Study Details in Trends of Cardiovascular Death Among Cancer Patients in US Since 1999

Zahra Raise-Estabragh, PhD

An analysis of data from the US Centers for Disease Control and Prevention (CDC) WONDER database provides insight into trends in disease-specific cardiovascular causes of mortality among cancer patients in the US since the turn of the century.

Performed by an international team of investigators, results of the analysis detail temporal trends in disease-specific cardiovascular causes of mortality among patients with cancer in the US stratified according to age, sex, and cancer site, with results suggesting ischemic heart disease (IHD) was the leading cause of death, but the attributable fraction of deaths from IHD had decreased while the proportion of deaths attributable to hypertensive disease increased during the entire duration of the study period.

“Our work highlights the importance of cardiovascular risk factor modification in patients with cancer, who may benefit from targeted preventative therapies,” wrote investigators. “Given the rising number of cancer survivors and the huge prognostic implications of cardiovascular disease in this cohort, the cardiovascular care of cancer patients is transitioning from an area with a dedicated specialist focus to having growing relevance to the general cardiologist.”

In recent years, the interest in cardiovascular-specific causes of death in patients with cancer has garnered increased attention as cardio-oncology has begun to emerge as its own unique field and data related to cardiotoxicity of cancer agents has gained headlines. Led by Zahra Raisi-Estabragh, PhD, a clinical lecturer in cardiology at Queen Mary University of London, and a team of colleagues, the current study was launched with the intent of assessing disease-specific cardiovascular mortality statistics of cancer patients in the US population over the last two decades extracted from national death registry data, stratified by sex, age, and cancer site.

For the purpose of analysis, investigators used the Multiple Cause of Death database accessed through CDC WONDER database to obtain data related to death certificates from US residents from 1999-2019, with each death certificate containing a single underlying cause of death and up to 20 contributing causes in addition to demographic data. Overall, investigators identified 629,308 deaths attributed primarily to cardiovascular death with malignant neoplasm recorded as a contributing cause of death during the study period.

Of the 629,308 deaths identified for inclusion in the investigators’ analyses, 42.8% were in women, 0.7% were in individuals younger than 45 years of age, and 88.9% were among those older than 65 years of age. A group of 5 cancer sites comprised 72.8% of all cancers. With lung (13.8%), gastrointestinal (17.8%), gastrointestinal, prostate (16.6%), breast (11.4%), and hematological cancers (13.2%) accounting for the largest proportions of cancer sites. Investigators noted all cancers, with the exception of breast cancer, were more commonly observed in men than women and, in all cancers, cardiovascular death was significantly more common in those older than 65 years of age.

Among the entire study population, IHD was the most common cause of primary cardiovascular disease death, accounting for 54.1% of deaths in men and 43.9% of deaths in women. The other leading causes were cerebrovascular disease, hypertensive disease, and heart failure, accounting for 16.9%, 7.7%, and 7.5%, respectively.

When assessing trends over time, results demonstrated IHD accounted for a declining proportion of total cardiovascular deaths, with the proportion of deaths attributable to IHD decreasing from 55.0% in 1999 to 40.4% in 2019. In contrast, the proportions of deaths from cerebrovascular disease increased from 16.3% to 18.1%, from hypertensive diseases increased from 5.5% to 15.1%, from heart failure increased from 5.8% to 7.1%, and from other cardiovascular diseases increased from 17.4% to 19.3%. Additionally, investigators pointed out the largest percentage increase observed was from hypertensive disease, which underwent a 174.5% percent increase from 1999 to 2019.

In analyses assessing those with breast cancer as a contributing cause of death, IHD accounted for the greatest proportion of cardiovascular death, but this proportion was lower than the proportion observed in other cancer types. Further analysis demonstrated cerebrovascular disease (17%) and hypertensive disease (10.7%) were more common causes of death in breast cancer than in any other cancer type.

“In this study of cardiovascular causes of death amongst cancer patients in the US between 1999 to 2019, we identified differential patterns and trends by sex, age, and cancer site. The most common causes of primary CVD death, amongst patients with cancer entered as a contributing cause of death, were IHD, cerebrovascular disease, and hypertensive diseases,” investigators wrote.

This study, “Temporal trends in disease-specific causes of cardiovascular mortality amongst patients with cancer in the USA between 1999 to 2019,” was published in European Heart Journal: Quality of Care & Clinical Outcomes.