Patients with Head and Neck squamous cell carcinoma at significant risk of CV events

A new study on Head and Neck squamous cell carcinoma (HNSCC) revealed that suboptimally managed cardiovascular risk factors, the risk of stroke and myocardial infarction, represent a significant burden in HNSCC leading to an increased risk of death. The study was published in the journal JAMA Otolaryngology-Head & Neck Surgery.

Due to similar risk factors and exposure to potentially cardiotoxic cancer therapies, cardiovascular (CV) illness is a significant cause of morbidity and mortality among cancer patients. As there is much less information on the CV risk factors that influence those with head and neck squamous cell carcinoma (HNSCC), researchers conducted a retrospective, population-based cohort study to define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC between January 1, 2000, to December 31, 2020.

Nearly 35,897 US veterans with newly diagnosed HNSCC were included to study their Demographic, cancer-specific, and treatment characteristics. The median [IQR] age of the participants is 63 [58-69] years. Among the participants, there were 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals. There were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). The primary outcome of measurement included the prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death.

Key findings:

• Although most patients were under risk-lowering medications, at least 1 uncontrolled CV risk factor was seen in 15,941 (47%) patients.
• Among the races of participants, the black race was associated with an increased risk of having uncontrolled CV risk factor(s).
• Among various Head and neck cancers, laryngeal cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites.
• Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively.
• In cause-specific hazard models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and the presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI.
• Incident stroke and MI were associated with a 47% and 71% increased risk of all-cause death, respectively as per the extended Cox models.

Thus, modifiable CV risk factors are associated with the risk of adverse CV events, and these events are associated with a higher risk of death in patients with HNSCC.

Further reading: Sun L, Brody R, Candelieri D, et al. Risk of Cardiovascular Events Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online June 22, 2023. doi:10.1001/jamaoto.2023.1342