Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2016; 8(6): 368-374
Published online Jun 26, 2016. doi: 10.4330/wjc.v8.i6.368
Incidence and trends of cardiovascular mortality after common cancers in young adults: Analysis of surveillance, epidemiology and end-results program
Sadeer G Al-Kindi, Guilherme H Oliveira
Sadeer G Al-Kindi, Guilherme H Oliveira, Onco-Cardiology Center, University Hospitals Seidman Cancer Center and Harrington Heart and Vascular Institute, Cleveland, OH 44106, United States
Author contributions: Al-Kindi SG conceived the study, obtained the data, performed the statistical analysis, and drafted the manuscript; Oliveira GH conceived the study and revised the manuscript.
Institutional review board statement: This study included only deidentified data and was exempt from institutional review board approval at University Hospitals Case Medical Center.
Informed consent statement: This study used deidentified data and did not require informed consent.
Conflict-of-interest statement: Both authors have no conflict of interest pertinent to this study.
Data sharing statement: Data used for this analysis are available from SEER program (seer.cancer.gov).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guilherme H Oliveira, MD, FACC, Chief (Section of Heart Failure), Director (Onco-Cardiology Center), Director (Advanced Heart Failure and Transplantation Center, Harrington Heart and Vascular Institute and Seidman Cancer Center), Onco-Cardiology Center, University Hospitals Seidman Cancer Center and Harrington Heart and Vascular Institute, 11000 Euclid Avenue, Cleveland, OH 44106, United States. guilherme.oliveira@uhhospitals.org
Telephone: +1-216-8448242 Fax: +1-216-8448954
Received: February 27, 2016
Peer-review started: February 29, 2016
First decision: March 22, 2016
Revised: April 5, 2016
Accepted: April 21, 2016
Article in press: April 22, 2016
Published online: June 26, 2016
Processing time: 115 Days and 1.2 Hours
Abstract

AIM: To describe the incidence of cardiovascular mortality (CVM) in survivors of major cancers and identify its trends over the past two decades.

METHODS: We used the surveillance, epidemiology and end-results 19 registry to identify young adults (20-49 years), diagnosed with the following major primary cancers: Lung, breast, liver/intrahepatic bile duct, pancreas, prostate, colorectal, and ovarian from 1990 through 2012 and identified the cumulative incidence of CVM after adjusting for confounding factors.

RESULTS: We identified a total of 301923 cancers (breast 173748, lung 38938, colorectal 31722, prostate 22848, ovary 16065, liver 9444, pancreas 9158). A total of 2297 (0.8%) of patients had incident CVM. Lung (10-year cumulative CVM 2.4%) and liver (1.73%) cancers had the highest incidence of CVM, while breast (0.6%) and prostate (1.2%) had the lowest CVM mortality, even after multiple adjustments (P < 0.001). Overall, there was a significant improvement in CVM since 1990 [2005-2012 vs 1990-1994, adjusted HR 0.63 (0.54-0.72), P < 0.001]. This was driven by improvements in CVM in lung cancers (P = 0.02), breast (P < 0.001), and a trend in ovarian cancer (P = 0.097). There was no statistically significant improvement in CVM among survivors of colorectal, pancreatic, liver, or prostate cancers.

CONCLUSION: The risk of CVM differs among different cancers, and is highest among survivors of lung and liver cancers. The incidence of CVM has decreased over the past 2 decades mainly among survivors of lung and breast cancers.

Keywords: Cardiovascular disease; Cancer; Trends; Cardiovascular mortality; Type of cancer

Core tip: Cancers and cardiovascular diseases share many risk factors. Premature cardiovascular mortality (CVM) has been described in cancer survivors. However, the trends of CVM in cancer survivors are largely unknown. Using a large national cancer registry in the United States, we show that CVM has decreased in survivors of breast and lung cancers, but not other cancers. Surprisingly, more than half of all cardiovascular deaths occur before age of 50 years. It is likely that interventions targeted at decreasing CVM in cancer survivors will decrease the overall mortality in those patients.