Risk Factors for Fatal Heart Disease in Patients With Cancer

February is American Heart Month, a time when it is important for cardiologists and others who work with the heart to raise awareness for heart disease prevention. This is especially true with regard to a uniquely vulnerable group: patients with cancer. Patients diagnosed with cancer can be at a higher risk for, among other cardiovascular concerns, heart attack and stroke.¹

In 2020, a study published in Nature Communications examined factors that could make specific patients with cancer at a higher risk for fatal heart disease.² These factors included type of cancer, age, sex, and more. What factors should patients know about that may make them more at risk?

Type of Cancer

Among 7,529,481 patients with cancer in the study’s analysis (patients diagnosed invasive cancer between 1992 and 2015 found in the National Cancer Institute’s Surveillance, Epidemiology, and End Results program), 394,849 (5.24%) died from heart disease. Patients with breast, lung, prostate, and colorectal cancer made up a plurality of these heart disease fatalities, and found that patients with lung cancer had a uniquely high risk of fatal heart disease within the first year of diagnosis that decreased (while still remaining relatively elevated) throughout the remainder of the follow-up period. In cancers like colorectal, bladder, prostate, endometrial, melanoma, oral cavity, and pharynx, patients were more likely to die of heart disease than the cancer after 10 or more years past diagnosis.²

Age

The majority of heart disease deaths studied were from patients of a more advanced age, in large part because so many of the patients were diagnosed at an older age. Only 1593 (0.4%) of the patients who died from heart disease were age 39 or younger; a plurality of this group had breast cancer or lymphoma diagnoses. For patients older than 40, a plurality had breast, lung, prostate, or colorectal cancer. The researchers concluded that there should be heart disease prevention strategies that specifically target these patients.²

Sex

Men in this study were seen as being somewhat more at risk for fatal heart disease; although 51.4% of the overall population studied were men, they comprised 59.5% of the patients who died of heart disease. Women have specific risks as well, as the researchers noted that women receiving certain radiation therapy treatments for breast cancer have been found to be at an advanced risk for heart disease.²

Race

Black patients in the study were seen to have an elevated risk of heart disease compared to White patients, making up 10.2% of the total population but 10.6% of those who died of heart disease. In creating odds ratios and hazard ratios, the researchers also found that Black patients had a higher risk compared with the rest of the patients.²

Marital Status

The researchers also found that unmarried patients may have had their own unique risk of fatal heart disease. Unmarried patients accounted for just 38.5% of the overall patient pool, but were 43.9% of the patients who had fatal heart disease.²

Stage of Cancer

When looking at the cancer itself, patients with a more localized disease made up a plurality of the overall study population (33.3%) and an even larger plurality of those who died of heart disease (37.9%). While patients with localized disease may be at a higher risk for death from heart disease, the researchers noted that this may be related to patients with distant metastases having more aggressive cancers and therefore being more likely to die of the diagnosed cancer.²

References

1. Heart attack, stroke risk elevated following cancer diagnosis. National Cancer Institute. Published August 25, 2017. Accessed February 25, 2021, https://www.cancer.gov/news-events/cancer-currents-blog/2017/heart-attack-stroke-risk-cancer.
2. Stoltzfus KC, Zhang Y, Sturgeon K, et al. Fatal heart disease among cancer patients. Nat Commun. 2020;11(1):2011. doi:10.1038/s41467-020-15639-5