title: Risk of ischemic stroke in patients with ovarian cancer: a nationwide population-based study.
abstract: BACKGROUND
  Cancer patients are at risk of thromboembolism. However, studies investigating the relationship between ovarian cancer and ischemic stroke are lacking. The objectives of this study were to assess the association between ovarian cancer and ischemic stroke, and to determine the predictive risk factors.
  
  
  METHODS
  Ovarian cancer patients aged 20 years and older without antecedent cerebrovascular events and who were followed up for more than 1 year between 1 January 2003 and 31 December 2011 were recruited from the Taiwan National Health Insurance database. Hazard ratios (HRs) of stroke risk for ovarian cancer patients compared with an age- and comorbidity-matched cohort were calculated by Cox proportional regression analysis. The difference in cumulative ischemic stroke incidence between ovarian cancer patients and the matched cohort was analyzed with the Kaplan-Meier method and tested with the log-rank test.
  
  
  RESULTS
  Each cohort (ovarian cancer and matched cohort) consisted of 8,810 individuals, with a median age of 49 years. After a median follow-up of 2.68 and 3.85 years, respectively, the ischemic stroke incidence was 1.38-fold higher in the ovarian cancer cohort than in the comparison cohort (9.4 versus 6.8 per 1,000 person-years), with an age- and comorbidity-adjusted HR of 1.49 (P <0.001). The ischemic stroke risk imposed by ovarian cancer was more prominent in patients under 50 years old (HR 2.28; P <0.001) compared with patients 50 years and older (HR 1.33; P = 0.005). Significant risk factors predicting stroke development were age 50 years and older (HR 2.21; P <0.001), hypertension (HR 1.84; P <0.001), diabetes mellitus (HR 1.71; P <0.001), and treatment with chemotherapy (HR 1.45; P = 0.017), especially platinum-based regimens.
  
  
  CONCLUSIONS
  Ovarian cancer patients were at an increased risk of developing ischemic stroke. Age, hypertension, diabetes, and chemotherapy treatment were independent risk factors.
authors.forename: Ai-Seon
authors.initials: AS
authors.lastname: Kuan
authors.forename: Chung-Jen
authors.initials: CJ
authors.lastname: Teng
authors.forename: Hua-Hsi
authors.initials: HH
authors.lastname: Wu
authors.forename: Vincent Yi-Fong
authors.initials: VY
authors.lastname: Su
authors.forename: Yung-Tai
authors.initials: YT
authors.lastname: Chen
authors.forename: Sheng-Hsuan
authors.initials: SH
authors.lastname: Chien
authors.forename: Chiu-Mei
authors.initials: CM
authors.lastname: Yeh
authors.forename: Li-Yu
authors.initials: LY
authors.lastname: Hu
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Cheng-Hwai
authors.initials: CH
authors.lastname: Tzeng
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei, Taiwan. chiajenliu@gmail.com.
authors.forename: Chia-Jen
authors.initials: CJ
authors.lastname: Liu
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects; D002545:Brain Ischemia / Q000209:etiology; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D015994:Incidence; D008875:Middle Aged; D009313:National Health Programs; D010051:Ovarian Neoplasms / Q000150:complications* / Q000188:drug therapy; D012044:Regression Analysis; D012107:Research Design; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents