Cardiovascular Disease In Cancer Survivors

Abstract

Over 18 million cancer survivors are living in the United States. Cancer survivors are at high risk for numerous adverse events, including cardiovascular disease (CVD). As the community of cancer survivors grows, there is a need to disentangle the complex causal relationships between cancer and CVD.In our first two manuscripts, we investigated two potential causes of CVD in cancer survivors. Manuscript 1 evaluated the associations between cancer, T-Cell immunosenescence (immune system aging), and CVD using data from the Health and Retirement Study. Prevalent cancer was strongly associated with T-cell immunosenescence, with stronger associations among participants who received chemotherapy and radiation. However, T-cell Immunosenescence was not prospectively associated with CVD or cancer. For Manuscript 2, we used the Marketscan® administrative healthcare claims databases to estimate the cardiovascular risk associated with the use of two hormone therapies, aromatase inhibitors (with ovarian suppression) and tamoxifen in premenopausal female breast cancer survivors. Although CVD events were rare in this population, enrollees who used aromatase inhibitors with ovarian suppression had an elevated risk of CVD compared to those who used tamoxifen. Finally, Manuscript 3 assessed the performance of the Pooled Cohort Equations (PCEs), risk prediction tools used to estimate ten-year cardiovascular risk and prescribe interventions. Analyses included cancer survivors and cancer-free participants in the Atherosclerosis Risk in Communities Study. Although the PCEs overestimated CVD risk in each group, we found no evidence that prediction differed by cancer history. Together, these findings provide insights that can be used to improve cardiovascular healthcare and prevention for cancer survivors.