Cardiovascular disease incidence in adolescent and young adult cancer survivors: a retrospective cohort study
Menée aux Etats-Unis à partir de données portant sur 79 176 patients ayant survécu plus de 2 ans à un cancer diagnostiqué entre 15 et 39 ans sur la période 1996-2012, cette étude de cohorte rétrospective évalue les facteurs associés au risque de maladie cardiovasculaire (2 249 cas de maladie cardiovasculaire jusqu'en 2014) et analyse l'impact de ces maladies sur la mortalité
Purpose : 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. Methods : 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. Results : 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. Conclusion : 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.