Cancer-survivorship guidelines have progressed over the past few decades, and as a result, many cancer survivors are expected to live more than 10 years. However, there are many concerns about the long- term effects of cancer and chemotherapy, including cardiovascular risk after the diagnosis of cancer. Increased risk of cardiovascular disease is a result of cardiotoxic chemotherapy effects, mechanisms of cancer, and certain risk factors. Many randomized trials have shown short-term or long-term cardiovascular side effects from certain chemotherapies. However, some of these are not specific to other risk factors patients may also have.
In a population-based cohort study in the United Kingdom, electronic records were used to look at more than 90% of risk factors for patients with cancer and cardiovascular disease to identify risks of cardiovascular disease outcomes in the 20 most common site-specific cancers. The United Kingdom’s Clinical Practice Research Datalink links to national data on hospital admissions from a database called Hospital Episode Statistics Admitted Patient Care, cancer data from the National Cancer Registration and Analysis Service, and death registration and cause of death from the Office of National Statistics mortality database.
Patients were examined between January 1, 1990, and December 31, 2015, and inclusion criteria were age 18 years or older with a primary cancer. Patients were excluded if no information was listed on smoking, BMI, or index of multiple deprivation and if they had less than 1 year of follow-up. The outcomes that were examined were coronary artery disease, stroke, arrhythmia, venous thromboembolism, heart failure and cardiomyopathy, pericarditis, valvular heart disease, and peripheral vascular disease. The final analysis included 631,756 patients, some of whom were being followed up in the 10-year postdiagnosis phase.
It was noted that smoking, hypertension, previous cardiovascular disease, and chronic kidney disease were more prevalent in cancer survivors than in the control group. In addition, it was found that increased risk of heart failure after non-Hodgkin lymphoma was more pronounced at younger ages and in patients without a history of cardiovascular disease or hypertension than elderly patients. Venous thromboembolism was highest closer to the time of cancer diagnosis and then reduced over time, as was the case with arrhythmia. However, heart failure and cardiomyopathy increased over time after diagnosis.
The causes of increased cardiovascular disease are a major limitation, as they vary due to diagnosis, chemotherapy regimen, smoking, obesity, and other disease states, but researchers did find certain factors that increased specific events, such as increased risk of heart failure in non-Hodgkin lymphoma, likely due to anthracycline use. More studies are needed to establish a more concrete analysis of cardiovascular risks over time after cancer diagnosis in survivors, focusing on the types of cancer and the treatments received.
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