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Chen QF, Katsouras CS, Liu C, Shi J, Luan X, Ni C, Yao H, Lu Y, Lin WH, Zhou XD. Gender-specific risks for incident cancer in patients with different heart failure phenotypes. ESC Heart Fail 2024. [PMID: 39358863 DOI: 10.1002/ehf2.15097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/09/2024] [Accepted: 09/11/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND There is conflicting evidence regarding whether heart failure (HF) increases the risk of developing cancer. OBJECTIVE This study aimed to assess the association between HF and incident cancer, considering gender differences and HF phenotypes. METHODS This retrospective study was conducted on data of adult individuals, free of cancer at baseline, from the First Affiliated Hospital of Wenzhou Medical University between January 2009 and February 2023. The patients with HF were categorized as HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). The primary outcome was incident cancer, including obesity-related, tobacco-related, lung, colorectal and breast cancers. RESULTS Of 33 033 individuals enrolled, 16 722 were diagnosed with HF, including 10 086 (60.3%) with HFpEF and 6636 (39.7%) with HFrEF. During a median follow-up period of 4.6 years (inter-quartile range: 2.6-7.3), incident cancer was diagnosed in 10.5% (1707 patients) of the non-HF group and 15.1% (2533 individuals) of the HF group. After adjusting for potential confounding factors, patients with HF had a 58% increased risk of cancer than those without HF [adjusted hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.48-1.69, P < 0.001]. This risk was consistent across genders (female: adjusted HR 1.95, 95% CI 1.74-2.18, P < 0.001; male: adjusted HR 1.41, 95% CI 1.30-1.54, P < 0.001) and HF phenotypes (HFpEF: adjusted HR 1.69, 95% CI 1.57-1.81, P < 0.001; HFrEF: adjusted HR 1.32, 95% CI 1.20-1.46, P < 0.001). CONCLUSIONS Both HFpEF and HFrEF are associated with an increased risk of incident cancer. This correlation maintains its validity across genders.
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Affiliation(s)
- Qin-Fen Chen
- Medical Care Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
| | - Christos S Katsouras
- First Department of Cardiology, University Hospital of Ioannina Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Chenyang Liu
- Department of Cardiovascular Medicine, the Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jingjing Shi
- Wenzhou Medical University Renji College, Wenzhou, China
| | - Xiaoqian Luan
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chao Ni
- Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Zhejiang Provincial Clinical Research Center for Mental Disorders, Wenzhou Medical University, Wenzhou, China
| | - Hongxia Yao
- Department of Cardiovascular Medicine, the Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yingdan Lu
- Department of Cardiovascular Medicine, the Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Hong Lin
- Medical Care Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiao-Dong Zhou
- Department of Cardiovascular Medicine, the Heart Center, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Yu A, Thaliffdeen R, Park SK, Park C. Hospital outcomes and costs for prostate cancer patients with comorbid heart failure by age group: An analysis of the US Nationwide Inpatient Sample. J Eval Clin Pract 2023; 29:1016-1024. [PMID: 37256549 DOI: 10.1111/jep.13869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/28/2023] [Accepted: 04/30/2023] [Indexed: 06/01/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The prevalence of patients hospitalized with comorbid prostate cancer (PC) and heart failure (HF) has been steadily increasing. Both diseases share a set of common risk factors, with the most prominent being age. This study aimed to examine the outcomes and costs for patients with comorbid PC and HF, stratified by age. METHODS We analyzed 41,340 hospitalization events of patients with PC using the US National Inpatient Sample from 2015 to 2018. Associations of HF with in-hospital mortality, length of stay (LOS), and hospital costs per hospitalization were measured using multivariable logistic regression, negative binomial regression, and generalized linear regression with log-link and gamma distribution, respectively, controlling for covariates. Subgroup analyses were performed for age groups <65 and ≥65. RESULTS Visits of comorbid HF patients made up 2.3% (n = 952) of the PC study sample. Compared with PC patients without HF, those with HF had higher in-hospital mortality rates (odds ratio = 1.33, 95% confidence interval [CI] = 0.96-1.84, p = 0.085), longer hospital stays (incidence rate ratio = 1.32, 95% CI = 1.21-1.44, p < 0.001), and higher hospital costs (cost ratio = 1.17, 95% CI = 1.07-1.27, p = 0.001), controlling for covariates. On average, this amounted to a higher in-hospital mortality rate of 2.10%, an increased LOS of 1.73 days, and higher hospital costs of $2110 per patient. While in-hospital mortality did not differ significantly in patients aged <65 (p = 0.900), patients aged ≥65 had a 41% increased risk of in-hospital mortality compared with those without HF (p = 0.047). CONCLUSIONS In comparison to those without HF, PC patients with comorbid HF showed higher rates of in-hospital mortality, LOS, and hospital costs, with mortality showing a significant difference exclusively in the ≥65 population. Effective management of older patients with PC is needed to improve outcomes and decrease costs.
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Affiliation(s)
- Anthony Yu
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Ryan Thaliffdeen
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
| | - Sun-Kyeong Park
- School of Pharmacy, The Catholic University of Korea, Bucheon, South Korea
| | - Chanhyun Park
- Health Outcomes Division, College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA
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Kobo O, Raisi-Estabragh Z, Gevaert S, Rana JS, Van Spall HGC, Roguin A, Petersen SE, Ky B, Mamas MA. Impact of cancer diagnosis on distribution and trends of cardiovascular hospitalizations in the USA between 2004 and 2017. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 8:787-797. [PMID: 35913736 PMCID: PMC9603542 DOI: 10.1093/ehjqcco/qcac045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/25/2022] [Accepted: 07/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIMS There is limited data on temporal trends of cardiovascular hospitalizations and outcomes amongst cancer patients. We describe the distribution, trends of admissions, and in-hospital mortality associated with key cardiovascular diseases among cancer patients in the USA between 2004 and 2017. METHODS Using the Nationwide Inpatient Sample we, identified admissions with five cardiovascular diseases of interest: acute myocardial infarction (AMI), pulmonary embolism (PE), ischaemic stroke, heart failure, atrial fibrillation (AF) or atrial flutter, and intracranial haemorrhage. Patients were stratified by cancer status and type. We estimated crude annual rates of hospitalizations and annual in-hospital all-cause mortality rates. RESULTS From >42.5 million hospitalizations with a primary cardiovascular diagnosis, 1.9 million (4.5%) had a concurrent record of cancer. Between 2004 and 2017, cardiovascular admission rates increased by 23.2% in patients with cancer, whilst decreasing by 10.9% in patients without cancer. The admission rate increased among cancer patients across all admission causes and cancer types except prostate cancer. Patients with haematological (9.7-13.5), lung (7.4-8.9), and GI cancer (4.6-6.3) had the highest crude rates of cardiovascular hospitalizations per 100 000 US population. Heart failure was the most common reason for cardiovascular admission in patients across all cancer types, except GI cancer (crude admission rates of 13.6-16.6 per 100 000 US population for patients with cancer). CONCLUSIONS In contrast to declining trends in patients without cancer, primary cardiovascular admissions in patients with cancer is increasing. The highest admission rates are in patients with haematological cancer, and the most common cause of admission is heart failure.
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Affiliation(s)
- Ofer Kobo
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, ondon E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
| | - Sofie Gevaert
- Department of Cardiology, Ghent University Hospital, Ghent University, 9000 Ghent, Belgium
| | - Jamal S Rana
- Department of Cardiology, Permanente Medical Group, Oakland, CA 94612, USA
- Department of Medicine, University of California San Francisco, San Francisco, CA 94143, USA
| | - Harriette G C Van Spall
- Department of Medicine, Department of Health Research Methods, Evidence, and Impact, Population Health Research Institute, Research Institute of St. Joe's, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 38100, Israel
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, London E1 4NS, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London EC1A 7BE, UK
- Health Data Research UK, London NW1 2BE, UK
- Alan Turing Institute, London NW1 2DB, UK
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, Newcastle ST5 5BG, UK
- Institute of Population Health, University of Manchester, Manchester M13 9PL, UK
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Mędrek S, Szmit S. Are cardiovascular comorbidities always associated with a worse prognosis in patients with lung cancer? Front Cardiovasc Med 2022; 9:984951. [PMID: 36211566 PMCID: PMC9537604 DOI: 10.3389/fcvm.2022.984951] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/01/2022] [Indexed: 12/01/2022] Open
Abstract
Many factors contribute to mortality in lung cancer, including the presence of concomitant cardiovascular disease. In the treatment of early stage of lung cancer, the presence of comorbidities and occurence of cardiotoxicity may be prognostic. The effect of cardiotoxicity of radiotherapy and chemoradiotherapy on overall survival has been documented. Acute arterial and venous thromboembolic events seem to correlate with the degree of the histological malignancy, its clinical advancement, and even with optimal cardiac treatment, they may influence the survival time. In the case of high-grade and advanced lung cancer stage especially in an unresectable stadium, the prognosis depends primarily on the factors related to the histopathological and molecular diagnosis. Electrocardiographic and echocardiographic abnormalities may be prognostic factors, as they seem to correlate with the patient's performance status as well as tumor localization and size.
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Affiliation(s)
- Sabina Mędrek
- Department of Cardiology, Subcarpathian Oncological Center, Brzozów, Poland
- *Correspondence: Sabina Mędrek
| | - Sebastian Szmit
- Department of Pulmonary Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical Education, European Health Centre, Otwock, Poland
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Gan C, Zhang Y, Liang F, Guo X, Zhong Z. Effects of APOE gene ε4 allele on serum lipid profiles and risk of cardiovascular disease and tumorigenesis in southern Chinese population. World J Surg Oncol 2022; 20:280. [PMID: 36057714 PMCID: PMC9440530 DOI: 10.1186/s12957-022-02748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Background Human apolipoprotein E (APOE) polymorphisms are attributable to the presence of three common alleles, namely, ε2, ε3, and ε4, which generate six genotypes, viz, E2/E2, E2/E3, E3/E3, E3/E4, E4/E4, and E2/E4. APOE polymorphisms are associated with all types of tumors and cardiovascular diseases (CVD). However, the relationship between the type of APOE polymorphisms and tumorigenesis remains debatable. Therefore, we aimed to investigate the role of APOE polymorphisms on the tumor with or without CVD in southern China. Methods A total of 1438 participants were categorized into 4 groups: 409 patients with tumor, 369 patients with CVD, 338 patients with both tumor and CVD, and 322 controls. APOE polymorphisms were determined by genotyping assay. The factors influencing tumor patients with or without CVD were also analyzed by logistic regression analysis. Results The present study involved different types of solid tumors. Lung cancer was the most common cancer (20.2%, 151/747), followed by colorectal (17%, 127/747), esophageal (9.8%, 73/747), and liver (8.7%, 65/747) cancers. E3/E3 was the most frequent genotype, and ɛ3 was the greatest allele frequency in our study population. The frequencies of the E3/E3, E3/E4, E2/E3, E2/E4, E4/E4, and E2/E2 genotypes in tumor patients were 76.97% (575/747), 14.19% (106/747), 6.83% (51/747), 1.2% (9/747), 0.4% (3/747), and 0.4% (3/747), respectively. Tumor patients carrying ε3 with or without CVD showed higher levels of TG, TC, and LDL-C and lower levels of HDL-C compared to the controls carrying ε3. On the other hand, the tumor patients carrying ε4 with or without CVD showed higher levels of TG and LDL-C and lower levels of HDL-C (all P < 0.05). The frequency of APOE ε4 allele and the E3/E4 genotype was relatively greater in tumor or CVD patients (P < 0.001). In addition, ε4 allele acted as an independent risk factor for tumor patients group (P = 0.037, adjusted OR = 1.92, 95% CI 1.04–3.55) and tumor + CVD patients group (P = 0.012, adjusted OR = 2.53, 95% CI 1.22–5.23). Conclusions Individuals carrying ε4 are at a higher risk of tumor with or without CVD, and APOE polymorphisms affect the serum lipid profiles.
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Affiliation(s)
- Caiyan Gan
- Center for Precision Medicine, Meizhou People's Hospital, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China.,Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, China
| | - Yinmei Zhang
- Center for Precision Medicine, Meizhou People's Hospital, Meizhou, China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China.,Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, China
| | - Fei Liang
- Data Center, Meizhou People's Hospital, Meizhou, China
| | - Xuemin Guo
- Center for Precision Medicine, Meizhou People's Hospital, Meizhou, China. .,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China. .,Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, China.
| | - Zhixiong Zhong
- Center for Precision Medicine, Meizhou People's Hospital, Meizhou, China. .,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, China. .,Guangdong Provincial Engineering and Technological Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, China.
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Grading Evaluation of Cardiotoxicity in Patients with Breast Cancer Treated with Adjuvant Paclitaxel Anthracycline/Cyclophosphamide Chemotherapy: A Meta-Analysis. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:7963146. [PMID: 35979049 PMCID: PMC9377951 DOI: 10.1155/2022/7963146] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022]
Abstract
Objective The cardiac safety of concurrent treatment with anthracycline (A), cyclophosphamide (C), and paclitaxel (T) in an adjuvant BC treatment regimen is still under debate. In this study, we aimed to determine cardiotoxicity events following ACT chemotherapy among operable breast cancer patients without HER2-positive. Methods We searched PubMed and the Cochrane Library for RCTs prior to July 2019 evaluating the cardiac impairment of ACT chemotherapy regimens in BC patients. The search terms were “BC,” “chemotherapy,” “docetaxel or “doxorubicin,” “paclitaxel,” and “cyclophosphamide.” Cardiotoxic events included LVEF decline ≥ 10 points, congestive heart failure (CHF), and cardiac death. Results In total, 12 studies with 4032 subjects were included in this meta-analysis, and all patients received ACT regimen. The analysis results indicated that LVEF decrease ≥ 10 points was the most common cardiotoxic event (16%; (95% CI (8%–24%)) with χ2 = 95.75, P < 0.001, I2 = 95.8%). CHF showed the lowest rate (1%; (95% CI (0%–1%)) with χ2 = 8.00, P = 0.433, I2 = 0.0%). Subgroup analysis demonstrated that the incidence of CHF due to A → C → T chemotherapy regimen was lower than that of other events, however, without significance. No significant difference was observed in the occurrence of cardiac death. Conclusion The ACT regimen in patients with HER2-negative BC was associated with an increased risk of adverse cardiactoxic events.
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Cao S, Xue J, Chen L, Hao Y, Lu M, Feng M, Wang H, Zhou J, Yao C. Effects of the Chinese herbal medicine Hong Huang decoction, on myocardial injury in breast cancer patients who underwent anthracycline-based chemotherapy. Front Cardiovasc Med 2022; 9:921753. [PMID: 35935647 PMCID: PMC9353583 DOI: 10.3389/fcvm.2022.921753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 06/24/2022] [Indexed: 12/24/2022] Open
Abstract
Objective To assess the effects of Hong Huang Decoction (HHD), a Chinese herbal medicine, on myocardial injury in breast cancer patients who underwent anthracycline (ANT)-based chemotherapy. Methods A total of 51 patients with breast cancer who underwent an ANT-based chemotherapy program and met the inclusion/exclusion criteria were allocated to the treatment or placebo groups using a random number generation process. Patients in the treatment group received liquid HHD twice a day. Treatment was given from 1 day prior to chemotherapy up to the end of chemotherapy (after 6 months). Participants in the placebo group received a placebo over the same schedule. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diagnostic markers of acute myocardial infarction [e.g., lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), and B-type natriuretic peptide (BNP)], nitric oxide (NO), superoxide dismutase (SOD), as well as pro-inflammatory cytokines [e.g., tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and human C-reactive protein (CRP)], and anti-inflammatory cytokine interleukin-10 (IL-10), were outcome measures assessed before chemotherapy, 3 and 6 months after chemotherapy. Results Compared to the placebo group, the GLS value was significantly higher in the treatment group (19.95 ± 1.16 vs. 19.06 ± 1.64, P ≤ 0.001). Significant differences were also noted for levels of SOD (689.71 ± 203.60 vs. 807.88 ± 182.10, P < 0.05), IL-6 (58.04 ± 22.06 vs. 194.20 ± 40.14, P ≤ 0.001), IL-10 (237.90 ± 94.98 vs. 68.81 ± 32.92, P ≤ 0.001), NO (75.05 ± 26.39 vs. 55.83 ± 19.37, P ≤ 0.005), and TNF-α (301.80 ± 134.20 vs. 680.30 ± 199.60, P ≤ 0.001) in the patients before chemotherapy compared to 6 months after initiating chemotherapy. Conclusion HHD regulated the levels of IL-6, IL-10, SOD, NO, and TNF-α. The results demonstrated that GLS is a better indicator of early myocardial injury compared to LVEF, and HHD could modulate oxidative stress to protect against ANT cardio toxicity. Clinical trial registration Chinese Clinical Trial Registry, identifier ChiCTR1900022394. Date of registration: 2019-04-09.
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Affiliation(s)
- Sihan Cao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jingxian Xue
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Lu Chen
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yun Hao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meijuan Lu
- Department of Echocardiography, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Ming Feng
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Huanhuan Wang
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
- The First Clinical College, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jun Zhou
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Chang Yao
- Department of Breast Disease, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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Bracun V, Suthahar N, Shi C, de Wit S, Meijers WC, Klip IJT, de Boer RA, Aboumsallem JP. Established Tumour Biomarkers Predict Cardiovascular Events and Mortality in the General Population. Front Cardiovasc Med 2021; 8:753885. [PMID: 34957244 PMCID: PMC8692719 DOI: 10.3389/fcvm.2021.753885] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/10/2021] [Indexed: 01/07/2023] Open
Abstract
Introduction: Several lines of evidence reveal that cardiovascular disease (CVD) and cancer share similar common pathological milieus. The prevalence of the two diseases is growing as the population ages and the burden of shared risk factors increases. In this respect, we hypothesise that tumour biomarkers can be potential predictors of CVD outcomes in the general population. Methods: We measured six tumour biomarkers (AFP, CA125, CA15-3, CA19-9, CEA and CYFRA 21-1) and determined their predictive value for CVD in the Prevention of Renal and Vascular End-stage Disease (PREVEND) study. A total of 8,592 subjects were enrolled in the study. Results: The levels of CEA significantly predicted CV morbidity and mortality, with hazard ratios (HRs) of HR 1.28 (95% CI 1.08–1.53), respectively. Two biomarkers (CA15-3 and CEA) showed statistical significance in predicting all-cause mortality, with HRs 1.58 (95% CI 1.18–2.12) and HR 1.60 (95% CI 1.30–1.96), when adjusted for shared risk factors and prevalent CVD. Furthermore, biomarkers seem to be sex specific. CYFRA 21-1 presented as an independent predictor of CV morbidity and mortality in female, but not in male gender, with HR 1.82 (95% CI 1.40–2.35). When it comes to all-cause mortality, both CYFRA and CEA show statistical significance in male gender, with HR 1.64 (95% CI 1.28–3.12) and HR 1.55 (95% CI 1.18–2.02), while only CEA showed statistical significance in female gender, with HR 1.64 (95% CI 1.20–2.24). Lastly, CA15-3 and CEA strongly predicted CV mortality with HR 3.01 (95% CI 1.70–5.32) and HR 1.82 (95% CI 1.30–2.56). On another hand, CA 15-3 also presented as an independent predictor of heart failure (HF) with HR 1.67 (95% CI 1.15–2.42). Conclusion: Several tumour biomarkers demonstrated independent prognostic value for CV events and all-cause mortality in a large cohort from the general population. These findings support the notion that CVD and cancer are associated with similar pathological milieus.
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Affiliation(s)
- Valentina Bracun
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Navin Suthahar
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Canxia Shi
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Sanne de Wit
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Wouter C Meijers
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - IJsbrand T Klip
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, Groningen, Netherlands
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Kaneko H, Itoh H, Yotsumoto H, Kiriyama H, Kamon T, Fujiu K, Morita K, Michihata N, Jo T, Takeda N, Morita H, Yasunaga H, Komuro I. Association of Cancer With Outcomes in Patients Hospitalized for Heart Failure. Circ J 2020; 84:1771-1778. [PMID: 32921679 DOI: 10.1253/circj.cj-20-0314] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The complex clinical status of heart failure (HF) patients with concomitant cancer is gaining clinical interest. This study sought to explore the prevalence of cancer in patients with HF and its effect on outcomes using a nationwide inpatient database.Methods and Results:In total, 447,818 HF patients who were admitted and discharged between January 2010 and March 2018 were studied and included in the Diagnosis Procedure Combination (DPC) database. The median age was 81 years; 238,192 patients (53.2%) were men and 25,951 (5.8%) had concomitant cancer. The prevalence of cancer peaked in patients aged in their 70 s and 80 s and increased with time. Patients with cancer were older and more likely to be male. Cigarette smoking was more common in patients with cancer. Patients with cancer more frequently had infectious complications during hospitalization. Advanced medical procedures were less frequently performed for patients with cancer. In-hospital mortality was higher in patients with cancer than those without (10.0% vs. 6.7%, P<0.001). Among patients with cancer, in-hospital mortality was higher in patients with metastasis than those without (18.9% vs. 9.4%, P<0.001). Multivariable logistic regression analysis, fitted with a generalized estimating equation, indicated cancer is associated with higher in-hospital mortality (odds ratio 1.51, 95% confidential interval 1.43-1.59, P<0.001). CONCLUSIONS Cancer was frequently observed in patients hospitalized for worsened HF, and its prevalence increased with time. The presence of cancer increased the risk of in-hospital death. Further studies are warranted to establish the optimal management strategy for HF patients with cancer in the field of cardio-oncology.
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Affiliation(s)
- Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Hidetaka Itoh
- Department of Cardiovascular Medicine, The University of Tokyo
| | | | | | - Tatsuya Kamon
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Katsuhito Fujiu
- Department of Cardiovascular Medicine, The University of Tokyo.,Department of Advanced Cardiology, The University of Tokyo
| | - Kojiro Morita
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | | | - Taisuke Jo
- Department of Health Services Research, The University of Tokyo
| | - Norifumi Takeda
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo
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