹配我们使用粗略和调整后的考克斯模型比较了一系列心血管疾病结局的风险。我们拟合了相互作用来研究效应修正，并采用灵活的参数生存模型来估计随时间推移的绝对超额风险。结果在1990年1月1日至2015年12月31日期间，确定了126 120名诊断为癌症的患者，并在至少1年后进行了随访，并与630 144名对照组进行了匹配。排除后，108215名癌症幸存者和523541名对照被纳入主要分析。与对照组相比，20例部位特异性癌症中有18例的幸存者静脉血栓栓塞风险升高;校正后的风险比（HR）范围为前列腺癌患者的1.72（95%CI 1.57-1.89）至胰腺癌患者的9.72（5.50-17.18）。HR随时间降低，但在诊断后5年以上仍保持升高。我们观察到，20种癌症中有10种癌症患者发生心力衰竭或心肌病的风险增加，（校正HR 1.94，1.66-2.25，非霍奇金淋巴瘤; 1.77，1.50-2.09，白血病;多发性骨髓瘤患者分别为3.29，2.59-4.18）、食管癌（1.96，1.46-2.64）、肺癌（1.82，1.52-2.17）、肾癌（1.73，1.38-2.17）和卵巢癌（1.59，1.19-2.12）。还观察到多种癌症（包括血液系统恶性肿瘤）的心律失常、心包炎、冠状动脉疾病、卒中和心脏瓣膜病风险升高。在既往无心血管疾病的患者和年轻患者中，心力衰竭或心肌病和静脉血栓栓塞的HR更高。然而，随着年龄的增长，绝对超额风险通常更大。这些结果的风险增加似乎最明显的患者接受chemotherapy.Interpretation生存的大多数特定部位的癌症增加了中期至长期的一个或多个心血管疾病的风险相比，为一般人群，癌症部位之间有很大的差异。版权所有（C）2019作者。由Elsevier Ltd.发布，这是CC BY 4.0许可下的开放获取文章。
Background The past few decades have seen substantial improvements in cancer survival, but concerns exist about long-term cardiovascular disease risk in survivors. Evidence is scarce on the risks of specific cardiovascular diseases in survivors of a wide range of cancers to inform prevention and management. In this study, we used large-scale electronic health records data from multiple linked UK databases to address these evidence gaps.Methods For this population-based cohort study, we used linked primary care, hospital, and cancer registry data from the UK Clinical Practice Research Datalink to identify cohorts of survivors of the 20 most common cancers who were 18 years or older and alive 12 months after diagnosis and controls without history of cancer, matched for age, sex, and general practice. We compared risks for a range of cardiovascular disease outcomes using crude and adjusted Cox models. We fitted interactions to investigate effect modification, and flexible parametric survival models to estimate absolute excess risks over time.Findings Between Jan 1, 1990, and Dec 31, 2015, 126 120 individuals with a diagnosis of a cancer of interest still being followed up at least 1 year later were identified and matched to 630 144 controls. After exclusions, 108 215 cancer survivors and 523 541 controls were included in the main analyses. Venous thromboembolism risk was elevated in survivors of 18 of 20 site-specific cancers compared with that of controls; adjusted hazard ratios (HRs) ranged from 1.72 (95% CI 1.57-1.89) in patients after prostate cancer to 9.72 (5.50-17.18) after pancreatic cancer. HRs decreased over time, but remained elevated more than 5 years after diagnosis. We observed increased risks of heart failure or cardiomyopathy in patients after ten of 20 cancers, including haematological (adjusted HR 1.94, 1.66-2.25, with non-Hodgkin lymphoma; 1.77, 1.50-2.09, with leukaemia; and 3.29, 2.59-4.18, with multiple myeloma), oesophageal (1.96, 1.46-2.64), lung (1.82, 1.52-2.17) kidney (1.73, 1.38-2.17) and ovarian (1.59, 1.19-2.12). Elevated risks of arrhythmia, pericarditis, coronary artery disease, stroke, and valvular heart disease were also observed for multiple cancers, including haematological malignancies. HRs for heart failure or cardiomyopathy and venous thromboembolism were greater in patients without previous cardiovascular disease and in younger patients. However, absolute excess risks were generally greater with increasing age. Increased risks of these outcomes seemed most pronounced in patients who had received chemotherapy.Interpretation Survivors of most site-specific cancers had increased medium-term to long-term risk for one or more cardiovascular diseases compared with that for the general population, with substantial variations between cancer sites. Copyright (C) 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.