Jürgen H. Prochaska, Iris M. Hermanns, Andreas Schulz, Philipp S. Wild, Maria Blettner, Dagmar Laubert-Reh, Hugo ten Cate, Norbert Pfeiffer, Thomas Münzel, Manfred Beutel, Marina Panova-Noeva, Natalie Arnold, Karl J. Lackner, Henri M. Spronk
Background
The advancements in cancer treatment and detection of early cancer have resulted in steady increase of cancer survivors over the years. However, due to long term toxic effects of chemotherapy and radiotherapy, the incidence of cardiovascular disease (CVD) is increasing in survivors.
Objectives
This study investigates traditional cardiovascular risk factors (CVRFs), inflammation and coagulation profile in long-term cancer survivors (cancer diagnosis ≥ five years) from a large adult population-based study sample.
Methods
Presence of cardiovascular risk factors (CVRFs) and laboratory markers were compared in individuals with (n=723) and without (n=13626) long-term history of cancer from the Gutenberg Health Study. Coagulation factors, D-Dimer and von Willebrand factor (vWf) activity were available in 4974 individuals (n=244 cancer survivors).
Results
In multivariable regression models, history of cancer was, independently of CVRFs and CVD, associated with higher fibrinogen concentration (ß: 6.99, 95%CI[1.16-12.8]), vWf activity (ß: 5.08, [0.02-10.1]) and antithrombin activity (ß:1.85, [0.44-3.27]). Cancer survivors with CVD showed particularly higher vWf activity compared to individuals with CVD without cancer history with difference of the means = 23.0 (7.9-38.1). Multivariate cox-regression analysis confirmed that a long-term history of cancer is independent of CVRFs associated with a 73% higher mortality. Increased mortality in cancer survivors was dependent on fibrinogen concentration and vWf activity level.
Conclusion
Cancer survivors showed a worse inflammation and coagulation profile compared to individuals without history of cancer. Overall mortality in long-term cancer survivors was increased independent of traditional CVRFs. These results underline the need to further investigate plasma biomarkers as complementary cardiovascular risk predictors in cancer survivors.
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