Research shows ‘substantial’ cardiovascular risk among patients with head and neck cancer
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Key takeaways:
- Individuals with newly diagnosed HNSCC showed evidence of suboptimally controlled cardiovascular risk factors.
- Black race appeared associated with increased risk for uncontrolled cardiovascular risk factors.
Individuals with newly diagnosed head and neck squamous cell carcinoma are at high risk for adverse cardiovascular events, results of a retrospective study of U.S. veterans showed.
Findings from the analysis, published in JAMA Otolaryngology – Head & Neck Surgery, indicate suboptimal control of multiple cardiovascular risk factors among these patients, leading to increased risk for incident stroke, myocardial infarction (MI) and all-cause mortality.
“We hope that these findings bring awareness to the fact that patients with head and neck cancers have a substantial burden of modifiable cardiovascular risk factors and encourage providers, including oncologists and primary care physicians, to screen for and manage these risk factors to mitigate risk for cardiovascular events,” Lova Sun, MD, MSCE, assistant professor of hematology-oncology at Perelman School of Medicine at University of Pennsylvania, told Healio. “Overall, these findings highlight the cardiovascular risk in patients with HNSCC and underscore the critical need for targeted interventions to improve stratification and mitigation of cardiac risk in the growing population of HNSCC survivors.”
Background
The researchers hypothesized that patients with head and neck cancer may experience increased risk for cardiovascular events due to a number of shared risk factors and the use of cardiotoxic therapies to treat the disease.
“Cardiovascular disease is a significant cause of morbidity and mortality in patients with cancer, but our understanding of cardiovascular risk and events in patients with HNSCC is limited,” Sun said. “Thus, we conducted a nationwide analysis of baseline and longitudinal cardiovascular risk in over 35,000 U.S. veterans.”
Methodology
Sun and colleagues conducted a population-based cohort study of 35,897 U.S. veterans (median age, 63 years; 98.9% men; 82% white; 16.6% Black) with newly diagnosed HNSCC to determine their cardiovascular risk profile. The analysis used data from electronic health records from individuals diagnosed with HNSCC within the Veterans Health Administration between 2000 and 2020.
The prevalence of cardiovascular risk factors, medication use, risk factor disease control at diagnosis, cumulative incidence of stroke and myocardial infarction, and all-cause death served as the primary outcome measurements for the analysis.
Key findings
The investigators noted “substantial rates” of prevalent hypertension (67%), diabetes (22.3%) and hyperlipidemia (51.4%) among the study cohort.
Most patients received medications for hypertension, hyperlipidemia or diabetes. However, researchers found that 47% of individuals in the study cohort had at least one uncontrolled cardiovascular risk factor.
For example, despite taking medications, 31.8% of the study cohort had uncontrolled blood pressure, 19.9% had uncontrolled lipids and 15.3% had uncontrolled glucose levels.
A multivariate regression analysis revealed an association between Black race and increased risk for having an uncontrolled cardiovascular risk factor (RR = 1.06; 95% CI, 1.03-1.09).
Researchers reported a 10-year cumulative incidence of stroke of 12.5% and MI of 8.3% among the study cohort when considering death as the competing risk.
Additional cause-specific hazards models demonstrated significant associations between stroke/MI and the presence of uncontrolled cardiovascular risk factors.
Multivariate-adjusted Cox regression models for OS showed incident stroke associated with a 47% (95% CI, 41-54) increase in risk for death, whereas incident myocardial infarction demonstrated a 71% (95% CI, 63-81) increase in risk for death in a similar analysis.
Clinical implications
Beyond highlighting the additional “substantial risk” of cardiovascular events among patients with HNSCC, the results emphasize that proactive efforts from clinicians across multiple disciplines are needed to improve the effectiveness of targeted interventions, according to Sun.
“Often, risk factors for head/neck cancer and risk factors for cardiovascular disease overlap,” she told Healio. “Oncologists can play a key role in mitigating these risk factors by encouraging smoking cessation, monitoring and managing blood pressure, and referring to cardiologists and cardio-oncologists in high-risk cases to improve survivorship through multidisciplinary care.”
For more information:
Lova Sun, MD, MSCE, can be reached at Hematology and Oncology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104; email: lova.sun@pennmedicine.upenn.edu.
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