Rate control medications increased cancer risk in AF patients (HR 1.20; 95% CI 1.06-1.35), while immunotherapy (HR 1.54) and chemotherapy (HR 1.20) increased AF risk in cancer patients.
Cohort (n=57,318)
Do specific AF and cancer treatments affect the bidirectional risk of incident cancer and incident AF?
Specific treatments for AF (rate control) and cancer (immunotherapy, chemotherapy) are associated with increased bidirectional risks of cancer and AF, respectively, with notable sex-specific differences.
Hazard Ratio: 1.2 (95% CI 1.06–1.35)
p-value: p=0.003
Abstract Background Atrial fibrillation (AF) and cancer share common pathophysiological pathways, with each condition potentially affecting the occurrence, diagnosis, and outcomes of the other. While bidirectional associations are established, the impact of specific treatments on disease risk remains unclear. Understanding treatment-specific risks could inform clinical decision-making in both cardiology and oncology practice. Purpose To examine the bidirectional association between AF treatments and incident cancer risk, and between cancer treatments and incident AF risk, using comprehensive electronic health record data among women and men. Methods We conducted a retrospective cohort study using electronic health records from 2010-2023. Direction 1 included 18,317 patients with incident AF (mean age 65.9±12.4 years, 55.7% male) without prevalent cancer, followed for incident cancer (median 4.5 years). Direction 2 included 39,001 patients with incident cancer (mean age 60.7±12.8 years, 40.7% male) without prevalent AF, followed for incident AF (median 5.8 years). We used Cox proportional hazards regression with progressive adjustment for age, comorbidities, and concurrent treatments. Analyses were stratified by treatment and sex, while testingfor interaction. All-cause death was considered as a competing risk. Results Among AF patients, 2,131 patients (11.6%) developed cancer during follow-up. After full adjustment, rate control medications showed an association with cancer risk (HR 1.20, 95% CI 1.06-1.35, p=0.003), with consistent effects in males (HR 1.23, 1.05-1.43) and females (HR 1.17, 0.97-1.42; p-interaction=0.784). Anticoagulants showed a sex-specific association, significant only in females (HR 1.23, 1.03-1.45, p=0.019; p-interaction=0.062). Other AF treatments showed no independent associations after adjustment for concurrent therapies. Among cancer patients followed for AF development, 3,309 patients (8.5%) developed AF during follow-up. After full adjustment, palliative care showed the strongest association with AF risk (HR 1.99, 95% CI 1.83-2.16, p0.001), likely reflecting disease severity. Immunotherapy demonstrated 54% increased AF risk (HR 1.54, 1.24-1.92, p0.001) with significant sex interaction (p=0.002), showing substantially stronger effects in females (HR 2.21, 1.63-3.00) than males (HR 1.11, 0.82-1.51). Chemotherapy independently increased AF risk (HR 1.20, 1.09-1.31, p0.001) with similar effects in both sexes. Conclusions This study demonstrates bidirectional treatment-specific associations with important sex-specific differences. Rate control medications increase cancer risk in AF patients, while chemotherapy and immunotherapy increase AF risk. These findings may inform treatment selection and surveillance strategies in cardio-oncology practice.
Kousovista et al. (Mon,) conducted a cohort in Atrial fibrillation and cancer (n=57,318). AF treatments (rate control, anticoagulants) and cancer treatments (immunotherapy, chemotherapy) vs. Unexposed or concurrent treatments was evaluated on Incident cancer in patients with atrial fibrillation (HR 1.20, 95% CI 1.06-1.35, p=0.003). Rate control medications increased cancer risk in AF patients (HR 1.20; 95% CI 1.06-1.35), while immunotherapy (HR 1.54) and chemotherapy (HR 1.20) increased AF risk in cancer patients.
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