Abstract
BACKGROUND: The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD). AIM: To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD(A)); (b) The rates of patient admission with subsequent development of CVD (CVD(S)) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD(A) and CVD(S) on mortality rates relative to those seen in patients without overt CVD (CVD(-)) and (d) The time course of mortality in CVD(-) versus CVD(S) patients. METHODS: Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined. RESULTS: Of the total 17,389 patients, there were 2,159 with CVD(A). Over a median follow-up time of 4.6 years, CVD(S) admissions (n = 8,529) occurred more commonly in the presence of CVD(A) (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD(S) cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD(A), 64.7% for CVD(S), and 40.8% for CVD(-) (p < 0.001). Development of CVD(S) was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001). CONCLUSIONS: Approximately 50% of patients assigned to cancer chemotherapy developed CVD(S), heralding a particularly high risk of mortality over the next 12 months. Both CVD(A) and CVD(S) are associated with substantial increases in mortality rates relative to those in CVD(-) patients. This increased risk merits close individual monitoring.