Cardiovascular Disease Risk Profiles in Survivors of Adolescent and Young Adult (AYA) Cancer: The Kaiser Permanente AYA Cancer Survivors Study
Cardiovascular Disease Risk Profiles in Survivors of Adolescent and Young Adult (AYA) Cancer: The Kaiser Permanente AYA Cancer Survivors Study
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DOI：
10.1200/jco.2015.65.5845
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发表时间：
2016-05-10
影响因子：
45.3
通讯作者：
Armenian, Saro H.
中科院分区：
文献类型：
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作者：
Chao, Chun;Xu, Lanfang;Armenian, Saro H.
目的描述青少年和年轻成人 (AYA) 癌症幸存者中心血管疾病 (CVD) 的流行病学和危险因素。方法我们对南加州 Kaiser Permanente 诊断年龄在 15 至 39 岁之间（1998 年至 2009 年）的 AYA 癌症 2 年幸存者进行了回顾性队列研究。选择未患癌症的对照组，并根据年龄、性别、南加州凯撒医疗机构会员资格和日历年份以 10:1 的比例与癌症幸存者进行匹配。对患者的冠状动脉疾病、心力衰竭和中风进行随访至 2012 年 12 月 31 日。时间依赖性泊松回归用于评估癌症生存对发生 CVD 风险的影响，并根据心血管危险因素（CVRF；即糖尿病、高血压和血脂异常）、种族、吸烟和超重/肥胖进行调整。在癌症幸存者中，使用 Cox 回归检查按 CVD 状态划分的死亡风险。结果总共纳入了 5,673 名 AYA 癌症 2 年幸存者和 57,617 名对照患者，分别代表 24,839 人和 239,073 人年的随访。总体而言，与未患癌症的患者相比，癌症幸存者发生 CVD 的风险是非癌症患者的两倍多（调整后的发病率比为 2.37；95% CI，1.93 至 2.93）；白血病和乳腺癌幸存者发生CVD的风险最高（调整后发病率比分别为4.23；95% CI，1.73至10.31；和3.63；95% CI，2.41至5.47）。拥有任何 CVRF 都会增加癌症幸存者患 CVD 的风险。与没有 CVD 的幸存者相比，发生 CVD 的癌症幸存者的总体死亡风险增加 11 倍（风险比，10.9；95% CI，8.1 至 14.8）。 结论 AYA 癌症幸存者发生 CVD 的风险增加。 CVD 发病后的生存受到影响，而 CVRF 是 CVD 风险的独立调节因素。这些数据构成了识别高风险个体和主动管理 CVRF 的基础。 (C) 2016 年美国临床肿瘤学会
PurposeTo describe the epidemiology and risk factors for cardiovascular disease (CVD) in survivors of adolescent and young adult (AYA) cancer.MethodsWe identified a retrospective cohort of 2-year survivors of AYA cancer who were diagnosed between the ages of 15 to 39 years (1998 to 2009) at Kaiser Permanente Southern California. A comparison group without cancer was selected and matched 10: 1 to cancer survivors on the basis of age, sex, Kaiser Permanente Southern California membership, and calendar year. Patients were followed through December 31, 2012, for coronary artery disease, heart failure, and stroke. Time-dependent Poisson regression was used to evaluate the effect that cancer survivorship had on the risk of developing CVD, adjusted for cardiovascular risk factors (CVRFs; ie, diabetes, hypertension, and dyslipidemia), ethnicity, smoking, and overweight/ obesity. Among cancer survivors, mortality risk by CVD status was examined using Cox regression.ResultsA total of 5,673 2-year survivors of AYA cancer and 57,617 comparison patients were included, representing 24,839 and 239,073 person-years of follow-up, respectively. Overall, cancer survivors had more than two-fold risk of developing CVD (adjusted incidence rate ratio, 2.37; 95% CI, 1.93 to 2.93) when compared with patients without cancer; survivors of leukemia and breast cancer were at the highest risk (adjusted incidence rate ratio, 4.23; 95% CI, 1.73 to 10.31; and 3.63; 95% CI, 2.41 to 5.47, respectively) of developing CVD. Having any of the CVRFs increased the risk of CVD in cancer survivors. Cancer survivors who developed CVD had an 11-fold increased overall mortality risk (hazard ratio, 10.9; 95% CI, 8.1 to 14.8) when compared with survivors without CVD.ConclusionSurvivors of AYA cancer are at increased risk for developing CVD. Survival after CVD onset is compromised, and CVRFs are independent modifiers of CVD risk. These data form the basis for identifying high-risk individuals and proactive management of CVRFs. (C) 2016 by American Society of Clinical Oncology