Acute Myocardial Infarction in Head and Neck Cancer Patients and Survivors: A Population-Based Cohort Study of Patient, Disease, and Treatment Factors

AIMS Head and neck cancer (HNC) is increasingly recognized as a systemic disease with long-term vascular and metabolic complications. While cerebrovascular risks have been described, the association between HNC and acute myocardial infarction (AMI) remains less well characterized, particularly regarding patient-, disease-, and treatment-related factors. Hence, we sought to evaluate the risk of AMI among patients with HNC compared with the general population and to identify demographic, tumor, and treatment characteristics associated with increased risk. MATERIALS AND METHODS This population-based retrospective cohort study used data from the Singapore Cancer Registry and the Singapore Myocardial Infarction Registry. Individuals diagnosed with HNC between January 1, 2007, and December 31, 2021, without prior AMI were included. The primary outcome was incident AMI after HNC diagnosis. Risk was quantified using age-standardized incidence rate ratios (SIRRs) and rate differences (SIRDs) compared with the general population. Extensive subgroup analyses were conducted, defined by age, sex, ethnicity, tumor subsite, histology, and treatment modality (surgery, radiotherapy, chemotherapy, or combinations). RESULTS Among 9358 patients with HNC (median age, 59 years; 72% male), 403 (4.3%) developed AMI during a median follow-up of 3.7 years. The 10-year cumulative incidence was 5.4%. AMI risk was higher than in the general population (SIRR, 2.35 [95% computed tomography {CI}, 2.13-2.59]; SIRD, 5.06 per 1000 person-years [PY]), most pronounced within 5 years (SIRR, 5.07). Risk was highest with chemotherapy alone and hypopharyngeal cancer. CONCLUSION Patients with HNC have an approximately twofold increased AMI risk, particularly early after diagnosis, supporting cardiovascular risk stratification and cardio-oncology surveillance.