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

Zahra Raisi-Estabragh; Jackie Cooper; Celeste McCracken; Emma J Crosbie; Fiona M Walter; Charlotte H Manisty; John Robson; Mamas A Mamas; Nicholas C Harvey; Stefan Neubauer; Steffen E Petersen

doi:10.1136/heartjnl-2022-321888

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

Heart. 2023 Jun 14;109(13):1007-1015. doi: 10.1136/heartjnl-2022-321888.

Authors

Zahra Raisi-Estabragh^{1

2}, Jackie Cooper³, Celeste McCracken⁴, Emma J Crosbie^{5

6}, Fiona M Walter^{7

8}, Charlotte H Manisty^{2

9}, John Robson⁷, Mamas A Mamas^{10

11}, Nicholas C Harvey^{12

13}, Stefan Neubauer⁴, Steffen E Petersen^{3

2

14

15}

Affiliations

¹ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK zahraraisi@doctors.org.uk.
² Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
³ William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK.
⁴ Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁵ Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
⁶ Department of Obstetrics and Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁸ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
⁹ Institute of Cardiovascular Science, University College London, London, UK.
¹⁰ Institute of Population Health, Manchester University, manchester, UK.
¹¹ Keele Cardiovascular Research Group, Keele University, Keele, UK.
¹² MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton, UK.
¹³ NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
¹⁴ Health Data Research UK, London, UK.
¹⁵ Alan Turing Institute, London, UK.

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.

Keywords: epidemiology; magnetic resonance imaging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atrial Fibrillation*
Biological Specimen Banks
Female
Heart Failure*
Humans
Hypertension*
Male
Myocardial Ischemia*
Neoplasms* / epidemiology
Pericarditis*
Phenotype
Prospective Studies
Risk Factors
Stroke Volume
Stroke*
United Kingdom / epidemiology
Venous Thromboembolism*

Abstract

Publication types

MeSH terms

Grants and funding