Elderly Cancer Survivors at increased Cardiovascular Disease Risk, Study Finds
Australia: A new analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial has revealed that older patients diagnosed with cancer face a significantly increased cardiovascular risk, including heightened chances of myocardial infarction (MI), heart failure (HF), and ischemic stroke.
The study, published in Cancer Journal, found that aspirin did not affect the incidence of cardiovascular disease (CVD). Additionally, the risk may be greater for individuals with metastatic, hematological, and lung cancers, as well as for those undergoing chemotherapy.
In the past decade, there has been a decrease in cancer-related death rates, resulting in a growing population of cancer survivors. The researchers note that cancer survivors may face an increased risk of CVD due to their cancer or its treatment. While there are studies that explore the connection between cancer and CVD, few specifically focus on older adults, the effects of cancer treatment, or the potential role of aspirin in reducing risk within this group.
To fill this knowledge gap, Jaidyn Muhandiramge, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, and colleagues conducted a secondary analysis of the ASPREE trial to examine how cancer and its treatment influence a composite cardiovascular disease endpoint, which includes hospitalization for heart failure (HHF), myocardial infarction (MI), and stroke.
The following were the key findings of the study:
- Of 15,454 Australian and US ASPREE participants, 1392 had an incident cancer diagnosis.
- Rates of CVD were greater in the cancer risk set compared to the cancer-free risk set (20.8 versus 10.3 events per 1000 person-years; incidence rate ratio, 2.03), with increased incidence seen across MI, HHF, overall stroke, and ischemic stroke.
- Increased incidence remained after adjustment for clinically significant risk factors for CVD.
- Incidence was greatest in metastatic, hematological, and lung cancer.
- Chemotherapy was associated with an increased risk of CVD.
- Rates of CVD were similar across aspirin and placebo groups.
The findings prompted researchers to conclude that older adults with cancer experience a higher incidence of cardiovascular disease, including myocardial infarction, heart failure, and ischemic stroke.
"The incidence of CVD was comparable between participants who received aspirin and those who received a placebo during the ASPREE trial. The risk may be elevated in individuals with hematological malignancies, lung cancer, metastatic disease, and those undergoing cytotoxic chemotherapy," they wrote.
However, the researchers noted some limitations, including a shorter follow-up period for the cancer risk set, which may miss late cardiotoxicities. The study lacked ethnic diversity and had a healthy survivor bias, potentially underestimating CVD rates. The cancer cohort was small, leading to underpowered subgroup analyses, and data on treatment modality specifics were not captured.
Reference:
Muhandiramge, J., Zalcberg, J. R., Warner, E. T., Polekhina, G., Gibbs, P., Bernstein, W. B., Macrae, F., Haydon, A., Tie, J., Millar, J. L., Mar, V. J., Gately, L., Tonkin, A., Ford, L., Umar, A., Chan, A. T., Woods, R. L., & Orchard, S. G. Cardiovascular disease and stroke following cancer and cancer treatment in older adults. Cancer. https://doi.org/10.1002/cncr.35503
