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Elevated MI, stroke risk common with newly diagnosed cancer
Patients with newly diagnosed cancer have elevated risk for MI and stroke, particularly in the first 6 months after diagnosis, according to data published in the Journal of American College of Cardiology.
According to the researchers, cardiologists do not have a full understanding of MI and stroke risk in patients with cancer, and a deeper understanding of the epidemiological relationship is needed.
“About 40% of Americans will develop cancer in their lifetimes,” Babak B. Navi, MD, MS, from the department of neurology and Brain and Mind Research Institute at Weill Cornell Medicine in New York, and colleagues wrote. “Patients with cancer face an increased risk of medical complications, especially venous thromboembolism, and patients with cancer do not routinely receive therapies to prevent MI and stroke.”
Researchers used the Surveillance Epidemiology and End Results-Medicare linked database to identify patients newly diagnosed with breast, lung, prostate, colorectal, bladder, pancreatic, or gastric cancer or non-Hodgkin lymphoma.
A total of 279,719 patients with cancer were individually matched by demographics and comorbidities to a control Medicare-enrolled patient without cancer.
Researchers used competing risk survival statistics to measure cumulative incidence rates and Cox hazards to compare rates between groups at undisclosed points in time.
At 6 months, the researchers found that patients with cancer had a cumulative incidence of MI and stroke of 4.7% (95% CI, 4.6-4.8) compared with 2.2% (95% CI, 2.1-2.2) for those in the control group (HR = 2.2; 95% CI, 2.1-2.3).
It was also found that the 6-month cumulative incidence of MI was 2% (95% CI, 1.9-2) in patients with cancer compared with 0.7% (95% CI, 0.6-0.7) in those without cancer (HR = 2.9; 95% CI, 2.8-3.1).
There was a cumulative risk for ischemic stroke of 3% (95% CI, 2.9-3.1) and 1.6% (95% CI, 1.6-1.7) among patients with cancer and those in the control group, respectively (HR = 1.9; 95% CI, 1.8-2).
Depending on cancer type and stage, there were variations in data for excess risk, which were typically resolved at 1 year.
According to Navi and colleagues, the study results raise the question of whether patients with newly diagnosed malignant cancer should be considered for antithrombotic and statin therapies for primary prevention of CVD. Since patients with cancer are also susceptible to bleeding, “carefully designed clinical trials are needed to answer these questions,” they wrote.
“Our results suggest that malignant cancer may be an underappreciated, yet common factor for arterial thromboembolism,” the researchers wrote. “Future research should aim to investigate the mechanistic basis for these findings, the utility of including cancer in CV risk prediction instruments and optimal strategies to prevent arterial thromboembolism in patients with cancer.”
In a related editorial, Edward T.H. Yeh, MD, and Hui-Ming Chang, MD, MPH, from the Center for Precision Medicine in the department of medicine at the University of Missouri, wrote: “This paper should not be viewed as merely a big data confirmation of Trousseau’s syndrome. It is a call to action for cardiologists to work closely with oncologists to prevent the occurrence of MI or ischemic stroke in cancer patients; and, for interventional cardiologists to take an active role in managing cancer patients with acute MI.” – by Dave Quaile
Disclosures: Navi reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. Yeh reports receiving grant support from the NIH.