COVID-19: Is there a weaker sex? Gómez-Ochoa, Sergio Alejandro; Van Poll, Nina; Franco, Oscar H.
Case reports in women's health,
10/2020, Letnik:
28
Journal Article
We examined the incidence of cardiovascular disease (CVD) among 32 757 cancer survivors and age‐, gender‐, and geographically matched cancer‐free controls during a follow‐up period of 1‐13 years, and ...explored whetherCVD incidence differed by received cancer treatment, traditional cardiovascular risk factors, age, or gender. Adult 1‐year cancer survivors without a history ofCVD diagnosed with breast (n = 6762), prostate (n = 4504), non‐Hodgkin (n = 1553), Hodgkin (n = 173), lung and trachea (n = 2661), basal cell carcinoma (BCC; n = 12 476), and colorectal (n = 4628) cancer during 1999‐2011 were selected from the Netherlands Cancer Registry and matched to cancer‐free controls without a history ofCVD. Drug dispenses and hospitalizations from thePHARMO Database Network were used as proxy forCVD. Data were analyzed using Cox regression analyses. Prostate (HR: 1.17; 95%CI: 1.01‐1.35) and lung and trachea (HR: 1.48; 95%CI: 1.10‐1.97) cancer survivors had an increased risk for developingCVD compared to cancer‐free controls. This increased risk among lung and trachea cancer survivors remained statistically significant after including traditional cardiovascular risk factors and cancer treatment information (HR: 1.41; 95%CI: 1.06‐1.89). Among prostate cancer survivors, the increased risk of incidentCVD was limited to those who received hormones and those without traditional cardiovascular risk factors. Breast, non‐Hodgkin,BCC, and colorectal cancer survivors showed no increasedCVD risk compared to cancer‐free controls. There was an increased risk of incidentCVD among prostate, and lung and trachea cancer survivors compared to age‐, gender‐ and geographically matched cancer‐free controls. Studies including longer follow‐up periods are warranted to examine whether cancer survivors are at increased risk of long‐term incidentCVD.
This large population‐based matched cohort study among 32 757 cancer survivors and age‐, gender, and geographically matched cancer‐free controls (1:1) during a follow‐up period of 1‐13 years showed an increased risk of incident CVD among prostate and lung and trachea cancer. For prostate cancer survivors, the increased risk of incident CVD was limited to those who received hormones and those without traditional cardiovascular risk factors. Breast, non‐Hodgkin, skin, and colorectal cancer survivors showed no increased CVD risk.
Purpose
To examine the associations between pharmaceutically treated anxiety and depression present in the year prior to breast cancer diagnosis and the risk of incident cardiovascular disease (CVD), ...while controlling for traditional cardiovascular risk factors and clinical characteristics in a population-based observational study.
Methods
Adult 1-year breast cancer survivors (
n
= 7227), diagnosed between 01-01-1999 and 12-31-2010, with no history of CVD, were selected from the Netherlands Cancer Registry. Drug dispensing data were derived from the PHARMO Database Network and used as proxy for CVD, anxiety, and depression. By multivariable Cox regression analysis, we examined the risk associated with pharmaceutically treated anxiety and depression for developing CVD after cancer diagnosis, adjusting for age, pharmaceutically treated hypertension, hypercholesterolemia, and diabetes mellitus in the year prior to cancer diagnosis, tumor stage, and cancer treatment.
Results
During the 13-year follow-up period, 193 (3%) breast cancer survivors developed CVD. Women pharmaceutically treated for anxiety in the year prior to their cancer diagnosis had a 48% increased hazard for CVD HR = 1.48; 95% CI 1.05–1.08 after full adjustment. This association was restricted to breast cancer survivors who were 65 years or younger. Depression was not associated with CVD risk HR = 0.89; 95% CI 0.52–1.53. Older age HR = 1.06; 95% CI 1.05–1.08, hypertension HR = 1.80; 95% CI 1.32–2.46, and hypercholesterolemia HR = 1.63; 95% CI 1.15–2.33 were associated with an increased hazard for incident CVD, whereas hormone therapy HR = 0.59; 95% CI 0.42–0.83 was protective.
Conclusions
Anxiety present in the year prior to breast cancer diagnosis increases the risk of incident CVD in 1-year breast cancer survivors, after adjustment for depression, traditional cardiovascular risk factors, and clinical characteristics.
Due to aging of the population and cardiotoxic cancer treatment, there is an increasing group of patients with cancer and co-morbid cardiovascular disease (CVD). In order to find a balance between ...the risk of undertreating the malignancy on the one hand and inducing CVD on the other hand, CVD risk stratification at the time of cancer diagnosis and knowledge on the pathway for developing incident CVD in cancer patients is vital. In this paper, we propose an adapted multiple-hit hypothesis for developing CVD in cancer patients describing that patients with cancer are exposed to a series of sequential or concurrent events that together make them more vulnerable to reduced cardiovascular reserves, development of incident CVD and ultimately death. We highlight the possible impact of psychological distress secondary to a cancer diagnosis and/or treatment, which in turn may increase the risk of incident CVD in patients diagnosed with cancer. Furthermore, we discuss potential behavioral and pathophysiological mechanisms underlying the link between psychological distress and the pathophysiology of incident CVD. In addition, key unanswered questions for future research are posed. In the future, researching the adapted multiple-hit hypothesis for developing CVD among cancer patients will hopefully advance the care of cancer patients by finding some of the missing pieces of the puzzle. To do so, we need to focus on minimizing cardiovascular risk and promoting cardiovascular health in cancer patients by addressing the knowledge gaps formulated in this paper.
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