Cancer Patients at Heightened Risk for Arterial Thromboembolism

Patients with incident cancer have a significantly increased risk of arterial thromboembolism vs. patients without cancer, especially during the first six months after diagnosis, according to a study published August 14 in the Journal of the American College of Cardiology.

Using the Surveillance Epidemiology and End Results (SEER)-Medicare linked database for this retrospective study, Babak B. Navi, MD, MS, et al., assessed newly diagnosed patients with breast, lung, prostate, colorectal, bladder, pancreatic or gastric cancer or non-Hodgkin lymphoma between 2002 to 2011. The cancer patients were individually matched by demographics and comorbidities to a Medicare enrollee without cancer — totaling 279,719 pairs — and followed through 2012.

Among the pairs, median age was 74 years and 48 percent were men. Validated diagnosis codes were used to identify arterial thromboembolism, defined as myocardial infarction (MI) or ischemic stroke. Cumulative incidence rates were calculated using competing risk survival statistics and Cox proportional hazards analysis was used to compare rates between groups at discrete times.

Results showed that the six-month cumulative incidence of arterial thromboembolism was 4.7 percent (95 percent confidence interval [CI], 4.6-4.8 percent) in patients with cancer compared with 2.2 percent (95 percent CI, 2.1-2.2 percent) in patients without cancer (hazard ratio [HR], 2.2; 95 percent CI, 2.1-2.3).

In patients with cancer compared with those without cancer, at six months the cumulative incidence of MI was higher (2.0 percent vs. 0.7 percent; HR, 2.9; 95 percent CI, 2.8-3.1) as well as ischemic stroke (3.0 percent vs. 1.6 percent; HR, 1.9; 95 percent CI, 1.8-2.0).

The investigators also found that excess risk for arterial thromboembolism was higher in patients with later cancer stages and with lung, gastric and pancreatic cancers. However, cancer patients at all stages were at heightened risk.

“These data suggest that cancer is a common risk factor for arterial thromboembolism,” the study authors write. “Future research should investigate the mechanistic basis for these findings, the utility of including cancer in cardiovascular risk prediction models, and optimal strategies to prevent arterial thromboembolism in cancer patients.”

In an accompanying editorial, Edward T.H. Yeh, MD, FACC, and Hui-Ming Chang, MD, MPH, comment, "This paper should not be viewed as merely a big data confirmation of Trousseau Syndrome.” They add, “It is a call to action: for cardiologists to work closely with oncologists to prevent the occurrence of MI or ischemic stroke in cancer patients; and, for interventional cardiologists to take an active role in managing cancer patients with acute MI."

Clinical Topics: Cardio-Oncology

Keywords: Incidence, Risk Factors, Retrospective Studies, Prostate, Research Personnel, Comorbidity, Urinary Bladder, Confidence Intervals, Stomach Neoplasms, Thromboembolism, Medicare, Stroke, Myocardial Infarction, Lymphoma, Non-Hodgkin, Pancreatic Neoplasms, Cardiotoxicity

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