Incident cardiovascular events and imaging phenotypes in UK Biobank participants with past cancer

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Abstract

Objectives

To evaluate incident cardiovascular outcomes and imaging phenotypes in UK Biobank participants with previous cancer.

Methods

Cancer and cardiovascular disease (CVD) diagnoses were ascertained using health record linkage. Participants with cancer history (breast, lung, prostate, colorectal, uterus, haematological) were propensity matched on vascular risk factors to non-cancer controls. Competing risk regression was used to calculate subdistribution HRs (SHRs) for associations of cancer history with incident CVD (ischaemic heart disease (IHD), non-ischaemic cardiomyopathy (NICM), heart failure (HF), atrial fibrillation/flutter, stroke, pericarditis, venous thromboembolism (VTE)) and mortality outcomes (any CVD, IHD, HF/NICM, stroke, hypertensive disease) over 11.8±1.7 years of prospective follow-up. Linear regression was used to assess associations of cancer history with left ventricular (LV) and left atrial metrics.

Results

We studied 18 714 participants (67% women, age: 62 (IQR: 57–66) years, 97% white ethnicities) with cancer history, including 1354 individuals with cardiovascular magnetic resonance. Participants with cancer had high burden of vascular risk factors and prevalent CVDs. Haematological cancer was associated with increased risk of all incident CVDs considered (SHRs: 1.92–3.56), larger chamber volumes, lower ejection fractions, and poorer LV strain. Breast cancer was associated with increased risk of selected CVDs (NICM, HF, pericarditis and VTE; SHRs: 1.34–2.03), HF/NICM death, hypertensive disease death, lower LV ejection fraction, and lower LV global function index. Lung cancer was associated with increased risk of pericarditis, HF, and CVD death. Prostate cancer was linked to increased VTE risk.

Conclusions

Cancer history is linked to increased risk of incident CVDs and adverse cardiac remodelling independent of shared vascular risk factors.

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Most cited references 26

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Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2.

Dennis J Slamon, Brian Leyland-Jones, Steven Shak … (2001)

The HER2 gene, which encodes the growth factor receptor HER2, is amplified and HER2 is overexpressed in 25 to 30 percent of breast cancers, increasing the aggressiveness of the tumor. We evaluated the efficacy and safety of trastuzumab, a recombinant monoclonal antibody against HER2, in women with metastatic breast cancer that overexpressed HER2. We randomly assigned 234 patients to receive standard chemotherapy alone and 235 patients to receive standard chemotherapy plus trastuzumab. Patients who had not previously received adjuvant (postoperative) therapy with an anthracycline were treated with doxorubicin (or epirubicin in the case of 36 women) and cyclophosphamide alone (138 women) or with trastuzumab (143 women). Patients who had previously received adjuvant anthracycline were treated with paclitaxel alone (96 women) or paclitaxel with trastuzumab (92 women). The addition of trastuzumab to chemotherapy was associated with a longer time to disease progression (median, 7.4 vs. 4.6 months; P<0.001), a higher rate of objective response (50 percent vs. 32 percent, P<0.001), a longer duration of response (median, 9.1 vs. 6.1 months; P<0.001), a lower rate of death at 1 year (22 percent vs. 33 percent, P=0.008), longer survival (median survival, 25.1 vs. 20.3 months; P=0.01), and a 20 percent reduction in the risk of death. The most important adverse event was cardiac dysfunction of New York Heart Association class III or IV, which occurred in 27 percent of the group given an anthracycline, cyclophosphamide, and trastuzumab; 8 percent of the group given an anthracycline and cyclophosphamide alone; 13 percent of the group given paclitaxel and trastuzumab; and 1 percent of the group given paclitaxel alone. Although the cardiotoxicity was potentially severe and, in some cases, life-threatening, the symptoms generally improved with standard medical management. Trastuzumab increases the clinical benefit of first-line chemotherapy in metastatic breast cancer that overexpresses HER2.

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Europe contains 9% of the world population but has a 25% share of the global cancer burden. Up-to-date cancer statistics in Europe are key to cancer planning. Cancer incidence and mortality estimates for 25 major cancers are presented for the 40 countries in the four United Nations-defined areas of Europe and for Europe and the European Union (EU-28) for 2018.

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Is Open Access

Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies

Peter C Austin (2010)

In a study comparing the effects of two treatments, the propensity score is the probability of assignment to one treatment conditional on a subject's measured baseline covariates. Propensity-score matching is increasingly being used to estimate the effects of exposures using observational data. In the most common implementation of propensity-score matching, pairs of treated and untreated subjects are formed whose propensity scores differ by at most a pre-specified amount (the caliper width). There has been a little research into the optimal caliper width. We conducted an extensive series of Monte Carlo simulations to determine the optimal caliper width for estimating differences in means (for continuous outcomes) and risk differences (for binary outcomes). When estimating differences in means or risk differences, we recommend that researchers match on the logit of the propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. When at least some of the covariates were continuous, then either this value, or one close to it, minimized the mean square error of the resultant estimated treatment effect. It also eliminated at least 98% of the bias in the crude estimator, and it resulted in confidence intervals with approximately the correct coverage rates. Furthermore, the empirical type I error rate was approximately correct. When all of the covariates were binary, then the choice of caliper width had a much smaller impact on the performance of estimation of risk differences and differences in means. Copyright © 2010 John Wiley & Sons, Ltd.

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Author and article information

Journal

Journal ID (nlm-ta): Heart

Journal ID (iso-abbrev): Heart

Journal ID (hwp): heartjnl

Journal ID (publisher-id): heart

Title: Heart

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 1355-6037

ISSN (Electronic): 1468-201X

Publication date (Print): July 2023

Publication date (Electronic): 18 April 2023

Volume: 109

Issue: 13

Pages: 1007-1015

Affiliations

[1 ] departmentWilliam Harvey Research Institute , NIHR Barts Biomedical Research Centre, Queen Mary University of London , London, UK

[2 ] departmentBarts Heart Centre , St Bartholomew’s Hospital, Barts Health NHS Trust , London, UK

[3 ] departmentDivision of Cardiovascular Medicine , Radcliffe Department of Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust , Oxford, UK

[4 ] departmentDivision of Cancer Sciences , Faculty of Biology, Medicine and Health, University of Manchester , Manchester, UK

[5 ] departmentDepartment of Obstetrics and Gynaecology , St Mary’s Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester, UK

[6 ] departmentWolfson Institute of Population Health , Queen Mary University of London , London, UK

[7 ] departmentDepartment of Public Health and Primary Care , University of Cambridge , Cambridge, UK

[8 ] departmentInstitute of Cardiovascular Science , University College London , London, UK

[9 ] departmentInstitute of Population Health , Manchester University , manchester, UK

[10 ] departmentKeele Cardiovascular Research Group , Keele University , Keele, UK

[11 ] departmentMRC Lifecourse Epidemiology Centre , University of Southampton , Southampton, UK

[12 ] NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust , Southampton, UK

[13 ] Health Data Research UK , London, UK

[14 ] Alan Turing Institute , London, UK

Author notes

[Correspondence to ] Dr Zahra Raisi-Estabragh, William Harvey Research Institute, Queen Mary University of London, London E1 4NS, UK; zahraraisi@ 123456doctors.org.uk

Author information

Zahra Raisi-Estabragh http://orcid.org/0000-0002-7757-5465

Mamas A Mamas http://orcid.org/0000-0001-9241-8890

Steffen E Petersen http://orcid.org/0000-0003-4622-5160

Article

Publisher ID: heartjnl-2022-321888

DOI: 10.1136/heartjnl-2022-321888

PMC ID: 10314020

PubMed ID: 37072241

SO-VID: ba4354e4-03c4-4b5f-b91d-23eff32fa192

License:

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

History

Date received : 14 September 2022

Date accepted : 28 December 2022

Funding

Funded by: FundRef http://dx.doi.org/10.13039/501100000266, Engineering and Physical Sciences Research Council;

Award ID: EP/P001009/1

Funded by: FundRef http://dx.doi.org/10.13039/501100000265, Medical Research Council;

Award ID: MC_PC_21001

Award ID: MC_PC_21003

Award ID: MR/L016311/1

Funded by: FundRef http://dx.doi.org/10.13039/501100000274, British Heart Foundation;

Award ID: Clinical Research Training Fellowship

Award ID: FS/17/81/33318

Funded by: FundRef http://dx.doi.org/10.13039/100010661, Horizon 2020 Framework Programme;

Award ID: 825903

Funded by: FundRef http://dx.doi.org/10.13039/501100000272, National Institute for Health and Care Research;

Award ID: NIHR300650

Funded by: NIHR Manchester Biomedical Research Centre;

Award ID: IS-BRC-1215-20007

Funded by: FundRef http://dx.doi.org/10.13039/501100000289, Cancer Research UK;

Award ID: CC8640/A23385

Funded by: Barts Charity;

Award ID: G-002346

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: epidemiology,magnetic resonance imaging

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: epidemiology, magnetic resonance imaging

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Incident cardiovascular events and imaging phenotypes in UK Biobank participants with past cancer

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Most cited references 26

Use of chemotherapy plus a monoclonal antibody against HER2 for metastatic breast cancer that overexpresses HER2.

Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018

Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies

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Cited by 5

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