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Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

Lau KK, Wong YK, Teo KC, Chang RS, Hon SF, Chan KH, Cheung RT, Li LS, Tse HF, Ho SL, Siu CW - PLoS ONE (2014)

Bottom Line: Cancer patients are at increased risk of cardiovascular and cerebrovascular events.Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission.In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China ; Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background and purpose: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke.

Methods: This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality.

Results: Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality.

Conclusions: Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

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Kaplan-Meier estimate of percentage of cardiovascular mortality.
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pone-0088283-g002: Kaplan-Meier estimate of percentage of cardiovascular mortality.

Mentions: During the follow-up period, 388 patients (35%) died, 156 (14%) due to a cardiovascular cause. Of these, 36 deaths (23%) were due to stroke, 16 (10%) due to acute coronary events, 8 (5%) due to congestive heart failure (5%), and 96 (62%) due to sudden cardiac death. The overall cardiovascular mortality was 2.44% per year. Patients with a history of cancer appeared to have a higher annual cardiovascular mortality than patients without (4.30% per year vs. 2.35% per year, p = 0.08) (Figure 2). Cardiovascular mortality was associated with higher age (77±9 years vs. 71±12 years, p<0.01), and a greater prevalence of underlying atrial fibrillation (32% vs. 20%, p<0.01), significant carotid atherosclerosis (32% vs. 19%, p<0.01), coronary artery disease (24% vs. 16%, p<0.01), heart failure (19% vs. 5%, p<0.01) and chronic kidney disease (14% vs. 6%, p<0.01). Underlying cancer was present in 8% of patients with cardiovascular mortality and in 5% of those without cardiovascular mortality (p = 0.08). Multi-variate Cox regression analysis revealed that presence of cancer (HR: 2.08; 95% CI: 1.08–4.02, p = 0.03), age (HR: 1.04; 95% CI: 1.02–1.06, p<0.01), heart failure (HR: 3.07; 95% CI 1.72–5.47, p<0.01) and significant carotid atherosclerosis (HR: 1.55; 95% CI: 1.02–2.36, p = 0.04) were independent predictors for cardiovascular death (Table 4).


Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

Lau KK, Wong YK, Teo KC, Chang RS, Hon SF, Chan KH, Cheung RT, Li LS, Tse HF, Ho SL, Siu CW - PLoS ONE (2014)

Kaplan-Meier estimate of percentage of cardiovascular mortality.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3921146&req=5

pone-0088283-g002: Kaplan-Meier estimate of percentage of cardiovascular mortality.
Mentions: During the follow-up period, 388 patients (35%) died, 156 (14%) due to a cardiovascular cause. Of these, 36 deaths (23%) were due to stroke, 16 (10%) due to acute coronary events, 8 (5%) due to congestive heart failure (5%), and 96 (62%) due to sudden cardiac death. The overall cardiovascular mortality was 2.44% per year. Patients with a history of cancer appeared to have a higher annual cardiovascular mortality than patients without (4.30% per year vs. 2.35% per year, p = 0.08) (Figure 2). Cardiovascular mortality was associated with higher age (77±9 years vs. 71±12 years, p<0.01), and a greater prevalence of underlying atrial fibrillation (32% vs. 20%, p<0.01), significant carotid atherosclerosis (32% vs. 19%, p<0.01), coronary artery disease (24% vs. 16%, p<0.01), heart failure (19% vs. 5%, p<0.01) and chronic kidney disease (14% vs. 6%, p<0.01). Underlying cancer was present in 8% of patients with cardiovascular mortality and in 5% of those without cardiovascular mortality (p = 0.08). Multi-variate Cox regression analysis revealed that presence of cancer (HR: 2.08; 95% CI: 1.08–4.02, p = 0.03), age (HR: 1.04; 95% CI: 1.02–1.06, p<0.01), heart failure (HR: 3.07; 95% CI 1.72–5.47, p<0.01) and significant carotid atherosclerosis (HR: 1.55; 95% CI: 1.02–2.36, p = 0.04) were independent predictors for cardiovascular death (Table 4).

Bottom Line: Cancer patients are at increased risk of cardiovascular and cerebrovascular events.Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission.In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality.

View Article: PubMed Central - PubMed

Affiliation: Division of Neurology, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China ; Research Center of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.

ABSTRACT

Background and purpose: Cancer patients are at increased risk of cardiovascular and cerebrovascular events. It is unclear whether cancer confers any additional risk for recurrent stroke or cardiovascular mortality after stroke.

Methods: This was a single center, observational study of 1,105 consecutive Chinese ischemic stroke patients recruited from a large stroke rehabilitation unit based in Hong Kong. We sought to determine whether patients with cancer are at higher risk of recurrent stroke and cardiovascular mortality.

Results: Amongst 1,105 patients, 58 patients (5.2%) had cancer, of whom 74% were in remission. After a mean follow-up of 76 ± 18 months, 241 patients developed a recurrent stroke: 22 in patients with cancer (38%, annual incidence 13.94%/year), substantially more than those without cancer (21%, 4.65%/year) (p<0.01). In a Cox regression model, cancer, age and atrial fibrillation were the 3 independent predictors of recurrent stroke with a hazard ratio (HR) of 2.42 (95% confidence interval (CI): 1.54-3.80), 1.01 (1.00-1.03) and 1.35 (1.01-1.82) respectively. Likewise, patients with cancer had a higher cardiovascular mortality compared with those without cancer (4.30%/year vs. 2.35%/year, p = 0.08). In Cox regression analysis, cancer (HR: 2.08, 95% CI: 1.08-4.02), age (HR: 1.04, 95% CI 1.02-1.06), heart failure (HR: 3.06, 95% CI 1.72-5.47) and significant carotid atherosclerosis (HR: 1.55, 95% CI 1.02-2.36) were independent predictors for cardiovascular mortality.

Conclusions: Stroke patients with a past history of cancer are at increased risk of recurrent stroke and cardiovascular mortality.

Show MeSH
Related in: MedlinePlus