title: Cardiovascular Disease Among Survivors of Adult-Onset Cancer: A Community-Based Retrospective Cohort Study.
abstract: OBJECTIVE
  Cardiovascular diseases (CVDs), including ischemic heart disease, stroke, and heart failure, are well-established late effects of therapy in survivors of childhood and young adult (< 40 years at diagnosis) cancers; less is known regarding CVD in long-term survivors of adult-onset (≥ 40 years) cancer.
  
  
  METHODS
  A retrospective cohort study design was used to describe the magnitude of CVD risk in 36,232 ≥ 2-year survivors of adult-onset cancer compared with matched (age, sex, and residential ZIP code) noncancer controls (n = 73,545) within a large integrated managed care organization. Multivariable regression was used to examine the impact of cardiovascular risk factors (CVRFs; hypertension, diabetes, dyslipidemia) on long-term CVD risk in cancer survivors.
  
  
  RESULTS
  Survivors of multiple myeloma (incidence rate ratio [IRR], 1.70; P < .01), carcinoma of the lung/bronchus (IRR, 1.58; P < .01), non-Hodgkin lymphoma (IRR, 1.41; P < .01), and breast cancer (IRR, 1.13; P < .01) had significantly higher CVD risk when compared with noncancer controls. Conversely, prostate cancer survivors had a lower CVD risk (IRR, 0.89; P < .01) compared with controls. Cancer survivors with two or more CVRFs had the highest risk of CVD when compared with noncancer controls with less than two CVRFs (IRR, 1.83 to 2.59; P < .01). Eight-year overall survival was significantly worse among cancer survivors who developed CVD (60%) when compared with cancer survivors without CVD (81%; P < .01).
  
  
  CONCLUSIONS
  The magnitude of subsequent CVD risk varies according to cancer subtype and by the presence of CVRFs. Overall survival in survivors who develop CVD is poor, emphasizing the need for targeted prevention strategies for individuals at highest risk of developing CVD.
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL. sarmenian@coh.org.
authors.forename: Saro H
authors.initials: SH
authors.lastname: Armenian
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Lanfang
authors.initials: L
authors.lastname: Xu
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Canlan
authors.initials: C
authors.lastname: Sun
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Leonardo T
authors.initials: LT
authors.lastname: Farol
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Sumanta Kumar
authors.initials: SK
authors.lastname: Pal
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Smita
authors.initials: S
authors.lastname: Bhatia
authors.affiliation: Saro H. Armenian, Canlan Sun, and Sumanta Kumar Pal, City of Hope Comprehensive Cancer Center, Duarte; Lanfang Xu and Chun Chao, Kaiser Permanente Southern California, Pasadena; Leonardo T. Farol, City of Hope-Kaiser Permanente, Los Angeles, CA; Bonnie Ky, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Pamela S. Douglas, Duke Clinical Research Institute, Duke University, Durham, NC; and Smita Bhatia, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Chun
authors.initials: C
authors.lastname: Chao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D003324:Coronary Artery Disease / Q000453:epidemiology; D048909:Diabetes Complications / Q000453:epidemiology; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D009369:Neoplasms; D009765:Obesity / Q000150:complications / Q000453:epidemiology; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D017741:Survivors / Q000706:statistics & numerical data*
references.citation: Health Serv Res. 2008 Oct;43(5 Pt 1):1722-36
references.pmid: 18479410
references.citation: Cancer Epidemiol Biomarkers Prev. 2013 Apr;22(4):561-70
references.pmid: 23535024
references.citation: J Natl Cancer Inst. 2008 Aug 6;100(15):1058-67
references.pmid: 18664656
references.citation: Br J Cancer. 2004 Jul 5;91(1):45-9
references.pmid: 15173858
references.citation: Ann Oncol. 2003 Feb;14(2):277-81
references.pmid: 12562656
references.citation: J Clin Oncol. 2013 Oct 10;31(29):3673-80
references.pmid: 24002505
references.citation: CA Cancer J Clin. 2014 Jul-Aug;64(4):252-71
references.pmid: 24890451
references.citation: J Clin Oncol. 2008 Jul 1;26(19):3159-65
references.pmid: 18591554
references.citation: J Clin Oncol. 2005 Dec 1;23(34):8597-605
references.pmid: 16314622
references.citation: Subst Use Misuse. 2013 Jun;48(9):731-42
references.pmid: 23621678
references.citation: J Clin Oncol. 2015 Apr 10;33(11):1232-4
references.pmid: 25753444
references.citation: JAMA. 2009 Aug 26;302(8):866-73
references.pmid: 19706860
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1223-30
references.pmid: 18227530
references.citation: Breast Cancer Res Treat. 2014 Jul;146(2):411-9
references.pmid: 24951268
references.citation: J Clin Oncol. 2006 Sep 1;24(25):4107-15
references.pmid: 16908934
references.citation: J Clin Oncol. 2014 Aug 20;32(24):2654-61
references.pmid: 25071122
references.citation: J Clin Oncol. 2013 Nov 20;31(33):4222-8
references.pmid: 24127446
references.citation: Med Care Res Rev. 2013 Jun;70(3):330-45
references.pmid: 23169896
references.citation: Cancer. 2014 Feb 15;120(4):469-79
references.pmid: 24166350
references.citation: J Natl Cancer Inst. 2014 May 21;106(6):dju110
references.pmid: 24848622
references.citation: J Natl Cancer Inst. 2011 Jan 19;103(2):117-28
references.pmid: 21228314
references.citation: Perm J. 2012 Summer;16(3):37-41
references.pmid: 23012597
references.citation: Circulation. 2004 Jun 29;109(25):3122-31
references.pmid: 15226229
references.citation: J Clin Oncol. 2009 Apr 20;27(12):1983-91
references.pmid: 19289616
references.citation: Med Care. 2014 May;52(5):e30-8
references.pmid: 22643199
references.citation: JAMA. 2003 Dec 3;290(21):2831-7
references.pmid: 14657067
references.citation: Circulation. 2013 Oct 22;128(17):1927-95
references.pmid: 24081971
references.citation: J Natl Cancer Inst. 2012 Sep 5;104(17):1293-305
references.pmid: 22949432
references.citation: J Clin Oncol. 2002 Mar 1;20(5):1215-21
references.pmid: 11870163
references.citation: Cancer. 2003 Jun 1;97(11):2869-79
references.pmid: 12767102
references.citation: MMWR Surveill Summ. 2010 Dec 10;59(10):1-221
references.pmid: 21150869
references.citation: J Clin Oncol. 2012 Oct 20;30(30):3657-64
references.pmid: 23008297
references.citation: Support Care Cancer. 2014 Jul;22(7):1949-58
references.pmid: 24584711
references.citation: Med Clin North Am. 2015 Jul;99(4):711-31
references.pmid: 26042878
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1231-8
references.pmid: 18250349
references.citation: J Clin Oncol. 2004 May 15;22(10):1864-71
references.pmid: 15143078
references.citation: J Clin Oncol. 2015 Apr 10;33(11):1243-51
references.pmid: 25732167