Long-term risk of cardiovascular disease among colorectal cancer survivors in a population-based cohort study.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 113-113 ◽  
Author(s):  
David Baraghoshi ◽  
Makenzie L. Hawkins ◽  
Sarah Abdelaziz ◽  
Jihye Park ◽  
Yuan Wan ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Cvd Risk ◽  
Colorectal Cancer Survivors ◽  
Increased Risk ◽  
After Cancer

113 Background: In the United States, colorectal cancer is the fourth most common cancer and one of the leading causes of cancer death. Few studies have examined the relationship between colorectal cancer survivorship and long-term cardiovascular disease (CVD) risk. Methods: Individuals diagnosed with colorectal cancer were identified using the Utah Population Database. For a comparison group, up to 5 cancer-free individuals were matched by birth year, birth state, follow-up time and sex to each cancer case. For individuals with > 10 years of follow-up, we estimated CVD risk > 10 years after cancer diagnosis. Cox regression models were used to estimate hazard ratios (HR) and 95% Confidence Intervals. Results: Among 1,749 colorectal cancer survivors who had survived for at least 10 years, 1,001 (57.2%) were diagnosed with CVD > 10 years after cancer diagnosis. Compared to the general population, colorectal cancer survivors had an increased risk of CVD > 10 years after cancer diagnosis: HR = 2.84 (95% CI = 2.59, 3.11) for hypertension; HR = 2.66 (95% CI 2.37, 2.98) for diseases of the heart; HR = 3.91 (95% CI = 3.33, 4.58) for diseases of the arteries, arterioles and capillaries; HR = 2.58 (95% CI = 2.46, 2.99) for diseases of the veins and lymphatics; HR = 2.98 (95% CI = 2.36, 3.76) for cerebrovascular disease. Colorectal cancer survivors with ≥1 comorbidity had an increased risk of CVD > 10 years after cancer diagnosis compared to survivors with no comorbidities (HR = 1.7, 95% CI = 1.49, 1.95). Colorectal cancer survivors who were ≥65 years had an increased risk of CVD > 10 years after cancer diagnosis. Colorectal cancer survivors who were obese at the time of diagnosis had an increased risk of CVD > 10 years after cancer diagnosis when compared to survivors with normal BMIs (HR = 1.25; 95% CI = 1.06, 1.49). Conclusions: Compared to the general population, colorectal cancer survivors had an increased risk of CVD during the > 10 year follow-up period. Within colorectal cancer survivors, there was an increased risk of CVD for those that were older, had ≥1 comorbidity and were obese. The increased risk of CVD among survivors may be attributable to the lifestyle risk factors shared by colorectal cancer and CVD.

Prevalence and Predictors of Delayed Cardiovascular Disease (CVD) Among Survivors of Adults with Hematologic Malignancies

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 857-857
Author(s):  
Saro Armenian ◽  
Lanfang Xu ◽  
Can-Lan Sun ◽  
Len Farol ◽  
Smita Bhatia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cancer Survivors ◽  
Cardiovascular Risk Factors ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Cvd Risk ◽  
Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of long-term survivors of hematologic malignancies. In the general U.S. population, CVD (heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. Childhood (Circulation 2013 22;128) and young adult (<40y at diagnosis; JNCI2014 21;106) cancer survivors have a substantially increased risk of CVD when compared to the general population; this is largely attributable to exposure to cardiotoxic therapies (anthracyclines, radiation) at a young age. Less is known regarding the magnitude of risk of CVD in individuals with hematologic malignancies diagnosed at age ≥40y, a population that accounts for the largest proportion of new cancer diagnoses in the U.S. and has a high prevalence of CVRFs. The few studies addressing this issue have been limited by small sample size, short (<1y) follow-up, varying definitions of cardiovascular outcomes, and lack of comparison to non-cancer controls. The current study overcomes these limitations. Methods: Using a retrospective cohort study design, 2,993 2+y survivors of non-Hodgkin lymphoma (NHL), lymphocytic leukemia (LL), and multiple myeloma (MM) diagnosed at age ≥40y between 2000 to 2007 and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 10-year insurance retention rates for cancer survivors exceeding 70% (JAYAO 2013 2:59). A non-cancer comparison group (N=6,272) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:2) on age at diagnosis, sex, and zip-code. Cumulative incidence of CVD (ICD-9 definition: congestive heart failure, stroke, or myocardial infarction) was calculated, taking into consideration the competing risk of death. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per the National Cholesterol Education Program Adult Treatment Panel III criteria. Cox proportional hazards regression analysis was used to calculate hazard ratio (HR) estimates and 95% confidence intervals (CI), adjusted for relevant covariates. Results: Median age at cancer diagnosis was 63y (range: 40-96); 53.6% were male; 68% were non-Hispanic white; diagnoses: NHL (N=1,787 [59.7%]), LL (N=705 [23.6%], MM (N=501 [16.7%]). In cancer survivors, median time from cancer diagnosis to end of follow-up was 6.2 years (range: 2-10), representing 12,622 person-years of follow-up. Comparison with non-cancer cohort: The 8y cumulative incidence of CVD was significantly higher for NHL survivors (17% vs. 14%, p<0.01), LL (19% vs. 16%, p=0.02), and MM (21% vs. 11%, p<0.01), when compared to non-cancer subjects (Figures). Multivariable analysis adjusted for age, sex, race/ethnicity and CVRFs revealed a significantly increased risk of CVD across all cancer diagnoses (NHL: HR=1.3, 95%CI, 1.1-1.6; LL: HR=1.3, 95%CI, 1.0-1.6, MM=1.9, 95%CI, 1.5-2.5) when compared to non-cancer subjects; younger (<65y at diagnosis) MM survivors were at highest risk (HR=3.5, 95%CI, 2.2-5.6). Modifiers of CVD risk among cancer survivors: Hypertension and diabetes were independent modifiers of CVD risk. Hypertension was associated with a 1.9-fold (95%CI,1.1-3.3) increased risk of developing CVD in NHL survivors and a 3.1-fold (95%CI, 1.4-6.7) increased risk in MM survivors. Diabetes was associated with increased CVD risk across all diagnoses (NHL: HR=1.7, 95%CI, 1.2-2.4; LL: HR=1.6, 95%CI, 1.0-2.6; MM: HR=1.6, 95%CI, 1.0-2.3). Conclusions: Survivors of adult-onset NHL, LL and MM are at increased risk for developing cardiovascular disease when compared to a matched non-cancer cohort. Cardiovascular risk factors such as hypertension and diabetes are independent modifiers of risk of delayed cardiovascular disease. Taken together these data form the basis for identifying high-risk individuals for targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1 Figure 1. Figure 2 Figure 2. Figure 3 Figure 3. Disclosures No relevant conflicts of interest to declare.

scholarly journals Estimating Risk of Cardiovascular Disease Among Long-Term Colorectal Cancer Survivors: A Nationwide Cohort Study

2022 ◽  
Vol 8 ◽  
Author(s):  
Seogsong Jeong ◽  
Gyeongsil Lee ◽  
Seulggie Choi ◽  
Kyae Hyung Kim ◽  
Jooyoung Chang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cvd Risk ◽  
Predictive Tools ◽  
Colorectal Cancer Survivors ◽  
Independent Risk Factors ◽  
Independent Cohort

BackgroundConcerns about a growing number of colorectal cancer survivors have emerged regarding cardiovascular disease (CVD) risks. However, there is not yet a predictive tool that can estimate CVD risk and support the management of healthcare as well as disease prevention in terms of CVD risk among long-term colorectal cancer survivors.AimTo develop predictive tools to estimate individualized overall and each subtype of CVD risk using a nationwide cohort in South Korea.Methods and ResultsA total of 4,709 newly diagnosed patients with colorectal cancer who survived at least 5 years in the National Health Insurance System were analyzed. Cox proportional hazard regression was used for the identification of independent risk factors for the derivation of predictive nomograms, which were validated in an independent cohort (n = 3,957). Age, fasting serum glucose, γ-glutamyl transpeptidase, Charlson comorbidity index, household income, body mass index, history of chemotherapy, cigarette smoking, and alcohol consumption were identified as independent risk factors for either overall CVD or each subtype of CVD subtype. Based on the identified independent risk factors, six independent nomograms for each CVD category were developed. Validation by an independent cohort demonstrated a good calibration with a median C-index of 0.687. According to the nomogram-derived median score, relative risks of 2.643, 1.821, 4.656, 2.629, 4.248, and 5.994 were found for overall CVD, ischemic heart disease, myocardial infarction, total stroke, ischemic stroke, and hemorrhage stroke in the validation cohort.ConclusionsThe predictive tools were developed with satisfactory accuracy. The derived nomograms may support the estimation of overall and individual CVD risk for long-term colorectal cancer survivors.

scholarly journals Cardiovascular Disease in Adolescents and Young Adults with Hematologic Malignancies

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 880-880
Author(s):  
Chun Chao ◽  
Lanfang Xu ◽  
Cooper Robert ◽  
Smita Bhatia ◽  
Saro Armenian
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Risk ◽  
Cancer Survivors ◽  
Cardiovascular Risk Factors ◽  
Cancer Diagnosis ◽  
Hematologic Malignancies ◽  
Cvd Risk ◽  
Increased Risk

Abstract Introduction: Advances in treatment strategies and supportive care have resulted in a growing number of survivors of adolescents and young adults (AYA: diagnosed 15-39y) with hematologic malignancies. In the general U.S. population, cardiovascular disease (CVD: heart failure, stroke, myocardial infarction) is a leading cause of morbidity and mortality, and cardiovascular risk factors (CVRFs: diabetes, hypertension and dyslipidemia) are well-established modifiers of CVD risk. While considerable effort has been made to characterize long-term CVD outcomes in survivors of childhood (<21y) cancer, there is a paucity of information on the magnitude and modifiers of CVD risk, as well as outcomes after onset of CVD in survivors of AYA cancers. AYAs diagnosed with hematologic malignancies may be at a higher risk of CVD when compared to the general population because of exposure to cardiotoxic therapies (anthracyclines, radiation), and the development of new CVRFs as they age. Methods: Using a retrospective cohort study design, 779 2+y survivors of non-Hodgkin lymphoma (NHL: N=274), Hodgkin lymphoma (HL: N=323), and acute leukemia (Leuk: N=182), diagnosed at age 15-39y between 1998 to 2009, and treated at Kaiser Permanent Southern California (KPSC) were included in the study. KPSC is the largest integrated managed care organization in Southern California, with documented 5-year insurance retention rates for AYA cancer survivors approaching 80% (J Adolesc Young Adult Oncol 2013 2:59). A non-cancer comparison group (N=8,062) was constructed by selecting individuals enrolled in KPSC and matched to cancer survivors (1:10) on age at diagnosis, sex, health plan membership and calendar year. Time-dependent Poisson regression was used to derive incidence rate ratio (IRR) estimates and 95% confidence intervals (CI) for CVD (ICD-9 definition: heart failure, stroke, or myocardial infarction), adjusted for relevant covariates. Kaplan-Meier curves were generated for cancer survivors, stratified by CVD status. Definition of CVRFs (hypertension, diabetes, dyslipidemia) was per an algorithm developed by KPSC's case management system, which uses a combination of ICD-9 codes, laboratory test results, and documentation of receipt of medications for these conditions (Am J Epidemiol. 2014 179:27). Results: Median age at cancer diagnosis was 29y (range: 15-39 years); 53.4% were male; 58.2% were non-Hispanic white; diagnoses: HL (41.5%), NHL (35.2%), Leuk (23.4%). In cancer survivors, median time from cancer diagnosis to end of follow-up was 5.4y (range: 2-14.9y), representing 4,961 person-years of follow-up. Comparison with non-cancer controls: Multivariable analysis adjusted for age, sex, race/ethnicity, CVRFs, smoking history and overweight/obesity, revealed a significantly increased risk of CVD across all cancer diagnoses (Overall: IRR=3.5, 95%CI, 2.0-6.1) and by certain cancer types (Leuk: IRR=4.5, 95%CI, 1.8-11.2; HL: IRR=3.0, 95%CI, 1.0-8.9; NHL: IRR=2.0, 95%, 0.7-5.6) when compared to non-cancer controls. Modifiers of CVD risk: Hypertension, diabetes, and dyslipidemia were independent modifiers of CVD risk. Hypertension was associated with a 5.1-fold (95%CI, 2.1-12.1) increased risk, diabetes was associated with a 4.4-fold (95%CI, 1.9-9.9) increased risk, and dyslipidemia was associated with a 2.8-fold (95%CI, 1.2-6.6) increased risk of CVD in AYA survivors when compared to survivors without these CVRFs. Outcomes by CVD status among cancer survivors: Overall survival was significantly worse (5y: 64%, 10y: 56%) among cancer survivors who developed CVD when compared to survivors without CVD (5y: 95%, 10y: 91%), p<0.01 (Figure). Conclusions: Survivors of AYA hematologic malignancies are at increased risk for developing cardiovascular disease when compared to a matched non-cancer controls. In these survivors, overall survival following onset of CVD is especially poor, and cardiovascular risk factors are independent modifiers of delayed cardiovascular disease risk. Taken together these data form the basis for identifying high-risk individuals for population-based targeted surveillance, as well as aggressive management of cardiovascular risk factors. Figure 1. Figure 1. Disclosures No relevant conflicts of interest to declare.

Difference in cardiovascular disease incidence by sociodemographic factors in adolescent and young adult (AYA) cancer survivors.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 6565-6565
Author(s):  
Theresa Keegan ◽  
Lawrence H. Kushi ◽  
Qian Li ◽  
Ann Brunson ◽  
Marcio H. Malogolowkin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Sociodemographic Factors ◽  
Cancer Type ◽  
Cvd Risk ◽  
Risk Of Death ◽  
Increased Risk ◽  
Race Ethnicity ◽  
The Impact

6565 Background: AYA cancer survivors are at increased risk of developing cardiovascular disease (CVD) compared to AYAs without a history of cancer. In AYA cancer survivors, few population-based studies have focused on CVD risk and none have considered whether the occurrence of CVD differs by sociodemographic factors. Methods: Analyses focused on 64,918 patients aged 15-39 y at diagnosis for one of 14 first primary cancers during 1996-2010 and surviving > 2 years after diagnosis, with follow-up through 2013. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. We estimated the cumulative incidence of developing CVD, accounting for death as a competing risk, stratified by race/ethnicity, neighborhood socioeconomic status (SES) at diagnosis, health insurance status at diagnosis/initial treatment and cancer type. We examined the impact of CVD on mortality using multivariable Cox proportional hazards regression with CVD as a time-dependent covariate. Results: Overall, 2374 (3.7%) patients developed CVD, and 7690 (11.9%) died over the follow-up period. Survivors of acute myeloid leukemia (12.6%), acute lymphoid leukemia (11.1%), central nervous system cancer (9.0%) and non-Hodgkin lymphoma (6.0%) had the highest incidence of CVD at 10-years. Incidence was significantly higher among Blacks (6.7%) at 10-years than non-Hispanic Whites (3.0%), Hispanics (3.7%) and Asian/Pacific Islanders (3.7%) (p < 0.001). AYA survivors with public or no insurance (vs private) had a higher 10-year incidence of CVD (5.8% vs 2.9%; p < 0.001), as did survivors residing in low (vs high) SES neighborhoods (4.1% vs 2.7%; p < 0.001). These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by five-fold or higher among AYAs who developed CVD. Conclusions: AYA cancer survivors who were uninsured or publicly insured, of Black race/ethnicity, or who resided in lower SES neighborhoods are at increased risk for developing CVD and experiencing higher mortality. The proactive management of CVD risk factors in these subgroups may improve patient outcomes.

Cardiovascular disease risk in survivors of 20 adult cancers.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11571-11571
Author(s):  
Helen Strongman ◽  
Sarah Gadd ◽  
Anthony Matthews ◽  
Kathryn Mansfield ◽  
Susannah Jane Stanway ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cancer Survivors ◽  
Cox Regression ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Cancer Site ◽  
Cvd Risk ◽  
Increased Risk ◽  
Wide Range

11571 Background: There are concerns about long-term cardiovascular disease (CVD) risk in cancer survivors, but few studies have quantified the risks for a wide range of cancers and specific CVD outcomes. Methods: Using UK electronic health records, we identified cohorts of adults alive one year after a cancer diagnosis at 20 different sites. Risks of a range of CVD outcomes were compared to age, sex and general practice matched cancer free controls using Cox regression; crude and adjusted models were compared to investigate the role of shared cancer/CVD risk factors (e.g. smoking and diabetes). Results: 126 120 cancer survivors and 603 144 controls were followed over a median (IQR) 4.6 (2.5-8.1) and 5.6 (3.2-9.2) years. Crude and adjusted hazard ratios (HRs) were similar. In adjusted models, there was strong evidence (p<0.01) of increased risk of CVDs among cancer survivors compared with controls: venous thromboembolism (VTE, 18 cancers), heart failure/cardiomyopathy (7 cancers), arrhythmia (4 cancers), and stroke (3 cancers). In stratified analyses HRs were higher in younger people and continued beyond 5 years post diagnosis. Conclusions: We found increased long term CVD risk among survivors of several cancers compared to the general population, which varied by cancer site and specific CVD outcome.[Table: see text]

Living with long‐term consequences: Experience of follow‐up care and support needs among Asian long‐term colorectal cancer survivors

2020 ◽  
Vol 29 (10) ◽  
pp. 1557-1563 ◽  
Author(s):  
Sungwon Yoon ◽  
Teck Beng Chua ◽  
Iain Beehuat Tan ◽  
David Matchar ◽  
Marcus Eng Hock Ong ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Cancer Survivors ◽  
Support Needs ◽  
Colorectal Cancer Survivors ◽  
Care And Support ◽  
Follow Up Care ◽  
Long Term Consequences

Endocrine and metabolic diseases among colorectal cancer survivors in a population-based cohort.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 10074-10074
Author(s):  
Makenzie Hawkins ◽  
Sean Patrick Soisson ◽  
Brenna Blackburn ◽  
Kerry G. Rowe ◽  
Vikrant Deshmukh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Risk Factor ◽  
Cancer Survivors ◽  
Late Effects ◽  
Metabolic Diseases ◽  
Colorectal Cancer Survivors ◽  
General Population Cohort ◽  
Time Periods

10074 Background: Colorectal cancer is the third most common cancer among men and women in the United States. As of 2016, there were an estimated 1.4 million colorectal cancer survivors. Research on endocrine and metabolic diseases over the long term in colorectal cancer survivors is limited. Obesity is a risk factor for colorectal cancer, thus it is of interest to investigate diseases that may share this risk factor such as diabetes for long term health effects among survivors. Methods: A total of 7,077 colorectal cancer patients who were diagnosed between 1997 to 2012 were identified in the Utah Population Database. A general population cohort of 35,354 individuals was matched on birth year, sex, birth state and follow-up time as a comparison group. Late effects were identified using electronic medical records and statewide ambulatory and inpatient data and were assessed over three time periods of 1-5 years, 5-10 years, and > 10 years. Cox proportional hazard models were used to estimate the risk of late effects after adjusting for matching factors, race, baseline body mass index, and the baseline Charlson Comorbidity Index. Results: Across all three time periods, late effects risk for endocrine diseases and metabolic disorders was significantly greater for colorectal cancer survivors compared to the general population cohort. Risk for diabetes mellitus with complications was significantly increased for survivors and risk was greatest for uncontrolled diabetes (HR = 5.04, 99%CI = 2.38, 10.67) and diabetes with neurological manifestations (HR = 4.10, 99%CI = 2.08, 8.26). Higher risk was also observed for thyroid disorders (HR = 3.09, 99%CI = 2.34, 4.08) and nutritional deficiencies (HR = 4.98, 99%CI = 3.47, 7.17). The risk of obesity in survivors was greatest 1-5 years post cancer diagnosis (HR = 5.04, 99%CI = 2.91, 8.75), but remained significantly increased at all follow-up time periods. Conclusions: Endocrine and metabolic diseases were significantly higher in colorectal cancer survivors across the follow-up periods. As the number of colorectal cancer survivors increases, understanding the long term multimorbidity trajectory is critical for improved survivorship care.

scholarly journals Disparities in Cardiovascular Disease Risk among Hispanic Breast Cancer Survivors in a Population-Based Cohort

2021 ◽  
Author(s):  
Qingqing Hu ◽  
Chun-Pin Chang ◽  
Kerry Rowe ◽  
John Snyder ◽  
Vikrant Deshmukh ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cardiovascular Disease ◽  
General Population ◽  
Cancer Survivors ◽  
Cancer Diagnosis ◽  
Breast Cancer Survivors ◽  
Disease Risk ◽  
Circulatory System ◽  
Cvd Risk ◽  
After Cancer

Abstract Background Breast cancer is the leading cause of cancer death among Hispanic women. The aim of our study was to estimate Cardiovascular disease (CVD) risk among Hispanic and non-Hispanic White (NHW) breast cancer survivors compared to their respective general population cohorts. Methods Cohorts of 17,469 breast cancer survivors (1,774 Hispanic and 15,695 NHW) in the Utah Cancer Registry diagnosed 1997–2016, and 65,866 women (6,209 Hispanic and 59,657 NHW) from the general population in the Utah Population Database were identified. Cox Proportional Hazards models were used to estimate hazard ratios (HRs) for CVD. Results The risk of diseases of the circulatory system was higher in Hispanic than NHW breast cancer survivors (HRHispanic =1.94, 99% confidence interval [CI] =1.49–2.53; H NHW =1.38, 99%CI = 1.33–1.43; P  heterogeneity=0.01) 1–5 years after cancer diagnosis, in comparison with their respective general population cohorts. Increased risks were observed for both Hispanic and NHW breast cancer survivors for diseases of the heart and the veins and lymphatics, compared to the general population cohorts. More than 5 years after cancer diagnosis, elevated risk of diseases of the veins and lymphatics persisted in both ethnicities. The CVD risk due to chemotherapy and hormone therapy was higher in Hispanic than NHW breast cancer survivors, but did not differ for distant stage, higher baseline comorbidities or baseline smoking. Conclusions We observed a risk difference for diseases of the circulatory system between Hispanic and NHW breast cancer survivors compared to their respective general population cohorts but only within the first 5 years of cancer diagnosis.

Sign in / Sign up

Export Citation Format

Share Document