Cardiovascular (CV) disease (CVD) is the leading non-cancer cause of morbidity and mortality in patients with head and neck squamous cell carcinoma (HNSCC). This study aimed to define CV risk profiles and evaluate the incidence of stroke, myocardial infarction, and mortality in patients with HNSCC. Recently published in JAMA, the results underscore the substantial risk of cardiovascular events in individuals with HNSCC, emphasising the importance of implementing strategies to mitigate cardiovascular risk in these patients.
Head and neck squamous cell carcinoma (HNSCC) is the sixth most common cancer worldwide. While the survival of these patients has improved in the last years, there is a growing concern about the risks of other chronic diseases after cancer treatment. In particular, multiple large population-based studies have shown that cardiovascular (CV) disease (CVD) is the leading non-cancer cause of morbidity and mortality in patients with HNSCC. Despite this fact, the understanding of CV risk in patients with HNSCC is limited. To address this gap, this study aimed to define CV risk profiles and evaluate the incidence of stroke, myocardial infarction, and mortality in patients with HNSCC.
This retrospective study was conducted in the USA and included participants with newly diagnosed HNSCC. The electronic health record data of these patients were obtained and accessed through the Corporate Data Warehouse (CDW) from 2000 to 2020. Patients with distant metastatic disease at diagnosis were excluded. The presence of baseline CV risk factors and prevalent stroke or myocardial infarction (MI) was defined using the International Classification of Diseases, ninth revision (ICD-9) and ICD-10 coding definitions. Uncontrolled CV risk factors were defined as having either uncontrolled blood pressure or cholesterol and/or glucose levels. Stroke- and MI-free survival was defined as the time from HNSCC diagnosis to the first occurrence of stroke or MI, respectively. The incident of stroke and MI was defined as 2 or more outpatient diagnosis codes or 1 or more inpatient diagnosis codes. Death was considered as a competing risk in the incidence of stroke/MI analysis.
A total of 35,857 patients with nonmetastatic HNSCC and a median age of 63 years were included in the study. Black race was found to be associated with a higher risk of having uncontrolled CV risk factors (relative risk: 1.06; 95% CI: 1.03-1.09), and patients with larynx cancer exhibited higher rates of prevalent and uncontrolled risk factors compared to other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and the presence of uncontrolled CV risk factors were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively.
This large population-based cohort study on patients with HNSCC revealed a significant prevalence of baseline CV risk factors, many of which were poorly controlled, along with a high incidence of CV events following diagnosis. The presence and inadequate control of modifiable risk factors, such as hypertension and diabetes, particularly among Black individuals, were associated with an elevated risk of CV events. Moreover, patients who experienced these events faced a higher risk of all-cause mortality. These findings underscore the substantial risk of cardiovascular events in individuals with HNSCC, emphasising the importance of implementing strategies to mitigate CV risk in these patients.
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