Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study
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Few population-based studies have focused on cardiovascular disease (CVD) risk in adolescent and young adult (AYA; 15–39 years) cancer survivors and none have considered whether CVD risk differs by sociodemographic factors.
Analyses focused on 79,176 AYA patients diagnosed with 14 first primary cancers in 1996–2012 and surviving > 2 years after diagnosis with follow-up through 2014. Data were obtained from the California Cancer Registry and State hospital discharge data. CVD included coronary artery disease, heart failure, and stroke. The cumulative incidence of developing CVD accounted for the competing risk of death. Multivariable Cox proportional hazards regression evaluated factors associated with CVD and the impact of CVD on mortality.
Overall, 2249 (2.8%) patients developed CVD. Survivors of central nervous system cancer (7.3%), acute lymphoid leukemia (6.9%), acute myeloid leukemia (6.8%), and non-Hodgkin lymphoma (4.1%) had the highest 10-year CVD incidence. In multivariable models, African-Americans (hazard ratio (HR) = 1.55, 95% confidence interval (CI) = 1.33–1.81; versus non-Hispanic Whites), those with public/no health insurance (HR = 1.78, 95% CI = 1.61–1.96; versus private) and those who resided in lower socioeconomic status neighborhoods had a higher CVD risk. These sociodemographic differences in CVD incidence were apparent across most cancer sites. The risk of death was increased by eightfold or higher among AYAs who developed CVD.
While cancer therapies are known to increase the risk of CVD, this study additionally shows that CVD risk varies by sociodemographic factors.
Implications for cancer survivors
The identification and mitigation of CVD risk factors in these subgroups may improve long-term patient outcomes.
KeywordsCancer Cardiovascular diseases Insurance Adolescent Young adult Race/ethnicity Socioeconomic factors
This work was supported by the Rich and Weissman Family Lymphoma and Survivorship Fund St. Baldrick’s Research Grant. Dr. Wun’s effort also supported by National Center for Advancing Translational Sciences TR000002. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, contract HHSN261201000035C awarded to the University of Southern California, and contract HHSN261201000034C awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement U58DP003862-01 awarded to the California Department of Public Health. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study did not involve interactions with human subjects and was considered exempt (category 4) by the Institutional Review Board of the University of California, Davis.
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