BACKGROUND AND AIMS
Advances in cancer care have improved survival, increasing the importance of comorbidities at diagnosis for longer-term outcomes. Pre-existing cardiovascular disease (CVD) can complicate management and prognosis, yet its long-term trends and future burden at cancer diagnosis are unclear. This study aimed to quantify temporal trends in pre-existing CVD among patients with newly diagnosed cancer and project prevalence through 2050.
METHODS
Linked primary care, cancer registry, and hospitalization records were used to identify 773 590 adults (≥18 years) diagnosed with the five most common cancers between 2001 and 2020 in England. Serial cross-sectional analyses estimated annual crude and age-standardized prevalence of pre-existing CVD and comorbidities. Temporal trends were assessed using logistic regression adjusted for demographics and cancer type. The contributions of changes in risk factor domains were evaluated using sequential modelling, and CVD prevalence was projected to 2050 using demographic-adjusted spline models.
RESULTS
The age-standardized prevalence of pre-existing CVD rose from 31.4% [95% confidence interval (CI) 31.2-31.6] in 2001-2005 to 39.2% (95% CI 39.0-39.4) in 2016-2020, with the steepest increases in lung and haematological cancers. Valvular disease, heart failure, atrial fibrillation, and diabetes showed the largest subtype rises. Sequential modelling showed the greatest attenuation of the temporal trend after adjustment for cardiometabolic conditions and chronic comorbidities. Projection analyses suggest that, if current temporal patterns continue, approximately half of patients may present with pre-existing CVD at cancer diagnosis by 2050.
CONCLUSIONS
Pre-existing CVD at cancer diagnosis has increased substantially over 2 decades and is projected to affect nearly half of patients by 2050. These trends underscore the need for the expansion of cardio-oncology services.
A. Alshahrani, E. Kontopantelis, C. Morgan et al.· European Heart Journal· 0 citations
BACKGROUND AND AIMS
The incidence of cancer in people with cardiovascular disease (CVD) is poorly understood. This study aimed to understand the sex differences in incident cancer and cancer-related mortality in people with and without CVD.
METHODS
Participants were drawn from the European Prospective Investigation into Cancer (EPIC)-Norfolk study and followed up for a median of 26.2 years. Participants were stratified by sex and incident CVD during follow-up. Cumulative cancer incidence was calculated for each group. Sex-specific lifetime risks of cancer were determined, accounting for competing risks of death. Cause-specific hazard ratios (HRs) were determined using Royston-Parmar models, adjusted for ethnicity and time-updated covariates, including deprivation index, cardiovascular risk factors, comorbidities, and medication. Participants' CVD status was updated throughout follow-up.
RESULTS
A total of 22 534 participants were cancer-free at baseline (57% women; mean age 58.6 ± 9.3 and 59.5 ± 9.3 for women and men, respectively); 10 889 participants either had prevalent CVD at baseline or developed CVD during follow-up. Men had more comorbidities. The adjusted lifetime risk of incident cancer in CVD participants at age 75 was higher in men (17.3%) than in women (12.8%), with a significant cause-specific HR of 1.39 (99% confidence interval [CI] 1.25-1.53, P < .0001). Corresponding data for participants with no CVD were 10.2% for men and 8.2% for women, with an HR of 1.27 (99% CI 1.15-1.41, P < .0001 for men vs women). A similar trend exists for cancer-related mortality (HR 1.51, 99% CI 1.31-1.75, P < .0001 for men with CVD and HR 1.31, 99% CI 1.14-1.50, P < .0001 for men without CVD).
CONCLUSIONS
This study showed an increased lifetime cancer risk and mortality in men compared with women, which was mediated by comorbid CVD.
R. Thuemmler, T. Pana, M. Mamas et al.· European Heart Journal· 0 citations
The burden of pre-existing CVD at cancer diagnosis has increased substantially over the past two decades in the UK and is projected to rise further, highlighting the growing need for integrated prevention strategies and cardio-oncology services to address increasing multimorbidity in patients with cancer.
A. Alshahrani, E. Kontopantelis, C. Morgan et al.· European Heart Journal, Supp...· 0 citations
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