New study endometrial cancer and heart disease risk

When compared with matched controls, endometrial cancer survivors were 47% more likely to develop hypertension, diseases of the arteries, arterioles, and capillaries; diseases of the veins and lymphatics; and diseases of the heart between 1 year and 5 years after cancer diagnosis, reported Mia Hashibe, PhD, of the Huntsman Cancer Institute in Salt Lake City, and colleagues.

An elevated risk was observed for peripheral and vascular atherosclerosis (HR= 1.81); hypotension (HR=1.86); pulmonary heart disease (HR=1.74); atrial fibrillation (HR =1.50); and phlebitis, thrombophlebitis, and thromboembolism (HR= 2.07) in the first 5 years after a diagnosis of cancer, the study authors reported online in the Journal of the National Cancer Institute.

At 5 to 10 years after diagnosis, survivors of endometrial cancer were 33% more likely to have heart disease than women in the general population were.

"These results highlight the importance of placing greater emphasis on survivorship and that increased monitoring and risk management for cardiovascular disease for 10 years among endometrial cancer survivors is warranted," the researchers wrote. "Cerebrovascular disease was the only major category for which no increased risk was observed among endometrial cancer survivors."

Since cardiovascular disease is the leading causeof death among endometrial cancer survivors, more research into the long-term cardiovascular outcomes among endometrial cancer survivors is "critical," the team emphasized. As of 2017, there were an estimated 757,200 survivors of endometrial cancer in the United States.

"We hope that our study contributes to awareness of the endometrial cancer survivor's experience of cancer treatment side effects that can persist in the long-term and of new treatment-related diseases that may be diagnosed years after the cancer diagnosis," Hashibe told MedPage Today.

The same lifestyle changes that help prevent cardiovascular disease, such as quitting smoking, increasing physical activity, maintaining a healthy weight, and eating more fresh fruits and vegetables, "would be beneficial to cancer survivors as well," she said. The study showed that overweight and obese endometrial cancer survivors had a 20-25% increase in heart disease risk.

"We are currently working on developing risk-prediction models that will help to calculate individualized risk estimates for cardiovascular disease among endometrial cancer survivors. We hope this will help patients be informed about their cardiovascular disease risks due to their lifestyle and clinical profiles."

Although several earlier studies have examined long-term cardiovascular outcomes among endometrial cancer survivors, this study is the first to quantify hypertension risk among endometrial cancer survivors compared with the general population, the researchers said.

The results showed that endometrial cancer survivors had an increased risk for hypertension for up to 10 years following cancer diagnosis (HR=1.52 at 1-5 years after diagnosis; and HR=1.25 at 5-10 years). The strongest predictors of developing hypertension were overweight or obesity, increased age, and a higher Charlson Comorbidity Index. These are all shared risk factors for endometrial cancer, the investigators noted.

However, the burden of cardiovascular disease remained high even after adjusting for body mass index, baseline Charlson Comorbidity Index, and race, they said. The risk did not vary based on treatment type, stage, or grade. "Our findings provide further evidence for the strong association between shared risk factors for both endometrial cancer and hypertension."

Survivors of endometrial cancer who had radiation and/or chemotherapy were at increased risk for heart and circulatory system disorders between 1 year and 5 years after cancer diagnosis when compared with women treated with surgery alone, the study showed.

For the analysis, endometrial cancer survivors age 18 and older with a diagnosis of invasive first primary endometrial cancer between 1997 and 2012 were identified using data from the Statistics, Epidemiology, and End Results Utah Cancer Registry. Electronic medical records and statewide ambulatory surgery and inpatient data were used to identify cardiovascular disease diagnoses.

Each survivor was then matched with up to five women from the general population identified through the Utah Population Database.

The cohort of endometrial cancer survivors had a higher proportion of obese individuals than the general population cohort (44.2% versus 19.2%; P<0.001) Low-grade tumors were diagnosed in 81.5% of the endometrial cancer survivors and 80.3% had local-stage disease.

A total of 68.5% of the survivors were treated with surgery alone, while 21.9% received surgery and radiotherapy; 3.2% underwent surgery and chemotherapy; and 4.7% received surgery, radiotherapy, and chemotherapy.

There were few associations with heart disease 10 or more years after a diagnosis of cancer. Those associations that remained included hypotension (HR= 1.71), diseases of the veins and lymphatics (HR=1.46), and other diseases of the veins and lymphatics (HR=2.48).

Study limitations, Hashibe et al said, included the fact that baseline data on body mass index was not available for all study subjects, and that treatment data were limited to broad categories that did not include radiation dosage, specific chemotherapy agents, and treatment duration.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner 

LAST UPDATED 05.15.2018

Next: Hydrochlorothiazide Tied to Increased Melanoma Risk