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Monaghan NP, Duckett KA, Nguyen SA, Newman JG, Albergotti WG, Kejner AE. Vascular events in patients with head and neck cancer: A systematic review and meta-analysis. Head Neck 2024; 46:1557-1572. [PMID: 38334324 DOI: 10.1002/hed.27675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/02/2024] [Accepted: 01/29/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVE To assess the incidence of vascular events in patients with head and neck cancer. REVIEW METHODS Primary studies identified through April 2023. Meta-analysis was performed. RESULTS There were 146 studies included in the systematic review. Rates of events were collected in the overall group, those with chemoprophylaxis, and those that underwent surgery, radiation, or chemotherapy. Of 1 184 160 patients, 4.3% had a vascular event. Radiation therapy had highest risk of overall events and stroke when compared to surgery and chemotherapy. Chemotherapy had a higher risk of stroke and overall events when compared to surgery. CONCLUSIONS Vascular events occur in 4%-5% of patients with head and neck cancer. Our data does not support the use of routine anticoagulation. Patients undergoing radiation therapy had the highest frequency of events.
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Affiliation(s)
- Neil P Monaghan
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Kelsey A Duckett
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jason G Newman
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - W Greer Albergotti
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Alexandra E Kejner
- Department of Otolaryngology, Medical University of South Carolina, Charleston, South Carolina, USA
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2
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Logotheti S, Pavlopoulou A, Rudsari HK, Galow AM, Kafali Y, Kyrodimos E, Giotakis AI, Marquardt S, Velalopoulou A, Verginadis II, Koumenis C, Stiewe T, Zoidakis J, Balasingham I, David R, Georgakilas AG. Intercellular pathways of cancer treatment-related cardiotoxicity and their therapeutic implications: The paradigm of radiotherapy. Pharmacol Ther 2024:108670. [PMID: 38823489 DOI: 10.1016/j.pharmthera.2024.108670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 05/16/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Advances in cancer therapeutics have improved patient survival rates. However, cancer survivors may suffer from adverse events either at the time of therapy or later in life. Cardiovascular diseases (CVD) represent a clinically important, but mechanistically understudied complication, which interfere with the continuation of best-possible care, induce life-threatening risks, and/or lead to long-term morbidity. These concerns are exacerbated by the fact that targeted therapies and immunotherapies are frequently combined with radiotherapy, which induces durable inflammatory and immunogenic responses, thereby providing a fertile ground for the development of cardiovascular diseases (CVDs). Stressed and dying irradiated cells produce 'danger' signals including, but not limited to, major histocompatibility complexes, cell-adhesion molecules, proinflammatory cytokines, and damage-associated molecular patterns. These factors activate intercellular signaling pathways which have potentially detrimental effects on the heart tissue homeostasis. Herein, we present the clinical crosstalk between cancer and heart diseases, describe how it is potentiated by cancer therapies, and highlight the multifactorial nature of the underlying mechanisms. We particularly focus on radiotherapy, as a case known to often induce cardiovascular complications even decades after treatment. We provide evidence that the secretome of irradiated tumors entails factors that exert systemic, remote effects on the cardiac tissue, potentially predisposing it to CVDs. We suggest how diverse disciplines can utilize pertinent state-of-the-art methods in feasible experimental workflows, to shed light on the molecular mechanisms of radiotherapy-related cardiotoxicity at the organismal level and untangle the desirable immunogenic properties of cancer therapies from their detrimental effects on heart tissue. Results of such highly collaborative efforts hold promise to be translated to next-generation regimens that maximize tumor control, minimize cardiovascular complications, and support quality of life in cancer survivors.
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Affiliation(s)
- Stella Logotheti
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
| | - Athanasia Pavlopoulou
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | | | - Anne-Marie Galow
- Institute for Genome Biology, Research Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany
| | - Yağmur Kafali
- Izmir Biomedicine and Genome Center, Izmir, Turkey; Izmir International Biomedicine and Genome Institute, Dokuz Eylül University, Izmir, Turkey
| | - Efthymios Kyrodimos
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Aris I Giotakis
- First Department of Otorhinolaryngology, Head and Neck Surgery, Hippocrateion General Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephan Marquardt
- Institute of Translational Medicine for Health Care Systems, Medical School Berlin, Hochschule Für Gesundheit Und Medizin, 14197 Berlin, Germany
| | - Anastasia Velalopoulou
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ioannis I Verginadis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Thorsten Stiewe
- Institute of Molecular Oncology, Philipps-University, 35043 Marburg, Germany; German Center for Lung Research (DZL), Universities of Giessen and Marburg Lung Center (UGMLC), 35043 Marburg, Germany; Genomics Core Facility, Philipps-University, 35043 Marburg, Germany; Institute for Lung Health (ILH), Justus Liebig University, 35392 Giessen, Germany
| | - Jerome Zoidakis
- Department of Biotechnology, Biomedical Research Foundation, Academy of Athens, Athens, Greece; Department of Biology, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Robert David
- Department of Cardiac Surgery, Rostock University Medical Center, 18057 Rostock, Germany; Department of Life, Light & Matter, Interdisciplinary Faculty, Rostock University, 18059 Rostock, Germany
| | - Alexandros G Georgakilas
- DNA Damage Laboratory, Physics Department, School of Applied Mathematical and Physical Sciences, National Technical University of Athens (NTUA), Zografou, 15780, Athens, Greece.
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3
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Kim DK. Exploring the Link between Head and Neck Cancer and the Elevated Risk of Acute Myocardial Infarction: A National Population-Based Cohort Study. Cancers (Basel) 2024; 16:1930. [PMID: 38792008 PMCID: PMC11119621 DOI: 10.3390/cancers16101930] [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: 04/23/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Enhanced screening protocols for cancer detection have increased survival in patients with head and neck cancer (HNC), which highlights the need to address the sequelae of therapy-induced cardiovascular complications. This study was conducted to assess the incidence and risk of acute myocardial infarction (AMI) in patients with HNC who have not undergone radiation or chemotherapy using a comprehensive, population-based cohort dataset. A total of 2976 individuals without cancer and 744 individuals with HNC were matched using the propensity score method. The findings indicated that the occurrence rates of AMI were comparable between the HNC (2.19) and non-cancer groups (2.39). Cox regression analysis did not demonstrate a significant increase in the risk of AMI in patients with HNC (hazard ratio: 0.93, 95% confidence interval: 0.50-1.73). No increased risk of AMI was observed in the HNC group compared to the non-cancer group, regardless of the time since the HNC diagnosis. Subgroup analyses showed no notable differences in the AMI risk between the groups when considering sex, age, comorbidities, and cancer type. This study showed that patients with HNC who have not been treated with radiation or chemotherapy did not exhibit an increased incidence or risk of AMI compared to individuals without cancer.
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Affiliation(s)
- Dong-Kyu Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea; ; Tel.: +82-33-240-5180; Fax: +82-33-241-2909
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea
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Li L, Tan J, Yu L, Li C, Nan H, Zheng S. LSAM: L2-norm self-attention and latent space feature interaction for automatic 3D multi-modal head and neck tumor segmentation. Phys Med Biol 2023; 68:225004. [PMID: 37852283 DOI: 10.1088/1361-6560/ad04a8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective.Head and neck (H&N) cancers are prevalent globally, and early and accurate detection is absolutely crucial for timely and effective treatment. However, the segmentation of H&N tumors is challenging due to the similar density of the tumors and surrounding tissues in CT images. While positron emission computed tomography (PET) images provide information about the metabolic activity of the tissue and can distinguish between lesion regions and normal tissue. But they are limited by their low spatial resolution. To fully leverage the complementary information from PET and CT images, we propose a novel and innovative multi-modal tumor segmentation method specifically designed for H&N tumor segmentation.Approach.The proposed novel and innovative multi-modal tumor segmentation network (LSAM) consists of two key learning modules, namely L2-Norm self-attention and latent space feature interaction, which exploit the high sensitivity of PET images and the anatomical information of CT images. These two advanced modules contribute to a powerful 3D segmentation network based on a U-shaped structure. The well-designed segmentation method can integrate complementary features from different modalities at multiple scales, thereby improving the feature interaction between modalities.Main results.We evaluated the proposed method on the public HECKTOR PET-CT dataset, and the experimental results demonstrate that the proposed method convincingly outperforms existing H&N tumor segmentation methods in terms of key evaluation metrics, including DSC (0.8457), Jaccard (0.7756), RVD (0.0938), and HD95 (11.75).Significance.The innovative Self-Attention mechanism based on L2-Norm offers scalability and is effective in reducing the impact of outliers on the performance of the model. And the novel method for multi-scale feature interaction based on Latent Space utilizes the learning process in the encoder phase to achieve the best complementary effects among different modalities.
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Affiliation(s)
- Laquan Li
- College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, People's Republic of China
- School of Science, Chongqing University of Posts and Telecommunications, Chongqing, People's Republic of China
| | - Jiaxin Tan
- College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, People's Republic of China
| | - Lei Yu
- Emergency Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Chunwen Li
- Emergency Department, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China
| | - Hai Nan
- College of Computer Science and Engineering, Chongqing University of Technology, Chongqing, People's Republic of China
| | - Shenhai Zheng
- College of Computer Science and Technology, Chongqing University of Posts and Telecommunications, Chongqing, People's Republic of China
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5
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Depboylu B, Eryilmaz A, Basak HS, Kirbac V, Basal Y, Omurlu IK, Gok M. Comparison of Arterial Stiffness and Strain Measured with Speckle Tracking Carotid Strain Ultrasonography after Radiation and Surgical Treatment for Head and Neck Cancer-A Clinical Trial. Diagnostics (Basel) 2023; 13:3090. [PMID: 37835836 PMCID: PMC10572110 DOI: 10.3390/diagnostics13193090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
This study assessed arterial stiffness in head and neck cancer patients using speckle tracking carotid strain ultrasonography (STCS-US). It investigated the impacts of neck irradiation and neck dissection on the arterial stiffness of these patients by comparing their stiffness parameters with those of healthy controls. A total of 101 participants (67 patients and 34 healthy controls) were enrolled in this study. Fifty-two patients received definitive radiation therapy (TD: 60-72 Gy in 30 days) at least two years ago. Participants were grouped into four according to their states of neck irradiation (IR) and neck dissection (ND): Group (IR+/ND-) had 28 patients, Group (IR+/ND+) had 24 patients, Group (IR-/ND+) had 15 patients, and Group (IR-/ND-) had 34 healthy controls. All the participants underwent STCS-US. Arterial stiffness parameters relating to arterial compliance (AC) and elastic modulus (EM) were significantly changed in Group (IR+/ND-) and Group (IR+/ND+) in the transverse plane (p < 0.001, p < 0.001) and in the longitudinal plane (p < 0.001, p < 0.001); the change in β-stiffness index (β-SI) was more significant in the transverse plane (p = 0.002). Group (IR+/ND+) had significant transverse circumferential (p = 0.001) and radial strain parameters (p = 0.001). The carotid intimal medial thickness (CIMT) significantly changed in Group (IR+/ND+) compared to controls (p = 0.001). Our findings indicate that neck irradiation and neck dissection increase arterial stiffness as single treatments; however, double treatment is associated with a higher increase. Neck irradiation affects strain parameters more than neck dissection alone. The study demonstrated the feasibility and clinical value of the STCS method in assessing arterial stiffness and its potential use in cardiovascular risk assessment for patients with head and neck cancer.
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Affiliation(s)
- Bengu Depboylu
- Department of Radiation Oncology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Aylin Eryilmaz
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Hatice Sema Basak
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Veli Kirbac
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Yesim Basal
- Department of Otolaryngology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye; (A.E.); (H.S.B.); (V.K.); (Y.B.)
| | - Imran Kurt Omurlu
- Department of Biostatistics, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye;
| | - Mustafa Gok
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın 09010, Türkiye
- Department of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2050, Australia
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Agarwala V, Ghosh A, Guha A, Parikh PM, Dent S. Editorial: Cancer treatment-related cardiovascular disease - real world data in cardio-oncology. Front Oncol 2023; 13:1277042. [PMID: 37799461 PMCID: PMC10548460 DOI: 10.3389/fonc.2023.1277042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Affiliation(s)
- Vivek Agarwala
- Medical Oncology & Hemat-Oncology, Narayana Superspeciality Hospital & Cancer Institute, Howrah and RN Tagore International Institute of Cardiac Sciences (RTIICS), Kolkata, India
| | - Arjun Ghosh
- Cardiology, Barts Heart Centre and University College London Hospital, London, United Kingdom
| | - Avirup Guha
- Medical College of Georgia, Augusta University, Augusta, GA, United States
| | - Purvish M. Parikh
- Clinical Hematology, Mahatma Gandhi University of Medical Sciences Technology, Jaipur, India
| | - Susan Dent
- Duke Cancer Institute, School of Medicine, Duke University, Durham, NC, United States
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Sun L, Brody R, Candelieri D, Lynch JA, Cohen RB, Li Y, Getz KD, Ky B. Risk of Cardiovascular Events Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:717-725. [PMID: 37347472 PMCID: PMC10288380 DOI: 10.1001/jamaoto.2023.1342] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/27/2023] [Indexed: 06/23/2023]
Abstract
Importance Cardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited. Objective To define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC. Design, Setting, and Participants This retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023. Exposures Demographic, cancer-specific, and treatment characteristics. Main Outcomes Prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death. Results Of 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively. Conclusion The results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.
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Affiliation(s)
- Lova Sun
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Robert Brody
- Division of Otorhinolaryngology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Corporal Michael Crescenz VA Medical Center, Philadelphia, Pennsylvania
| | | | - Julie A. Lynch
- VA Salt Lake City Health Care System, University of Utah, Salt Lake City
| | - Roger B. Cohen
- Division of Hematology Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kelly D. Getz
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Mukherjee A, Wiener HW, Griffin RL, Lenneman C, Chatterjee A, Nabell LM, Lewis CE, Shrestha S. Traditional risk factors and cancer-related factors associated with cardiovascular disease risk in head and neck cancer patients. Front Cardiovasc Med 2023; 9:1024846. [PMID: 36712282 PMCID: PMC9877509 DOI: 10.3389/fcvm.2022.1024846] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023] Open
Abstract
Background Risk of incident cardiovascular disease (CVD) in head and neck squamous cell carcinoma (HNSCC) patients is under-reported. We assessed the association of HNSCC-related factors and traditional risk factors with 1- and 5-year CVD risk in HNSCC patients without prevalent CVD at cancer diagnosis. Methods A clinical cohort of 1,829 HNSCC patients diagnosed between 2012 and 2018, at a National Cancer Institute (NCI)-designated cancer center was included. Information on HNSCC-related factors [HNSCC anatomical subsite, stage at diagnosis, treatment, and tumor human papillomavirus (HPV) status] were extracted from the tumor registry. Data on traditional risk factors (hypertension, dyslipidemia, diabetes, tobacco smoking status, and obesity) were extracted from the electronic health records system (EHR) at baseline (HNSCC diagnosis). A composite of ischemic heart disease, heart failure, and ischemic stroke was the outcome of interest in time to event analysis. Hazard ratio (HR) (95% CI) were reported with death as a competing risk. Results In patients diagnosed with HNSCC, 10.61% developed incident CVD events by 1-year post cancer diagnosis. One-year CVD risk was lower in patients using antihypertensive medications at baseline, compared to patients without baseline hypertension [HR (95% CI): 0.41 (0.24-0.61)]. One-year CVD risk was high in patients receiving HNSCC surgery. Patients receiving radiation therapy had a higher 5-year CVD risk than surgery patients [HR (95% CI): 2.17 (1.31-3.04)]. Patients using antihypertensive medications had a lower 5-year CVD risk than patients without baseline hypertension [HR (95% CI): 0.45 (0.22-0.75)]. Older age and diabetes were associated with increased 1- and 5-year CVD risk. HPV-negative patients were older (p 0.006) and had a higher 5-year cumulative incidence of CVD (p 0.013) than HPV-positive patients. Conclusion Traditional risk factors and cancer-related factors are associated with CVD risk in HNSCC patients. Future research should investigate the role of antihypertensive medications in reducing CVD risk in HNSCC patients.
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Affiliation(s)
- Amrita Mukherjee
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States,Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States,*Correspondence: Amrita Mukherjee,
| | - Howard W. Wiener
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Russell L. Griffin
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Carrie Lenneman
- Division of Cardiovascular Disease, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Arka Chatterjee
- Department of Medicine, Sarver Heart Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Lisle M. Nabell
- Division of Hematology and Oncology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
| | - Sadeep Shrestha
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham School of Public Health, Birmingham, AL, United States
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Dongchen X, Tongyi L, Xueping M, Jingjing S, Quanhong L. Risk of mortality and other adverse outcomes from myocardial infarction in cancer survivors: a meta-analysis. Int J Clin Oncol 2023; 28:41-51. [PMID: 36443616 DOI: 10.1007/s10147-022-02276-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 11/16/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Myocardial infarction (MI) is an acute cardiovascular disease that can increase prognosis risks such as arrhythmia, heart failure, shock, etc. Studies have found that even well-controlled coexistence of cancer could affect the quality of life in MI patients. However, the prognostic impact of cancer on MI patients is controversial. This meta-analysis aimed to assess the influence of cancer on the risk of future all-cause mortality, cardiovascular mortality, and major adverse cardiovascular and cerebrovascular events (MACCE) in MI patients. METHODS The Embase, PubMed, and Cochrane libraries were searched for cohort studies and case-control from inception to May 2022. The quality of the included pieces of literature was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). All statistical analyses were performed using Stata statistical software versions 14.0 and 16.0. Sensitivity analysis assessed the robustness of the results, and funnel plots and Egger's tests evaluated the publication bias. RESULTS A total of 10 studies were included, covering 7,210,530 participants. Summary analyses show that compared with non-cancer patients, cancer increased the risk of long-term all-cause mortality in MI patients (HR 1.58, 95% CI 1.36-1.84, I2 = 94.2%). However, no significant difference was observed in the risk of cardiovascular mortality (HR 1.18, 95% CI 0.91-1.54, I2 = 52.4%) or MACCE (HR 1.26, 95% CI 0.94-1.70, I2 = 99.2%). In subgroup analysis, cancer was associated with the risk of recurrent MI (HR 1.18, 95% CI 1.03-1.34, I2 = 88.8%), and major bleeding (HR 2.01, 95% CI 1.60-2.52, I2 = 93.1%), with no significant difference in the risk of stroke (HR 1.11, 95% CI 0.97-1.27, I2 = 85.1%). CONCLUSION This meta-analysis shows that cancer increases the risk of all-cause mortality, recurrent MI, and major bleeding in MI patients but is not associated with the risk of cardiovascular death. Therefore, comprehensive multidisciplinary management and monitoring of potential future adverse events in MI patients with cancer are needed. SYSTEMATIC REVIEW REGISTRATION The meta-analysis was registered in the International Register of Prospective Systematic Reviews (NO. CRD42022332775).
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Affiliation(s)
- Xu Dongchen
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Li Tongyi
- Hospital of Chengdu University of Traditional Chinese Medicine, Jinan, China
| | - Mu Xueping
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Shan Jingjing
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Li Quanhong
- Jinan Municipal Hospital of Traditional Chinese Medicine, Jinan, China.
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Yeh TL, Hsu MS, Hsu HY, Tsai MC, Jhuang JR, Chiang CJ, Lee WC, Chien KL. Risk of cardiovascular diseases in cancer patients: A nationwide representative cohort study in Taiwan. BMC Cancer 2022; 22:1198. [PMID: 36411401 PMCID: PMC9677651 DOI: 10.1186/s12885-022-10314-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The associations with cancer and cardiovascular diseases (CVD) had inconsistent results. The study aimed to investigate the risk of cardiovascular diseases (CVD) between populations with and without cancer. METHODS Patients with common cancers in Taiwan were enrolled in the study between 2007 and 2018 using the Taiwan Cancer Registry. We focused on colorectal cancer, women's breast cancer, lung cancer, liver cancer, oral cancer, prostate cancer, and thyroid cancers. The study endpoint was fatal and non-fatal CVD, which was defined as ischemic heart disease and ischemic stroke according to the National Health Insurance Research Database. We compared the risk of CVD between patients with cancer and age- and sex-matched (1:1 ratio) participants who did not have cancer or CVD. Multivariable adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were obtained from Cox regression analysis. To evaluate the chronological trend, we estimated the HRs and 95% CI yearly since the diagnosis. RESULTS Among the 552,485 cancer patients (mean age, 60.6 years; women, 47.7%) during the median follow-up period of 4.1 years, 32,634 cases of fatal and non-fatal CVD were identified. Compared with that noted in the non-cancer population, the overall fully adjusted HR with 95% CI was 1.28 (1.25, 1.30) in the cancer population. The CVD risk was the highest in the first year, the adjusted HR with 95% CI was 2.31 (2.23, 2.40), and this risk decreased yearly. CONCLUSIONS Patients with cancer had a significantly higher risk of fatal or non-fatal CVD. The risk was the highest in the first year since diagnosis and decreased yearly.
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Affiliation(s)
- Tzu-Lin Yeh
- grid.413593.90000 0004 0573 007XDepartment of Family Medicine, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan ,grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Min-Shu Hsu
- grid.413593.90000 0004 0573 007XDepartment of Medical Research, MacKay Memorial Hospital, New Taipei, Taiwan
| | - Hsin-Yin Hsu
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,grid.413593.90000 0004 0573 007XDepartment of Family Medicine, Taipei MacKay Memorial Hospital, Taipei, Taiwan ,grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Ming-Chieh Tsai
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,grid.452449.a0000 0004 1762 5613Department of Medicine, MacKay Medical College, New Taipei City, Taiwan ,grid.413593.90000 0004 0573 007XDivision of Endocrinology, Department of Internal Medicine, MacKay Memorial Hospital, Tamsui Branch, New Taipei City, Taiwan
| | - Jing-Rong Jhuang
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,Taiwan Cancer Registry, Taipei, Taiwan
| | - Chun-Ju Chiang
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,Taiwan Cancer Registry, Taipei, Taiwan
| | - Wen-Chung Lee
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,Taiwan Cancer Registry, Taipei, Taiwan ,grid.19188.390000 0004 0546 0241Innovation and Policy Center for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kuo-Liong Chien
- grid.19188.390000 0004 0546 0241Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan ,grid.412094.a0000 0004 0572 7815Department of Internal Medicine, National Taiwan University Hospital, Room 517, No.17, Xu-Zhou Rd, Taipei, Taiwan 10055
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11
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Lun R, Roy DC, Hao Y, Deka R, Huang WK, Navi BB, Siegal DM, Ramsay T, Fergusson D, Shorr R, Dowlatshahi D. Incidence of stroke in the first year after diagnosis of cancer—A systematic review and meta-analysis. Front Neurol 2022; 13:966190. [PMID: 36203979 PMCID: PMC9530058 DOI: 10.3389/fneur.2022.966190] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/26/2022] [Indexed: 11/28/2022] Open
Abstract
Background Patients newly diagnosed with cancer represent a population at highest risk for stroke. The objective of this systematic review and meta-analysis was to estimate the incidence of stroke in the first year following a new diagnosis of cancer. Methods We searched MEDLINE and EMBASE from January 1980 to June 2021 for observational studies that enrolled adults with a new diagnosis of all cancers excluding non-melanoma skin cancer, and that reported the incidence of stroke at 1 year. PRISMA guidelines for meta-analyses were followed. Two reviewers independently extracted data and appraised risk of bias. We used the Dersimonian and Laird random effects method to pool cumulative incidences after logit transformation, and reported pooled proportions as percentages. Statistical heterogeneity was assessed using the I2 statistic. Results A total of 12,083 studies were screened; 41 studies were included for analysis. Data from 2,552,121 subjects with cancer were analyzed. The cumulative incidence of total stroke at 1 year was 1.4% (95% CI 0.9–2.2%), while the pooled incidence of ischemic stroke was 1.3% (95% CI 1.0–1.8%) and 0.3% (95% CI 0.1–0.9%) for spontaneous intracerebral hemorrhage (ICH), with consistently high statistical heterogeneity (>99% I2). Conclusion The estimated incidence of stroke during the first year after a new diagnosis of cancer is 1.4%, with a higher risk for ischemic stroke than ICH. Cancer patients should be educated on the risk of stroke at the time of diagnosis. Future studies should evaluate optimal primary prevention strategies in this high-risk group of patients. Systematic review registration https://osf.io/ucwy9/.
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Affiliation(s)
- Ronda Lun
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology, University of Ottawa, Ottawa, ON, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- *Correspondence: Ronda Lun
| | | | - Yu Hao
- Biomedical Sciences Department, University of Calgary, Calgary, AB, Canada
| | - Rishi Deka
- Department of Psychiatry, University of California, San Diego School of Medicine, San Diego, San Diego, CA, United States
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego School of Medicine, San Diego, San Diego, CA, United States
- Veterans Affairs Health Care System, San Diego, CA, United States
| | - Wen-Kuan Huang
- Division of Hematology/Oncology, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Babak B. Navi
- Clinical and Translational Neuroscience Unit, Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, United States
- Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Deborah M. Siegal
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Division of Hematology, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | - Tim Ramsay
- School of Epidemiology, University of Ottawa, Ottawa, ON, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Dean Fergusson
- School of Epidemiology, University of Ottawa, Ottawa, ON, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Risa Shorr
- Department of Education, The Ottawa Hospital, Ottawa, ON, Canada
| | - Dar Dowlatshahi
- Division of Neurology, Department of Medicine, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology, University of Ottawa, Ottawa, ON, Canada
- Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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12
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Kang EJ, Lee Y, Koo M, Lee K, Park IH, Kim JS, Choi YJ. The risk of cardiovascular disease and stroke in survivors of head and neck cancer in Korea. Health Sci Rep 2022; 5:e517. [PMID: 35224218 PMCID: PMC8855631 DOI: 10.1002/hsr2.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Head and neck cancer (HNCA) survivors have a high risk of developing cardiovascular disease (CVD) or stroke because of sharing risk factors of disease. Therefore, we investigated the risk of CVD or stroke occurrence among HNCA survivors in Korea based on the Health Insurance Review and Assessment (HIRA) Service claims database. Methods We retrieved claims data of patients who were diagnosed with HNCA in 2014‐2015 using ICD‐10 code and followed up data until 2018. Patients with newly diagnosed with CVD or stroke after HNCA diagnosis during the follow‐up period were detected. We analyzed the characteristics of patients with HNCA who were subsequently diagnosed with CVD or stroke. In addition, the risk factors of CVD or stroke occurrence were investigated using Cox proportional hazard regression analysis. Results Among the 8288 patients with HNCA, 477 and 404 patients were diagnosed with new‐onset CVD and stroke, respectively. Patients with hypertension, diabetes mellitus (DM), and hyperlipidemia had a 3.25‐fold higher risk of CVD comparing to patients without any underlying disease (95% confidence index [CI], 2.38‐4.45) Patients with three underlying diseases had a 2.92‐fold higher risk of stroke compared to patients without any underlying disease (95% CI 2.03‐4.21). Conclusions HNCA survivors with hypertension, DM, and hyperlipidemia should be cautious of the risks of CVD and stroke.
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Affiliation(s)
- Eun Joo Kang
- Department of Internal Medicine Korea University Guro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Yun‐Gyoo Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital Sungkyunkwan University School of Medicine Seoul Republic of Korea
| | - Minji Koo
- Smart Healthcare Center Korea University Guro Hospital Seoul Republic of Korea
| | - Kyoungmin Lee
- Department of Internal Medicine Korea University Guro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - In Hae Park
- Department of Internal Medicine Korea University Guro Hospital, Korea University College of Medicine Seoul Republic of Korea
| | - Jung Sun Kim
- Department of Internal Medicine, Korea University Ansan Hospital Korea University College of Medicine Ansan Republic of Korea
| | - Yoon Ji Choi
- Department of Internal Medicine, Korea University Anam Hospital Korea University College of Medicine Seoul Republic of Korea
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