Patients with Endometrial Cancer Pose High Risk of Dying from Cardiovascular Disease

A study published in the European Heart Journal suggested that patients with endometrial cancer pose a very high risk of dying from cardiovascular diseases (CVD) in the first year after diagnosis, supporting early involvement of cardiologists for patients with endometrial cancer.¹

Research also suggested that from the point of cancer diagnosis forward into survivorship, all patients with cancer are at elevated risk of dying from CVDs compared to the general U.S. population.

In this comparison of 3,234,256 U.S. cancer survivors to the general U.S. population, among 28 cancer sites, 1,228,328 patients (38%) died from cancer and 365,689 (11.3%) died from CVDs. Among the CVDs, 76.3% of deaths were due to heart disease.

“Our observations highlight the need for earlier and more aggressive cardiovascular care in cancer patients, which may require enhanced coordinated care between oncologists, cardiologists, and PCPs,” the researchers wrote.

Patients with invasive cancer were analyzed from the Surveillance, Epidemiology, and End Results (SEER) program. The SEER program covers 28% of the U.S. population.

In 8 cancer types, CVD mortality risk surpassed index-cancer mortality risk at least one calendar year. CVD mortality risk was highest in survivors diagnosed at <35 years of age. CVD mortality risk was highest (SMR 3.93, 95% CI, 3.89-3.97) within the first year after cancer diagnosis, and remained elevated throughout follow-up compared to the general population.

In endometrial cancer patients, the risk of dying in the first year of diagnosis from CVD remained elevated compared to other cancer sites. The majority of deaths from CVD occurred in patients diagnosed with breast, prostate, or bladder cancer. For patients with cancers of the penis, vulva, bladder, endometrium, prostate, testes, thyroid, or Hodgkin’s lymphoma, there was a year-to-year variation in the leading cause of death.

“The current study is the largest and most comprehensive characterization of cardiovascular mortality among 28 individual cancer sites using a national cancer registry with 40 years of data. These data underscore the importance of multidisciplinary care for cancer patients,” the researchers wrote.

Researchers indicated that further research is needed to investigate the optimal approach in managing these patients and the collaboration between cardiologist and oncologists. Future studies addressing early cardiology evaluation and how aggressive cardiology care should be in cancer patients are also of particular importance. Such studies might include a focus on cancers of the larynx and endometrium, as these patients have a good cancer prognosis but relatively high risk of CVD mortality, particularly in the first year following diagnosis.

Cardiovascular disease and cancer share similar risk factors, including obesity, sedentary lifestyle, smoking, and chronic inflammation, according to a 2018 study published in the Journal of the Advanced Practitioner in Oncology. Cardiovascular risk factors can be enhanced during cancer treatment and lead to an increased risk of coronary artery disease in survivors.²

Heart disease and cancer are the leading causes of mortality, both in the U.S. and worldwide. For most cancer survivors, the most effective strategy for primary prevention and/or management of CVD is likely achieved through modification of traditional risk factors.

References:
1. Sturgeon KM, Deng L, Bluethmann SM, et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. European Heart Journal. doi:10.1093/eur-heartj/ehz766
2. Jessica Shank Coviello. Cardiovascular and Cancer Risk: The Role of Cardio-oncology. Journal of the Advanced Practitioner in Oncology. doi:10.6004/jadpro.2018.9.23