Older cancer survivors at elevated risk for cardiovascular disease
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Key takeaways:
- Cancer survivors 65 or older exhibited higher risk for cardiovascular disease than cancer-free individuals of the same age.
- The risk appeared higher among those with lung cancer or hematologic malignancies.
Older cancer survivors exhibited increased risk for cardiovascular disease than cancer-free individuals of the same age, according to a secondary analysis of a randomized study.
The elevated risk appeared greatest among people who had metastatic disease, hematologic malignancies or lung cancers, as well as those who had received cytotoxic chemotherapy, results showed.
“Cancer-related cardiovascular disease is a significant risk faced by cancer survivors,” Suzanne G. Orchard, PhD, senior research fellow in chronic disease and aging at Monash University in Australia, told Healio. “[It] can be managed, and even prevented, through measures such as risk factor control — stopping smoking, weight management, etc — treatment modifications, pre- and post-treatment cardiac screening and exercise interventions. Clinicians should consider these measures for all cancer survivors, not just those receiving cardiotoxic anticancer treatments.”
Background and methods
The number of cancer survivors in the U.S. — which stood at 18 million as of Jan. 1, 2022 — could increase to 26 million by 2040, according to an American Association for Cancer Research report
Cardiovascular disease risk rises with age, and several studies have shown various cancers and their treatments can further increase risk, according to study background.
Orchard and colleagues used the Aspirin in Reducing Events in the Elderly (ASPREE) trial to investigate the effects of cancer and its treatments on risk for cardiovascular disease among older individuals.
The ASPREE trial — a double-blind, placebo-controlled study conducted from March 2010 through June 12, 2017— examined whether low-dose aspirin extended disability-free survival for individuals aged at least 65 years from Australia and the U.S.
Orchard and colleagues conducted a secondary analysis that included 15,454 participants without cancer (median age, 74 years; interquartile range, 72-78; 58% women; 85% white Australian) and 1,392 individuals diagnosed with cancer during the trial (median age, 74 years; interquartile range, 72-78; 55% men; 88% white Australian).
Incidence of cardiovascular disease — including myocardial infarction, hospitalization for heart failure and stroke — served as the primary endpoint.
Results and next steps
Individuals who developed cancer during the trial exhibited significantly higher risk for cardiovascular disease than those who remained cancer free (20.8 vs. 10.3 events per 1,000-person years; incidence rate ratio = 2.03; 95% CI, 1.51-2.66).
Cancer survivors had higher incidence of myocardial infarction, hospitalization for heart failure, overall stroke and ischemic stroke.
Results showed particularly strong associations between cardiovascular disease and metastatic cancer (incidence rate ratio = 5.21; 95% CI, 2.78-8.79), lung cancer (incidence rate ratio = 5.09; 95% CI, 2.02-10.4) and hematologic cancers (incidence rate ratio = 3.39; 95% CI, 1.69-5.98). Researchers observed no association between cardiovascular disease and any other cancer type.
Individuals who received cytotoxic chemotherapy also had increased risk for cardiovascular disease (HR = 2.19; 95% CI, 1.21-3.98). Results showed no significant association between cardiovascular disease and any other form of systemic therapy.
Conversely, those who underwent surgery exhibited lower risk for cardiovascular disease (HR = 0.44; 95% CI, 0.24-0.82), myocardial infarction (HR = 0.38; 95% CI, 0.15-0.97) or hospitalization for heart failure (HR = 0.26; 95% CI, 0.08-0.84).
“None of the major treatment modalities conclusively demonstrated increased risk of composite cardiovascular disease, although this may reflect small sample sizes in each treatment subgroup," researchers wrote. "Although those who had surgery demonstrated decreased overall cardiovascular risk and risk of myocardial infarction and heart failure, this more likely reflects that participants who receive surgery are more likely to have an early‐stage cancer ... and, therefore, not only have less risk from the cancer itself, but are also less likely to receive other, more cardiotoxic treatments."
Aspirin use had no impact on cardiovascular disease risk.
Researchers acknowledged study limitations, including lack of ethnic diversity in the cohort and shorter follow-up for individuals diagnosed with cancer, which prevented the ability to assess for potential late cardiac toxicities of cancer treatment.
“Our analysis of different cancer types was limited by sample size, so more research should be conducted to explore whether the risk for cardiovascular disease is the same for all types of cancer,” Orchard said. “Additionally, further work should be done to explore whether the risk changes depending on the type of chemotherapy drug administered, and whether dose and duration also play a role.”
For more information:
Suzanne G. Orchard, PhD, can be reached at suzanne.orchard@monash.edu.
References:
- Do cancer and cancer-related treatments increase cardiovascular disease risk in older adults? (press release). Available at: https://newsroom.wiley.com/press-releases/press-release-details/2024/Do-cancer-and-cancer-related-treatments-increase-cardiovascular-disease-risk-in-older-cancer-survivors/default.aspx. Published Sept. 23, 2024. Accessed Sept. 23, 2024.
- Muhandiramge J, et al. Cancer. 2024;doi:10.1002/cncr.35503.
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