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Bak M, Park H, Lee SH, Lee N, Ahn MJ, Ahn JS, Jung HA, Park S, Cho J, Kim J, Park SJ, Chang SA, Lee SC, Park SW, Kim EK. The Risk and Reversibility of Osimertinib-Related Cardiotoxicity in a Real-World Population. J Thorac Oncol 2024:S1556-0864(24)02377-3. [PMID: 39395664 DOI: 10.1016/j.jtho.2024.10.003] [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: 08/05/2024] [Revised: 09/30/2024] [Accepted: 10/05/2024] [Indexed: 10/14/2024]
Abstract
INTRODUCTION Although osimertinib, a third-generation EGFR tyrosine kinase inhibitor, as the first-line therapy for metastatic NSCLC was found to have substantial survival benefits, concerns have arisen regarding its potential cardiotoxicity, particularly in real-world clinical settings. We aimed to investigate the incidence, risk factors, and reversibility of osimertinib-related cardiotoxicity. METHODS We analyzed 1126 patients with NSCLC treated with osimertinib from May 2016 to April 2023 in two cancer centers. Osimertinib-related cardiotoxicity was defined as a composite of osimertinib-related cardiac dysfunction (ORCD), newly developed arrhythmia, and cardiac death. Total follow-up duration was 20.6 (10.8-35.2) months. RESULTS The osimertinib was administered for a median of 12.4 months. The incidence of osimertinib-related cardiotoxicity was 4.7%. Advanced age (adjusted hazard ratio with 95% confidence interval: 1.07 [1.04-1.09], p < 0.001), a history of heart failure (3.35 [1.67-9.64], p = 0.025), atrial fibrillation (3.42 [1.27-9.22], p = 0.015), and baseline low left ventricle strain (0.87 [0.79-0.96], p = 0.005) were independently associated with development of cardiotoxicity. The recovery rate of ORCD was 82.4%, which did not differ between patients who discontinued medication and those who did not. CONCLUSIONS In real-world practice, the incidence of osimertinib-related cardiotoxicity was 4.7%, including 3.4% for ORCD requiring cardiologic intervention, which is higher than previously reported. Given the long-term medication of osimertinib and increased mortality associated with cardiotoxicity, vigilant monitoring is crucial, especially in patients with advanced age, history of heart failure, atrial fibrillation, or decreased baseline left ventricular strain.
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Affiliation(s)
- Minjung Bak
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyukjin Park
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Se-Hoon Lee
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Nuri Lee
- Department of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Myung-Ju Ahn
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin Seok Ahn
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyun Ae Jung
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sehhoon Park
- Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinhyun Cho
- Division of Hematology and Oncology, Department of Medicine, Inha University Hospital, Inchon, Republic of Korea
| | - Jihoon Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-Ji Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sung-A Chang
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Chol Lee
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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López-Fernández T, Marco I, Aznar MC, Barac A, Bergler-Klein J, Meattini I, Scott JM, Cardinale D, Dent S. Breast cancer and cardiovascular health. Eur Heart J 2024:ehae637. [PMID: 39320463 DOI: 10.1093/eurheartj/ehae637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/08/2024] [Accepted: 09/06/2024] [Indexed: 09/26/2024] Open
Abstract
Modern cancer therapies greatly improve clinical outcomes for both early and advanced breast cancer patients. However, these advances have raised concerns about potential short- and long-term toxicities, including cardiovascular toxicities. Therefore, understanding the common risk factors and underlying pathophysiological mechanisms contributing to cardiovascular toxicity is essential to ensure best breast cancer outcomes. While cardio-oncology has emerged as a sub-speciality to address these challenges, it is essential that all cardiologists recognize and understand the cardiovascular consequences of cancer therapy. This review aims to provide a comprehensive overview of the potential adverse cardiovascular effects associated with modern breast cancer therapies. A preventive, diagnostic, and therapeutic workflow to minimize the impact of cardiovascular toxicity on patient outcomes is presented. Key aspects of this workflow include regular monitoring of cardiovascular function, early detection and management of cancer therapy-related cardiovascular toxicities, and optimization of cardiovascular risk factor control. By highlighting the gaps in knowledge in some areas, this review aims to emphasize the critical role of cardio-oncology research in ensuring the holistic well-being of patients with breast cancer.
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Affiliation(s)
- Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
- Cardiology Department, Quironsalud University Hospital, C. Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Irene Marco
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Marianne C Aznar
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ana Barac
- Inova ScharHeart and Vascular, Inova Schar Cancer Institute, Fall Church, VA, USA
| | - Jutta Bergler-Klein
- Department of Cardiology, University Clinic of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences 'M. Serio', Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniela Cardinale
- Cardioncology Unit, European Institute of Oncology, I.R.C.C.S., Milan, Italy
| | - Susan Dent
- Wilmot Cancer Institute, Department of Medicine, University of Rochester, Rochester, NY, USA
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Liu AB, Zhang Y, Tian P, Meng TT, Chen JL, Zhang D, Zheng Y, Su GH. Metabolic syndrome and cardiovascular disease among adult cancer patients: results from NHANES 2007-2018. BMC Public Health 2024; 24:2259. [PMID: 39164696 PMCID: PMC11337603 DOI: 10.1186/s12889-024-19659-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 07/31/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a risk factor for cardiovascular disease (CVD), and CVD is a major challenge for cancer patients. This study aimed to investigate the prevalence and association of MetS and CVD among adult cancer patients. METHODS This cross-sectional study included cancer patients aged > 18 years from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. The prevalence of MetS and CVD was calculated using weighted analysis. Multivariable logistic regression was used to assess the association between MetS and CVD. RESULTS The study included 2658 adult cancer patients, of whom 1260 exhibited MetS and 636 had CVD. The weighted prevalence of MetS and CVD in cancer patients was 45.44%, and 19.23%, respectively. Multivariable logistic regression showed a 79% increased risk in higher CVD prevalence in cancer patients with MetS, with the OR (95% CI) of 1.79 (1.31, 2.44). Notably, obesity, elevated blood pressure (BP), high glucose, and low high density lipoprotein cholesterol (HDL-C) in the MetS components were significantly associated with higher CVD prevalence after adjusting for covariates. Moreover, the risk of CVD prevalence in cancer patients increased with more MetS components. Notably, MetS was more strongly linked to CVD in patients aged < 65 and women. CONCLUSIONS Among adult cancer patients, over two-fifths (45.44%) were estimated to have MetS, while about one-fifth (19.23%) were considered to have CVD. Notably, obesity, elevated BP, high glucose, low HDL-C, and higher number of MetS components were found to be significantly associated with higher CVD prevalence among cancer adults. Cancer patients under 65 and women with MetS may be at increased risk of CVD.
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Affiliation(s)
- An-Bang Liu
- Shandong First Medical University & Shandong Academy of Medical Sciences, Huaiyin District, No.6699, Qingdao Road, Jinan, 250000, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
| | - Yu Zhang
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- Jinan Central Hospital, Shandong University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
| | - Peng Tian
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- Jinan Central Hospital, Shandong University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
| | - Ting-Ting Meng
- Shandong First Medical University & Shandong Academy of Medical Sciences, Huaiyin District, No.6699, Qingdao Road, Jinan, 250000, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
| | - Jian-Lin Chen
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- School of Clinical Medicine, Shandong Second Medical University, No.7166, Baotong West Street, Weifang, 261000, Shandong, China
| | - Dan Zhang
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
- Jinan Central Hospital, Shandong University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
| | - Yan Zheng
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China.
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China.
| | - Guo-Hai Su
- Shandong First Medical University & Shandong Academy of Medical Sciences, Huaiyin District, No.6699, Qingdao Road, Jinan, 250000, Shandong, China
- Department of Cardiology, Central Hospital Affiliated to Shandong First Medical University, Lixia District, No.105, Jiefang Road, Jinan, 250000, Shandong, China
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Rivero-Santana B, Saldaña-García J, Caro-Codón J, Zamora P, Moliner P, Martínez Monzonis A, Zatarain E, Álvarez-Ortega C, Gómez-Prieto P, Pernas S, Rodriguez I, Buño Soto A, Cadenas R, Palacios Ozores P, Pérez Ramírez S, Merino Salvador M, Valbuena S, Fernández Gasso L, Juárez V, Severo A, Terol B, de Soto Álvarez T, Rodríguez O, Brion M, González-Costello J, Canales Albendea M, González-Juanatey JR, Moreno R, López-Sendón J, López-Fernández T. Anthracycline-induced cardiovascular toxicity: validation of the Heart Failure Association and International Cardio-Oncology Society risk score. Eur Heart J 2024:ehae496. [PMID: 39106857 DOI: 10.1093/eurheartj/ehae496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/24/2024] [Accepted: 07/18/2024] [Indexed: 08/09/2024] Open
Abstract
BACKGROUND AND AIMS Baseline cardiovascular toxicity risk stratification is critical in cardio-oncology. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) score aims to assess this risk but lacks real-life validation. This study validates the HFA-ICOS score for anthracycline-induced cardiovascular toxicity. METHODS Anthracycline-treated patients in the CARDIOTOX registry (NCT02039622) were stratified by the HFA-ICOS score. The primary endpoint was symptomatic or moderate to severe asymptomatic cancer therapy-related cardiac dysfunction (CTRCD), with all-cause mortality and cardiovascular mortality as secondary endpoints. RESULTS The analysis included 1066 patients (mean age 54 ± 14 years; 81.9% women; 24.5% ≥65 years). According to the HFA-ICOS criteria, 571 patients (53.6%) were classified as low risk, 333 (31.2%) as moderate risk, 152 (14.3%) as high risk, and 10 (0.9%) as very high risk. Median follow-up was 54.8 months (interquartile range 24.6-81.8). A total of 197 patients (18.4%) died, and 718 (67.3%) developed CTRCD (symptomatic: n = 45; moderate to severe asymptomatic: n = 24; and mild asymptomatic: n = 649). Incidence rates of symptomatic or moderate to severe symptomatic CTRCD and all-cause mortality significantly increased with HFA-ICOS score [hazard ratio 28.74, 95% confidence interval (CI) 9.33-88.5; P < .001, and hazard ratio 7.43, 95% CI 3.21-17.2; P < .001) for very high-risk patients. The predictive model demonstrated good calibration (Brier score 0.04, 95% CI 0.03-0.05) and discrimination (area under the curve 0.78, 95% CI 0.70-0.82; Uno's C-statistic 0.78, 95% CI 0.71-0.84) for predicting symptomatic or severe/moderate asymptomatic CTRCD at 12 months. CONCLUSIONS The HFA-ICOS score effectively categorizes patients by cardiovascular toxicity risk and demonstrates strong predictive ability for high-risk anthracycline-related cardiovascular toxicity and all-cause mortality.
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Affiliation(s)
- Borja Rivero-Santana
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Jesús Saldaña-García
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Juan Caro-Codón
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Pilar Zamora
- Oncology Department, La Paz University Hospital, IdiPAZ Research Institute, CIBER ONC, Madrid, Spain
| | - Pedro Moliner
- Cardiology Department, Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, CIBER CV, Barcelona, Spain
| | - Amparo Martínez Monzonis
- Cardiology Department, Clinic University Hospital, IDIS Research Institute, CIBERCV, Santiago de Compostela, Spain
| | - Eduardo Zatarain
- Cardiology Department, Hospital General Universitario Gregorio Marañón, CIBER-CV (ISCIII), IISGM, Complutense University, Madrid, Spain
| | - Carlos Álvarez-Ortega
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Pilar Gómez-Prieto
- Hematology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Sonia Pernas
- Medical Oncology Department, Institut Catala d'Oncologia-H.U.Bellvitge-IDIBELL, L'Hospitalet, Barcelona, Spain
| | - Isabel Rodriguez
- Radiation Oncology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Antonio Buño Soto
- Department of Laboratory Medicine, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Rosalía Cadenas
- Cardiology Department, Infanta Sofía University Hospital, European University of Madrid, Madrid, Spain
| | - Patricia Palacios Ozores
- Oncology Department, Oncology Translational Research Group, Clinic University Hospital, IDIS Research Institute, Santiago de Compostela, Spain
| | | | - María Merino Salvador
- Medical Oncology Department, Infanta Sofía University Hospital, Infanta Sofía University Hospital, Henares University Hospital Foundation for Biomedical Research and Innovation (FIIB HUIS HHEN), Madrid, Spain
| | - Silvia Valbuena
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Lucía Fernández Gasso
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | - Victor Juárez
- Cardiology Department, Hospital Universitario 12 de Octubre, CIBER CV, Madrid, Spain
| | - Andrea Severo
- Cardiology Department, Hospital Universitario 12 de Octubre, CIBER CV, Madrid, Spain
| | - Belén Terol
- Cardiology Department, Hospital Universitario Quironsalud, C. Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
| | - Teresa de Soto Álvarez
- Hematology Department, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - Olaia Rodríguez
- Department of Laboratory Medicine, La Paz University Hospital, IdiPAZ Research Institute, Madrid, Spain
| | - María Brion
- Cardiology Department, Clinic University Hospital, IDIS Research Institute, CIBERCV, Santiago de Compostela, Spain
| | - José González-Costello
- Cardiology Department, Bellvitge University Hospital, Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, CIBER CV, Barcelona, Spain
| | | | - José R González-Juanatey
- Cardiology Department, Clinic University Hospital, IDIS Research Institute, CIBERCV, Santiago de Compostela, Spain
| | - Raúl Moreno
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
| | | | - Teresa López-Fernández
- Cardiology Department, La Paz University Hospital, IdiPAZ Research Institute, C/Paseo de la Castellana n° 261, 28046 Madrid, Spain
- Cardiology Department, Hospital Universitario Quironsalud, C. Diego de Velázquez, 1, 28223 Pozuelo de Alarcón, Madrid, Spain
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Abramov D, Kobo O, Mamas MA. Association of Cardiovascular Health Metrics and Mortality Among Individuals With and Without Cancer. J Am Heart Assoc 2024; 13:e032683. [PMID: 38390816 PMCID: PMC10944047 DOI: 10.1161/jaha.123.032683] [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: 09/14/2023] [Accepted: 01/26/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Although metrics of cardiovascular health have been associated with improved mortality, whether the association remains among individuals with a history of cancer has not been well characterized. METHODS AND RESULTS The National Health and Nutrition Examination Survey data from 2009 to 2018 were used to identify individuals with and without a history of cancer. For each participant, American Heart Association Life's Essential 8 cardiovascular health metrics of health behaviors (diet, physical activity, nicotine exposure, and sleep) and health factors (body mass index, non-high-density lipoprotein cholesterol, blood glucose, and blood pressure) were obtained. All-cause, cardiovascular, and cancer-related mortality were noted. Out of 21 967 individuals, 8% had a history of cancer. In analyses adjusted for age, race and ethnicity, sex, and income among the whole cohort, better Life's Essential 8 cardiovascular health metrics were associated with lower all-cause (adjusted hazard ratio [aHR ], 0.38 [95% CI, 0.29-0.49]; P<0.001), cardiovascular (aHR, 0.38 [95% CI, 0.22-0.49]; P<0.001), and cancer mortality (aHR, 0.50 [95% CI, 0.31-0.79]; P=0.001). This association was driven by better health behaviors that were associated with lower all-cause (aHR, 0.30 [95% CI, 0.26-0.35]; P<0.001), cardiovascular (aHR, 0.39 [95% CI, 0.26-0.52]; P<0.001), and cancer mortality (aHR, 0.35 [95% CI, 0.26-0.47]; P<0.001), whereas better health factors were not associated with lower mortality. There were no significant interactions in these associations between individuals with and without cancer. CONCLUSIONS Better metrics of cardiovascular health, particularly health behaviors, are associated with improved all-cause, cardiovascular, and cancer mortality to a similar extent in individuals with and without cancer. Attempts to improve cardiovascular health should be prioritized similarly among individuals with and without cancer.
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Affiliation(s)
- Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University HealthLoma LindaCAUSA
| | - Ofer Kobo
- Department of CardiologyHillel Yaffe Medical CenterHaderaIsrael
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
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Dafaalla M, Abramov D, Van Spall HG, Ghosh AK, Gale CP, Zaman S, Rashid M, Mamas MA. Heart Failure Readmission in Patients With ST-Segment Elevation Myocardial Infarction and Active Cancer. JACC CardioOncol 2024; 6:117-129. [PMID: 38510288 PMCID: PMC10950442 DOI: 10.1016/j.jaccao.2023.10.011] [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: 05/02/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 03/22/2024] Open
Abstract
Background Although numerous studies have examined readmission with heart failure (HF) after acute myocardial infarction (AMI), limited data are available on HF readmission in cancer patients post-AMI. Objectives This study aimed to assess the rates and factors associated with HF readmission in cancer patients presenting with ST-segment elevation myocardial infarction (STEMI). Methods A nationally linked cohort of STEMI patients between January 2005 and March 2019 were obtained from the UK Myocardial Infarction National Audit Project registry and the UK national Hospital Episode Statistics Admitted Patient Care registry. Multivariable Fine-Gray competing risk models were used to evaluate HF readmission at 30 days and 1 year. Results A total of 326,551 STEMI indexed admissions were included, with 7,090 (2.2%) patients having active cancer. The cancer group was less likely to be admitted under the care of a cardiologist (74.5% vs 81.9%) and had lower rates of invasive coronary angiography (62.2% vs 72.7%; P < 0.001) and percutaneous coronary intervention (58.4% vs. 69.5%). There was a significant prescription gap in the administration of post-AMI medications upon discharge such as an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (49.5% vs 71.1%) and beta-blockers (58.4% vs 68.0%) in cancer patients. The cancer group had a higher rate of HF readmission at 30 days (3.2% vs 2.3%) and 1 year (9.4% vs 7.3%). However, after adjustment, cancer was not independently associated with HF readmission at 30 days (subdistribution HR: 1.05; 95% CI: 0.86-1.28) or 1 year (subdistribution HR: 1.03; 95% CI: 0.92-1.16). The opportunity-based quality indicator was associated with higher rates of HF readmission independent of cancer diagnosis. Conclusions Cancer patients receive care that differs in important ways from patients without cancer. Greater implementation of evidence-based care may reduce HF readmissions, including in cancer patients.
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Affiliation(s)
- Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Dmitry Abramov
- Loma Linda University International Heart Institute, Loma Linda, California, USA
| | - Harriette G.C. Van Spall
- Departments of Medicine and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Arjun K. Ghosh
- Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, London, United Kingdom
- Hatter Cardiovascular Institute, University College London Hospital National Health Service Foundation Trust, London, United Kingdom
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, United Kingdom
- Department of Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Kobo O, Abramov D, Fiuza M, Chew NWS, Ng CH, Parwani P, Menezes MN, Thavendiranathan P, Mamas MA. Cardiovascular Health Metrics Differ Between Individuals With and Without Cancer. J Am Heart Assoc 2023; 12:e030942. [PMID: 38038218 PMCID: PMC10727322 DOI: 10.1161/jaha.123.030942] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Although individuals with cancer experience high rates of cardiovascular morbidity, there are limited data on the potential differences in cardiovascular health (CVH) metrics between individuals with and without cancer. METHODS AND RESULTS The National Health and Nutrition Examination Survey between 2015 and 2020 was queried to evaluate the prevalence of health metrics that comprise the American Heart Association Life's Essential 8 construct of cardiovascular health among adult individuals with and without cancer in the United States. Health metric scores were also evaluated according to important patient demographics including age, sex, race and ethnicity, and socioeconomic status. Among 4370 participants representing >180 million US adults, 9.4% had a history of cancer. Individuals with cancer had lower overall cardiovascular health scores (67.1 versus 69.1, P<0.001) compared with individuals without cancer. Among individual components of the cardiovascular health score, those with cancer had better health scores on key behaviors including physical activity, diet, and sleep compared with those without cancer, although variation was noted based on age. Higher scores on these modifiable health behaviors among those with cancer compared with those without cancer were noted in older individuals, in White individuals compared with other races and ethnicities, and in individuals with higher socioeconomic status. CONCLUSIONS We highlight important variations in simple cardiovascular health metrics among individuals with cancer compared with individuals without cancer and demonstrate differences among health metrics based on age, race and ethnicity, and socioeconomic status. These findings may explain ongoing racial, ethnic, and socioeconomic status disparities in the cancer population and provide a framework for optimizing cardiovascular health among individuals with cancer.
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Affiliation(s)
- Ofer Kobo
- Department of CardiologyHillel Yaffe Medical CenterHaderaIsrael
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
| | - Dmitry Abramov
- Division of Cardiology, Department of MedicineLoma Linda University HealthLoma LindaCA
| | - Manuela Fiuza
- Cardio‐Oncology Unit, Serviço de CardiologiaCentro Hospitalar Universitário Lisboa Norte—EPE, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina da Universidade de LisboaLisboaPortugal
| | - Nicholas W. S. Chew
- Department of CardiologyNational University Heart Centre, National University Health SystemSingapore
| | | | - Purvi Parwani
- Division of Cardiology, Department of MedicineLoma Linda University HealthLoma LindaCA
| | - Miguel Nobre Menezes
- Structural and Coronary Heart Disease Unit, Cardio‐Oncology UnitCHULN Hospital de Santa Maria, Cardiovascular Center of the University of Lisbon(CCUL@RISE), Universidade de LisboaLisbonPortugal
| | - Paaladinesh Thavendiranathan
- Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, Toronto General HospitalUniversity Health Network (UHN), University of TorontoTorontoONCanada
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis ResearchKeele UniversityStoke‐on‐TrentUnited Kingdom
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8
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Raisi-Estabragh Z, Manisty CH, Cheng RK, Lopez Fernandez T, Mamas MA. Burden and prognostic impact of cardiovascular disease in patients with cancer. Heart 2023; 109:1819-1826. [PMID: 37321830 DOI: 10.1136/heartjnl-2022-321324] [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: 02/04/2023] [Accepted: 05/25/2023] [Indexed: 06/17/2023] Open
Abstract
The number of patients at the intersection of cancer and cardiovascular disease (CVD) is increasing, reflecting ageing global populations, rising burden of shared cardiometabolic risk factors, and improved cancer survival. Many cancer treatments carry a risk of cardiotoxicity. Baseline cardiovascular risk assessment is recommended in all patients with cancer and requires consideration of individual patient risk and the cardiotoxicity profile of proposed anticancer therapies. Patients with pre-existing CVD are potentially at high or very high risk of cancer-therapy related cardiovascular toxicity. The detection of pre-existing CVD should prompt cardiac optimisation and planning of surveillance during cancer treatment. In patients with severe CVD, the risk of certain cancer therapies may be prohibitively high. Such decisions require multidisciplinary discussion with consideration of alternative anti-cancer therapies, risk-benefit assessment, and patient preference. Current practice is primarily guided by expert opinion and data from select clinical cohorts. There is need for development of a stronger evidence base to guide clinical practice in cardio-oncology. The establishment of multicentre international registries and national-level healthcare data linkage projects are important steps towards facilitating enrichment of cardio-oncology research programmes. In this narrative review, we consider epidemiological trends of cancer and CVD comorbidities and the impact of their co-occurrence on clinical outcomes, current approach to supporting cancer patients with pre-existing CVD and gaps in existing knowledge.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Centre for Advanced Cardiovascular Imaging, Queen Mary University London, London, UK
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
| | - Charlotte H Manisty
- Barts Heart Centre, Saint Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, London, UK
| | - Richard K Cheng
- Division of Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | | | - Mamas A Mamas
- Institute of Population Health, University of Manchester, Manchester, UK
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9
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Kaneta K, Tanaka A, Nakai M, Sumita Y, Kaneko H, Noguchi M, Node K. Prevalence and temporal trends of prostate diseases among inpatients with cardiovascular disease: a nationwide real-world database survey in Japan. Front Cardiovasc Med 2023; 10:1236144. [PMID: 37928758 PMCID: PMC10620699 DOI: 10.3389/fcvm.2023.1236144] [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: 06/07/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Benign prostate hyperplasia (BPH) and prostate cancer (PCa) are major prostate diseases that potentially share cardiometabolic risk factors and an elevated risk for cardiovascular disease (CVD). However, the prevalence of prostate diseases among patients with established CVD remains unclear. Materials and methods This nationwide retrospective study assessed the prevalence and temporal trend of prostate diseases (i.e., BPH or PCa) among patients hospitalized for CVDs in Japan. We used a claims database (the Japanese Registry of All Cardiac and Vascular Diseases-Diagnosis Procedure Combination), which included data on 6,078,487 male patients recorded from 1,058 hospitals between April 2012 and March 2020. We conducted the Cochran-Armitage trend test and calculated the adjusted odds ratio (aOR) with 95% confidence intervals (CIs). Results The prevalence of prostate diseases over the entire study period was 5.7% (BPH, 4.4%; PCa, 1.6%). When dividing the overall cohort into age categories (<65, 65-74, and ≥75 years old), the prevalence was 1.1%, 4.7%, and 9.9%, respectively (P for trend <0.05). In addition, the annual prevalence showed a modest increasing trend over time. Patients admitted for heart failure (HF) were significantly associated with a higher incidence of coexisting prostate diseases than those admitted for non-HF causes [aOR 1.02 (95% CI, 1.01-1.03)] or acute coronary syndrome [aOR 1.19 (95% CI, 1.17-1.22)]. Conclusions The nationwide real-world database revealed that the prevalence of prostate diseases is increasing among patients hospitalized for CVD, particularly HF. Attention to detailed causality and continued surveillance are needed to further clarify the clinical characteristics of prostate diseases among patients with CVD.
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Affiliation(s)
- Kohei Kaneta
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoko Sumita
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
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10
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Liu AB, Zhang D, Meng TT, Zhang Y, Tian P, Chen JL, Zheng Y, Su GH. Association of Chronic Kidney Disease with Cardiovascular Disease in Cancer Patients: A Cross-Sectional Study. Cardiorenal Med 2023; 13:344-353. [PMID: 37839394 PMCID: PMC10664339 DOI: 10.1159/000534182] [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: 02/23/2023] [Accepted: 08/02/2023] [Indexed: 10/17/2023] Open
Abstract
INTRODUCTION Due to the cardiotoxicity of cancer treatment and traditional risk factors for cardiovascular disease (CVD) such as obesity, diabetes, dyslipidemia, and hypertension, cancer patients are at higher risk of developing CVD. However, limited research exists on the correlation between chronic kidney disease (CKD) and CVD risk in cancer patients. METHODS This cross-sectional study selected cancer patients aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) conducted from 2015 to 2020. Multivariable logistic regression was used to assess the association between CKD and CVD in cancer patients. Additionally, subgroup analyses were conducted to investigate the association among different groups of cancer patients. RESULTS We included 1,700 adult cancer patients (52.53% were females). After multivariable adjustment for covariates including traditional CVD factors, CKD was significantly associated with CVD, with an odds ratio (95% confidence interval) and p value of 1.61 (1.18, 2.19) and 0.004. Subgroup analyses after multivariable adjustment showed a significant correlation between CKD and increased CVD risk in the following cancer patients: age ≥60 years, males, white ethnicity, and individuals with or without traditional CVD factors (obesity, diabetes, dyslipidemia, and hypertension). CONCLUSIONS CKD remains a significant factor in the higher risk of CVD among adult cancer patients in the United States, even after adjustment for traditional CVD risk factors. Therefore, to reduce the risk of CVD in cancer patients, it is important to treat CKD as a non-traditional risk factor for CVD and actively manage it.
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Affiliation(s)
- An-Bang Liu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dan Zhang
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Jinan Central Hospital, Shandong University, Jinan, China
| | - Ting-Ting Meng
- Shandong First Medical University and Shandong Academy of Medical Sciences, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yu Zhang
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Jinan Central Hospital, Shandong University, Jinan, China
| | - Peng Tian
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Jinan Central Hospital, Shandong University, Jinan, China
| | - Jian-Lin Chen
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- School of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yan Zheng
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Guo-Hai Su
- Shandong First Medical University and Shandong Academy of Medical Sciences, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
- Research Center of Translational Medicine, Central Hospital Affiliated to Shandong First Medical University, Jinan, China
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11
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Font J, Milliez P, Ouazar AB, Klok FA, Alexandre J. Atrial fibrillation, cancer and anticancer drugs. Arch Cardiovasc Dis 2023; 116:219-226. [PMID: 37002156 DOI: 10.1016/j.acvd.2023.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
Active cancer is associated with an increased risk of atrial fibrillation (AF), which varies depending on the pre-existing substrate (particularly in older patients), the cancer type and stage, and the anticancer therapeutics being taken. To date, studies have not been able to identify the individual contribution of each factor. During anticancer drug therapy, AF may occur with a frequency of ≈ 15-20% according to several factors, including the patient's baseline cardiovascular toxicity risk and the AF-detection strategies used. Many anticancer drugs have been associated with AF or AF reporting, both in terms of incident and recurrent AF, but robust data are lacking. Only bruton tyrosine kinase inhibitor associated AF (mainly ibrutinib) has a high level of evidence, with a ≈ 3-4-fold higher risk of AF. AF in patients with active cancer is associated with a twofold higher risk of systemic thromboembolism or stroke, and the "TBIP" (Thromboembolic risk, Bleeding risk, drug-drug Interactions, Patient preferences) structured approach must be used to evaluate the need for anticoagulation therapy. AF in patients with active cancer is also associated with a sixfold higher risk of heart failure, and optimal symptom control must be targeted, usually with rate-control drugs (beta-blockers), but a rhythm-control strategy may be proposed in patients remaining symptomatic despite optimal rate-control. AF is generally manageable, with the continuation of anticancer drugs (including ibrutinib); interruption of cancer drugs must be avoided whenever possible and weighed against the risk of cancer progression.
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Affiliation(s)
- Jonaz Font
- Normandie University, UNICAEN, Inserm U1086 Anticipe, avenue du Général-Harris, 14000 Caen, France; CHU de Caen-Normandie, Department of Cardiology, avenue de la Côte de Nacre, 14000 Caen, France
| | - Paul Milliez
- CHU de Caen-Normandie, Department of Cardiology, avenue de la Côte de Nacre, 14000 Caen, France; Normandie University, UNICAEN, Inserm U1237 PhIND, GIP Cyceron, boulevard Henri-Becquerel, 14000 Caen, France
| | | | - Frederikus A Klok
- Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands
| | - Joachim Alexandre
- Normandie University, UNICAEN, Inserm U1086 Anticipe, avenue du Général-Harris, 14000 Caen, France; CHU de Caen-Normandie, PICARO Cardio-Oncology Program, Department of Pharmacology, avenue de la Côte de Nacre, 14000 Caen, France.
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