Arterial stiffness is associated with cardiovascular and cancer mortality in cancer patients: Insight from NHANESIII.

BACKGROUND: Cancer survivors are at greater risk for cardiovascular disease (CVD) than second malignancy, resulting in a decreased quality of life and increased cost of care. Additional knowledge of CVD prevention by identifying possible risk factors has clinical relevance. Our main objective was to determine the relevance of a clinical index of arterial stiffness, pulse pressure, in predicting CVD mortality in cancer patients, with a second objective to examine its relationship with cancer mortality. METHODS: We retrospectively analyzed 781 cancer patients from Third National Health and Nutrition Examination Survey and Linked Mortality File, including demographic, anthropometric, blood pressure, and cause of death. Kaplan-Meier survival curve and Cox hazard regression analyses were performed to assess the relationship between pulse pressure and cardiovascular, cancer, and all-cause mortality. RESULTS: During a mean follow-up time of 8.1 years, 603 deaths, 257 cancer and 151 CVD, occurred. In unadjusted models, the risk of CVD, cancer, and all-cause mortality were 3.8-fold, 5.3-fold, and 1.6-fold higher, respectively, for pulse pressure ≥70 â€‹mmHg compared to <50 â€‹mmHg. Adjusted analyses revealed a higher CVD mortality in cancer patients <65 years with a pulse pressure 60-70 â€‹mmHg (adjusted hazard ratio, 5.26; 95%CI, 1.12-24.78) when compared to pulse pressure of <50 â€‹mmHg. Pulse pressure was not associated with risk of all-cause, CVD, or cancer in those ≥65 years. CONCLUSION: Pulse pressure, an index of arterial stiffness, is predictive of CVD mortality in cancer patients. Our findings support non-invasive office-setting measurements of arterial stiffness to identify high risk patients.

Health behaviors and patient-practitioner communication in cancer patients and the general population: an analysis of the National Health and Nutrition Examination Survey (NHANES) 2005-2014.

PURPOSE: The purpose of the study was to investigate the prevalence of poor health behaviors (low dietary quality, low physical activity (PA), and high body mass index (BMI)) in cancer patients and the general population and its relationship with receipt of patient-physician recommendations. METHODS: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 2005-2014 to compare 1846 patients with a history of cancer to 16,641 with no cancer history. BMI was measured during physical exam. Dietary quality and PA were obtained from a questionnaire, along with receipt of physician recommendations for each behavior. RESULTS: Cancer patients had dietary quality that "needs improvement," were not meeting PA recommendations, and were overweight. Compared to the general population, dietary quality (54 vs. 54, p = .80), prevalence of physical inactivity (34% vs. 31%, p = .01), and BMI (28 vs. 28, p < .01) were similar. Among cancer patients, prevalence of physician recommendations to improve dietary quality (33.5%), increase PA or exercise (47.7%), and lose or control weight (32.1%) were low. Physicians recommended health behavior change to cancer patients more frequently than the general population (p < .01). Overweight and physically inactive cancer patients were more likely to receive physician recommendations (ps < .01). Physician recommendations were not associated with dietary quality (p = .65). CONCLUSIONS: Prevalence of poor diet, physical inactivity, and obesity is high in both populations with less than 50% of patients receiving physician health behavior recommendations. These findings underscore the need for increased frequency and efficacy of patient-physician health behavior recommendations, especially in cancer patients, to improve patient outcomes.

Anticancer Therapy-Related Increases in Arterial Stiffness: A Systematic Review and Meta-Analysis.

Background Cardio-oncology is a clinical discipline focused primarily on the early detection of anticancer therapy-related cardiomyopathy. However, there is growing evidence that the direct adverse consequences extend beyond the myocardium to affect the vasculature, but this evidence remains limited. In addition, there remains a paucity of clinically based strategies for monitoring vascular toxicity in these patients. Importantly, arterial stiffness is increasingly recognized as a surrogate end point for cardiovascular disease and may be an important vascular outcome to consider. Therefore, the aim of this systematic review and meta-analysis was to summarize evidence of increased arterial stiffening with anticancer therapy and evaluate the effect of treatment modifiers. Methods and Results A total of 19 longitudinal and cross-sectional studies that evaluated arterial stiffness both during and following anticancer therapy were identified using multiple databases. Two separate analyses were performed: baseline to follow-up (12 studies) and control versus patient groups (10 studies). Subgroup analysis evaluated whether stiffness differed as a function of treatment type and follow-up time. Standard mean differences and mean differences were calculated using random effect models. Significant increases in arterial stiffness were identified from baseline to follow-up (standard mean difference, 0.890; 95% CI, 0.448-1.332; P<0.0001; mean difference, 1.505; 95% CI, 0.789-2.221; P≤0.0001) and in patient versus control groups (standard mean difference, 0.860; 95% CI, 0.402-1.318; P=0.0002; mean difference, 1.437; 95% CI, 0.426-2.448; P=0.0052). Subgroup analysis indicated differences in arterial stiffness between anthracycline-based and non-anthracycline-based therapies (standard mean difference, 0.20; 95% CI, 0.001-0.41; P=0.048), but not follow-up time. Conclusions Significant arterial stiffening occurs following anticancer therapy. Our findings support the use of arterial stiffness as part of a targeted vascular imaging strategy for the identification of early cardiovascular injury during treatment and for the detection of long-term cardiovascular injury into survivorship.