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

Incident cardiovascular events and imaging phenotypes in UK Biobank participants with past cancer
Incident cardiovascular events and imaging phenotypes in UK Biobank participants with past cancer
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.
epidemiology, magnetic resonance imaging
1355-6037
1007-1015
Raisi-Estabragh, Zahra
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Cooper, Jackie
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McCracken, Celeste
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Crosbie, Emma J.
ee31bba5-659e-4165-a707-aaee00f040e0
Walter, Fiona M.
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Manistry, Charlotte H.
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Robson, John
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Mamas, Mamas
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Harvey, Nicholas
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Neubauer, Stefan
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Petersen, Steffen E.
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Raisi-Estabragh, Zahra
43c85c5e-4574-476b-80d6-8fb1cdb3df0a
Cooper, Jackie
f78de577-4cac-496f-ad11-5f59dd305046
McCracken, Celeste
5d772e9e-3aaa-41da-a5ef-3943b1631fd9
Crosbie, Emma J.
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Walter, Fiona M.
b7873b25-ca80-495e-9385-2f8b563e0d37
Manistry, Charlotte H.
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Robson, John
3aae61e5-2c15-49db-b25a-86a844287aa0
Mamas, Mamas
41515b72-75ff-4922-bb9f-8f9c63f9f5af
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Neubauer, Stefan
c8a34156-a4ed-4dfe-97cb-4f47627d927d
Petersen, Steffen E.
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Raisi-Estabragh, Zahra, Cooper, Jackie, McCracken, Celeste, Crosbie, Emma J., Walter, Fiona M., Manistry, Charlotte H., Robson, John, Mamas, Mamas, Harvey, Nicholas, Neubauer, Stefan and Petersen, Steffen E. (2023) Incident cardiovascular events and imaging phenotypes in UK Biobank participants with past cancer. Heart, 109, 1007-1015, [heartjnl-2022-321888]. (doi:10.1136/heartjnl-2022-321888).

Record type: Article

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.

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Accepted/In Press date: 28 December 2022
e-pub ahead of print date: 18 April 2023
Published date: 14 June 2023
Additional Information: Funding Information: ZR-E recognizes the National Institute for Health Research (NIHR) Integrated Academic Training programme which supports her Academic Clinical Lectureship post and was also supported by British Heart Foundation Clinical Research Training Fellowship No. FS/17/81/33318. EJC is supported by an NIHR Advanced Fellowship (NIHR300650) and the NIHR Manchester Biomedical Research Centre (IS-BRC-1215-20007). FMW is co-Director of the CanTest Collaborative, which is funded by Cancer Research UK (CC8640/A23385). SN and CM were supported by the Oxford NIHR Biomedical Research Centre and SN by Oxford NIHR Biomedical Research Centre and the Oxford British Heart Foundation Centre of Research Excellence. SEP acknowledges support from the 'SmartHeart' EPSRC programme grant (www. nihr.ac.uk; EP/P001009/1) and the European Union's Horizon 2020 research and innovation programme under grant agreement No 825903 (euCanSHare project). SEP and SN acknowledge the British Heart Foundation for funding the manual analysis to create a cardiovascular magnetic resonance imaging reference standard for the UK Biobank imaging-resource in 5000 CMR scans (www.bhf.org.uk; PG/14/89/31194). NCH acknowledges support from MRC (MC_PC_21003; MC_PC_21001) and NIHR Southampton Biomedical Research Centre. CHM is supported directly and indirectly from the NIHR Biomedical Research Centres at University College London Hospitals and Barts Health NHS Trusts. Barts Charity (G-002346) contributed to fees required to access UK Biobank data [access application #2964]. This article is supported by the London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare (AI4VBH), which is funded from the Data to Early Diagnosis and Precision Medicine strand of the government’s Industrial Strategy Challenge Fund, managed and delivered by Innovate UK on behalf of UK Research and Innovation (UKRI). Views expressed are those of the authors and not necessarily those of the AI4VBH Consortium members, the NHS, Innovate UK, or UKRI. This project was enabled through access to the MRC eMedLab Medical Bioinformatics infrastructure, supported by the Medical Research Council (www.mrc.ac.uk; MR/L016311/1). The funders did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
Keywords: epidemiology, magnetic resonance imaging

Identifiers

Local EPrints ID: 474175
URI: http://eprints.soton.ac.uk/id/eprint/474175
ISSN: 1355-6037
PURE UUID: f86ea324-dc41-4fa3-be56-aca2bb9375f8
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 14 Feb 2023 18:01
Last modified: 17 Mar 2024 07:38

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Contributors

Author: Zahra Raisi-Estabragh
Author: Jackie Cooper
Author: Celeste McCracken
Author: Emma J. Crosbie
Author: Fiona M. Walter
Author: Charlotte H. Manistry
Author: John Robson
Author: Mamas Mamas
Author: Nicholas Harvey ORCID iD
Author: Stefan Neubauer
Author: Steffen E. Petersen

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