title: Cardiovascular medication after cancer at a young age in Finland: A nationwide registry linkage study.
abstract: Despite improved survival rates, childhood and young adult (YA) cancer survivors face elevated risks for life-threatening morbidities, especially cardiovascular complications. Our nationwide Finnish registry study investigated the purchases of cardiovascular medication from 1993 to 2011 in patients diagnosed with cancer aged below 35 years (N = 8,197) between 1993 and 2004 compared to siblings (N = 29,974) via linkage to the drug purchase registry. The cumulative incidence for purchasing cardiovascular medications was higher in childhood and YA cancer patients compared to siblings with a rising trend over time. After childhood cancer, the highest hazard ratio (HR) was found for purchasing anticoagulants (HR 19.8, 95% CI 8.5-45.9). The HRs for any cardiovascular medication (HR 7.2, 95% CI 5.1-10.1) and cardiac medication (HR 4.8, 95% CI 3.3-6.9) were markedly elevated after childhood cancer as well. Regarding YA cancer patients, the respective HRs were 2.5 (95% CI 2.0-3.2) for anticoagulants, HR 1.7 (95% CI 1.5-1.9) for any cardiovascular medication and HR 1.5 (95% CI 1.3-1.7) for cardiac medication. Among cancer patients, highest HRs for cardiovascular medication were observed after childhood acute lymphoblastic leukemia (ALL) and bone tumors (HR 10.2, 95% CI 6.8-15.5 and HR 7.4, 95% CI 4.0-13.7) and YA ALL and acute myeloid leukemia (HR 5.1, 95% CI 3.5-7.1 and HR 2.8, 95% CI 1.8-4.0). Our study demonstrated increased HRs for purchasing cardiovascular medication after early-onset cancer compared to siblings reflecting elevated cardiovascular morbidity. Thus, the implementation of long-term cardiovascular disease screening is imperative to prevent, detect and adequately treat cardiovascular late effects after cancer at a young age.
authors.affiliation: Department of Pediatric and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland.
authors.forename: A E
authors.initials: AE
authors.lastname: Kero
authors.affiliation: Department of Pediatrics, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.|Finnish Cancer Registry, Helsinki, Finland.
authors.forename: L M
authors.initials: LM
authors.lastname: Madanat-Harjuoja
authors.affiliation: Department of Pediatric and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland.
authors.forename: L S
authors.initials: LS
authors.lastname: Järvelä
authors.affiliation: Finnish Cancer Registry, Helsinki, Finland.|School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: N
authors.initials: N
authors.lastname: Malila
authors.affiliation: Turku Clinical Research Center, Turku University Hospital, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Matomäki
authors.affiliation: Department of Pediatric and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland.
authors.forename: P M
authors.initials: PM
authors.lastname: Lähteenmäki
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009017:Morbidity; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology*; D011159:Population Surveillance; D016016:Proportional Hazards Models; D012042:Registries; D055815:Young Adult
keywords: cardiovascular medication; cardiovascular morbidity; childhood cancer; drug purchase registry; registry-linkage study; young adult cancer