The authors of a new study in The Lancet have called for strategies to minimise and manage cardiovascular risk in cancer survivors.
The population-based cohort study used linked primary care, hospital and cancer registry data from the UK Clinical Practice Research Datalink to identify cohorts of adult survivors of the 20 most common cancers who were alive 12 months after diagnosis. After exclusions, 108,215 cancer survivors and 523,541 age-, sex- and general practice-matched controls without a history of cancer were included in the analyses.
The data revealed that venous thromboembolism risk was elevated in survivors of 18 of 20 site-specific cancers compared with that of controls; adjusted hazard ratios (aHRs) ranged from 1.72 (95% CI, 1.57-1.89) in patients after prostate cancer to 9.72 (95% CI, 5.50-17.18) after pancreatic cancer. HRs decreased over time but remained elevated more than five years after diagnosis.
The researchers also found increased risks of heart failure or cardiomyopathy in patients after 10 of 20 cancers, including haematological (aHR, 1.94 with non-Hodgkin lymphoma; 1.77 with leukaemia; and 3.29 with multiple myeloma). The risk for heart failure or cardiomyopathy was almost doubled in oesophageal (aHR, 1.96), and was increased by 82 per cent in lung cancer, 73 per cent in kidney cancer and 59 per cent in ovarian cancer.
Risks for heart failure or cardiomyopathy and venous thromboembolism were greater in patients without previous cardiovascular disease and in younger patients. However, absolute excess risks were generally greater with increasing age. Increased risks of these outcomes seemed most pronounced in patients who had received chemotherapy.
Elevated risks of arrhythmia, pericarditis, coronary artery disease, stroke and valvular heart disease were also observed for multiple cancers, including haematological malignancies.
The authors say strategies are needed to minimise and manage cardiovascular risk for the growing population of cancer survivors.