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Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999–2018

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Abstract

There is a dearth of evidence pertaining to the relationship of cardiovascular disease (CVD) and its subtype with adjudicated cancer, thereby limiting our understanding of the heightened risk of CVD resulting from long-term complications of cancer and its therapies. The aim of this study was to quantify the risks of CVD and its subtypes in adult cancer survivors compared with cancer-free controls in a nationwide cross-sectional study on Continuous National Health and Nutrition Examination Survey (NHANES). We included 44,442 participants ranging in age from 20 to 85 years. Cancer and CVD diagnoses were ascertained via the household questionnaires. The association of cancer status with the risk of CVD and CVD subtype was examined using weighted logistic regression. Stratification analyses were also performed by age, sex, race, marital status, income status, educational level, and hyperlipidemia. The Wald test was used to calculate P-value for interaction. A total of 4178 participants have cancer, while 4829 participants had CVD, respectively. In the multivariable-adjusted model, the cancer was consistently linked to an elevated risk of CVD. Stratification analyses showed that stronger association between cancer status and CVD risk was found in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. Our study confirmed that cancer participants were strongly linked to living with CVD, independent of traditional cardiovascular risk factors, especially in younger adults, non-white, and participants living without a spouse or partner, and without hyperlipidemia. There exists a pressing requirement to establish effective strategies for the prevention of CVD within this population characterized by a heightened risk.

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Data Availability

No additional data are available. NHANES and the NDI linkage data are publicly available at https://www.cdc.gov/nchs/nhanes/index.htm and https://www.cdc.gov/nchs/data-linkage/mortality-public.htm. We intend to provide relevant code on written reasonable request. Dissemination to study participants and/or patient organizations is not possible/applicable given the nature of public use and deidentified NHANES and NDI data.

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Acknowledgements

We acknowledge the United States CDC/NCHS for providing the NHANES 1999-2018 data. Ruihuan Shen gratefully acknowledge spiritual support from the Lama Temple.

Funding

This work was supported by Beijing Municipal Science & Technology Commission Program (No. Z171100001017203 and No. D181100000218005).

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Authors and Affiliations

  1. Department of Cardiology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

    Ruihuan Shen & Tong Zou

  2. Graduate School of Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People’s Republic of China

    Ruihuan Shen & Tong Zou

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Contributions

Dr Shen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: R. Shen. Acquisition, analysis, or interpretation of data: All authors. Drafting of the manuscript: R. Shen. Critical revision of the manuscript for important intellectual content: R. Shen. Statistical analysis: R. Shen. Obtained funding: T. Zou. Administrative, technical, or material support: T. Zou. Supervision: T. Zou. All the listed authors have read and approved the manuscript.

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Correspondence to Tong Zou.

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The authors have no competing interests to declare.

Ethical Approval

The following protocol approval numbers were provided by the NCHS Research Ethics Review Board (ERB) for the presented surveys years: Protocol #98-12 (NHANES 1999–2004), Protocol #2005-06 (NHANES 2005–2006), Continuation of Protocol #2005-06 (NHANES 2007-2010), Protocol #2011-17 (NHANES 2011–2012), Continuation of Protocol #2011-17 (NHANES 2013-2016), Continuation of Protocol #2011-17 & Protocol #2018-01 (NHANES 2017–2018). More information about the NHANES database can be found at https://www.cdc.gov/nchs/nhanes/irba98.htm. And all participants provided informed written consent. This study is based on publicly available anonymized NHANES data, so it does not require further ethical review from the Ethics Committee of Beijing Hospital.

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Shen, R., Zou, T. Association Between Cancer and Cardiovascular Toxicity: A Nationwide Cross-Sectional Study on NHANES 1999–2018. Cardiovasc Toxicol 24, 351–364 (2024). https://doi.org/10.1007/s12012-024-09845-6

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