Cardiac events among a cohort of 17,389 patients receiving cancer chemotherapy: short and long term implications

The association between cardiovascular disease and carcinogenesis is bidirectional and well-established. Furthermore, cancer treatment improves overall patient survival, potentially at the cost of incremental and fatal cardiovascular disease (CVD). To evaluate (a) In a real-world cohort, the proportion of patients offered cancer chemotherapy who have antecedent CVD (CVD A ); (b) The rates of patient admission with subsequent development of CVD (CVD S ) requiring hospital admission post assignment to chemotherapy; (c) The impact of CVD A and CVD S on mortality rates relative to those seen in patients without overt CVD (CVD − ) and (d) The time course of mortality in CVD − versus CVD S patients. Retrospective analysis was performed in deidentified linked health data sets. Correlates of mortality were evaluated by Cox proportional hazards evaluation. Relative and absolute time-variability of CVD as a primary cause of death were determined. Of the total 17,389 patients, there were 2,159 with CVD A . Over a median follow-up time of 4.6 years, CVD S admissions ( n = 8,529) occurred more commonly in the presence of CVD A (70.0% vs. 46.1%, p < 0.001), and more than 50% of CVD S cases occurred in the first 12 months of follow-up. The 5-year mortality rates were 71.5% for CVD A , 64.7% for CVD S , and 40.8% for CVD − ( p < 0.001). Development of CVD S was associated with a substantially increased risk of mortality in the next 12 months. The development of CVDs was also associated with an increased risk of cardiovascular, as against non-cardiovascular, mortality (7.1% vs. 1.6%, p < 0.001). Approximately 50% of patients assigned to cancer chemotherapy developed CVD S , heralding a particularly high risk of mortality over the next 12 months. Both CVD A and CVD S are associated with substantial increases in mortality rates relative to those in CVD − patients. This increased risk merits close individual monitoring.