3670 - The Burden of Cardiovascular Disease in Long-Term Survivors of Nasopharyngeal Cancer: A Population-Based Cohort Study
Presenter(s)
R. Xu1, P. C. Au2, S. K. Chan3, C. Sing1, K. S. J. Fong4, J. Chow5, K. M. Cheung5, W. W. Y. Tin6, C. Y. Wong7, T. S. Lau8, K. C. Wong9, S. Y. Chan10, V. H. F. Lee3, A. W. M. Lee3, W. T. Ng11, I. C. K. Wong12, C. L. Cheung12, and C. L. Chiang13; 1Department of Clinical Oncology, University of Hong Kong, Hong Kong, China, 2Department of Pharmacy and Pharmacology, University of Hong Kong, Hong Kong, China, 3Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China, 4The University of Hong Kong, Hong Kong, Hong Kong, 5Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China, 6Department of Clinical Oncology, Tuen Mun Hospital, Tuen Mun, Hong Kong, 7Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China, 8Department of Clinical Oncology Princess Margaret Hospital, Hong Kong, China, 9Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong, China, 10Department of Clinical Oncology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong, 11Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hosptial, Kowloon, Hong Kong, 12Department of Pharmacy and Pharmacology, University of Hong Kong, Hong Kong, Hong Kong, 13Department of Clinical Oncology, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China, Hong Kong, Hong Kong
Purpose/Objective(s):
Long-term survivors of nasopharyngeal carcinoma (NPC) are at an increased risk of developing cardiovascular disease (CVD). However, the distribution of specific CVD subtypes and their associated risk factors are not well understood. This study aims to comprehensively characterize the spectrum of cardiovascular disease subtypes and identify both modifiable and non-modifiable risk factors contributing to cardiovascular morbidity among 5-year NPC survivors.Materials/Methods:
This population-based cohort study included adult NPC survivors in Hong Kong who were five years post-diagnosis, from 1997 to 2015. Cardiovascular events were classified into 25 subtypes, including major adverse cardiovascular events (MACE) - left ventricular dysfunction, myocardial infarction, stroke, lethal arrhythmia, cardiovascular mortality - and non-MACE events. Cumulative burden of CVD was estimated using the mean count of events per 1000 person-years, accounting for multiple types of recurrent events and competing risk of death (non-cardiovascular cause of death). A healthy cohort was derived from the general population, with individuals frequency-matched by age, sex, and calendar year. Poisson regression was used to analyze risk factors and calculate rate ratios (RRs).Results:
Among 7893 five-year survivors of NPC (median age 48, range 18-90), the HR compared to the healthy cohort for CVD mortality was 2.28 (95% CI 1.98-2.62, p <0.001). The cumulative burden per 1000 person-years of MACE among NPC survivors in age of 50-, 70-, 90- was 0.17, 1.00, 3.08 compared with 0.02, 0.20, 0.75 in healthy cohort, among which cumulative burden of lethal arrhythmia and stroke in NPC survivor were markedly elevated (0.40 vs. 0.03, p <0.001; 2.03 vs. 0.33, p <0.001, respectively). Non-MACE burden was higher in NPC survivors (5.02 vs 2.89), particularly atrial fibrillation (1.51 vs 0.51, p <0.001), and sinus tachycardia (0.22 vs 0.06, p <0.001). Besides, cumulative burden of non-MACE was associated with an increased future risk of MACE (one condition: RR 2.6, 95% CI 2.5-2.8, p <0.001; two conditions: 4.9, 4.5-5.4, p <0.001; three conditions: 5.1, 4.4-5.8, p <0.001; and four conditions and more: 8.6, 7.9-9.4, p <0.001). Alcohol was associated with an increased future risk of MACE (RR 1.4, 95% CI 1.3–1.5, p <0.001). Importantly, intensity-modulated radiation therapy (IMRT) was associated with a lower risk of stroke (RR 0.5, 95% CI 0.4-0.5, p <0.001), myocardial infarction (RR 0.9, 95% CI 0.7-1.0, p =0.019), and CVD death (RR 0.4, 95% CI 0.3-0.6, p <0.001).Conclusion:
To our knowledge, this is the largest cohort study to date examining the cardiovascular disease burden among the growing population of NPC survivors. Our findings underscore the importance of utilizing IMRT and establishing comprehensive survivorship programs that emphasize lifestyle modification, early detection and intervention to prevent major cardiovascular events.