Patients With Endometrial Cancer Have Greater Risk of Cardiovascular Disease

Patients with endometrial cancer were more likely to have cardiovascular disease before and after their cancer diagnosis compared with patients without cancer.

A higher prevalence of cardiovascular disease was observed in patients with endometrial cancer compared with those without a cancer diagnosis. The management of pre-existing and new cardiovascular disease may be required for women with endometrial cancer, according to research published in Gynecologic Oncology.1

The study aimed to describe the burden of cardiovascular disease diagnoses among women aged 65 years and older with endometrial cancer. What researchers found was that patients with endometrial cancer were more likely to have cardiovascular disease before and after their cancer diagnosis vs patients without a cancer diagnosis.

Data from the analyses showed that beginning follow-up at 1 year post-index date, which was defined as the endometrial cancer diagnosis date in the matched set, survivors of endometrial cancer had an increased risk of incident cardiovascular disease diagnoses, including ischemic heart diseases (HR, 1.73; 95% CI, 1.69-1.78), pulmonary heart disease (HR, 1.95; 95% CI, 1.88-2.02), and diseases of the veins and lymphatics (HR, 2.71; 95% CI, 95% CI: 2.64-2.78). Within the first-year post-index date, the risk of cardiovascular disease diagnoses among women with endometrial cancer was also higher.

“Results of the current study suggest that older women with endometrial cancer have a higher prevalence of cardiovascular disease-related conditions at the time of their cancer diagnosis, and a higher risk of these conditions after cancer diagnosis, than demographically similar women without a cancer history. Management of pre-existing cardiovascular disease and monitoring for new conditions may be critical during endometrial cancer treatment and throughout long-term survivorship,” wrote the study authors led by Chelsea Anderson, MD, Department of Epidemiology, University of North Carolina, Chapel Hill.

In the study, women aged 66 years and older with endometrial cancer diagnosed between 2004 and 2017 (n = 44,386) and matched women without cancer (n = 221,219) were identified using the Surveillance, Epidemiology, and End Results (SEER) program linked to Medicare enrollment records and claims.

Investigators examined the prevalence of cardiovascular disease-related conditions in the year prior to endometrial cancer diagnosis and the incidence of cardiovascular disease diagnoses after receiving the diagnosis. To address the possibility of an elevated risk of cardiovascular disease among older survivors of endometrial cancer relative to the general population, a matched comparison group of women without a cancer diagnosis were included.

Women with a first malignant primary endometrial cancer who were 66 years of age and older were identified for the study and patients were eligible for enrollment if they had at least 1 year of continuous enrollment in parts A and B of Medicare before receiving an endometrial cancer diagnosis.

Cases of endometrial cancer were then matched with replacement on year of birth, state of residence, and race/ethnicity to up to 5 women from the random 5% sample of Medicare beneficiaries without a cancer history. A total of 44,386 patients with endometrial cancer and 221,219 women without a cancer diagnosis were included in the study.

Primary end points included ischemic heart disease, pulmonary heart disease, other forms of heart disease,cerebrovascular disease, diseases of the arteries, arterioles, and capillaries, and diseases of the veins and lymphatics. Secondary end points of the study were acute myocardial infarction, cardiomyopathy, and more.

Patients were considered to have prevalent disease for their condition if they were diagnosed with a particular cardiovascular disease outcome within the year prior to the index date. Follow-up for incident cardiovascular disease-related diagnoses began at the index date and concluded at the outcome of interest, disenrollment from Medicare parts A or B, death, or end of the study period in December 2018.

At the index date, patients in the endometrial cancer group were more likely to have prevalent hypertension (75% vs 51%), hyperlipidemia (66% vs 45%) and a Charlson comorbidity index of ≥1 (62% vs 43%) compared with the matched comparison group. Most of the women enrolled in the trial had localized stage disease (65%), grade 1 or 2 disease (62%), and endometrioid histology (69%).

The most common treatments among those enrolled were hysterectomy only (43%) and hysterectomy and radiation (21%). Of patients with endometrial cancer who died during the study with a cause of death accessible through SEER (n= 13,045), 46% died from endometrial cancer, and 17% died from cardiovascular disease. Proportions were similar for deaths from endometrial cancer (26%) and cardiovascular diseases (26%) for patients with localized stage cancer.

There was a higher prevalence of all cardiovascular disease-related conditions in women with endometrial cancer vs the matched comparison group in the year prior to the index date, including other forms of heart disease (33% vs 23%; P < .001), ischemic heart disease (20% vs 15%; P <.001), and diseases of the arteries, arterioles, and capillaries (17% vs 13%; P <.001).

Then, the cumulative incidence among endometrial cancer survivors was higher than in the matched comparison group with approximately 18% of endometrial cancer survivors diagnosed with ischemic heart disease within a year following the index date. This led to the cumulative incidence to rise to 33% and 43% by 5 and 10 years, respectively. For the matched women without cancer, the cumulative incidence of ischemic heart disease at 1 year was 6%, 19% at 5 years, and 29% at 10 years.

In analyses of 1 year after the index date, risk of all level 1 cardiovascular disease outcomes increased among women with endometrial cancer. These included ischemic heart disease (hazard ratio [HR], 1.18; 95% CI, 1.14-1.21), pulmonary heart disease (HR, 1.41; 95% CI, 1.36-1.46), other forms of heart disease (HR, 1.39; 95% CI, 1.35-1.43), cerebrovascular disease (HR, 1.15; 95% CI, 1.12-1.18), disease of the arteries, arterioles, and capillaries (HR, 1.35; 95% CI, 1.32-1.39), and disease of the veins and lymphatic system (HR, 1.95; 95% CI, 1.90-2.01).

For patients with cancer, associations between demographic, cancer-related characteristics, and level 1 cardiovascular disease outcomes among women with endometrial cancer were observed. Cardiovascular disease increased with older age at diagnosis, and Charlson comorbidity index, Black women, and hypertension. Further, women with regional or distant stage disease typically had a higher risk of cardiovascular disease vs women with localized stage disease.

REFERENCE:
Anderson C, Olshan AF, Bae-Jump VL, Brewster WR, Lund JL, Nichols HB. Cardiovascular disease diagnoses among older women with endometrial cancer. Gynecol Oncol. 2022;167(1):51-57. doi:10.1016/j.ygyno.2022.08.014