High Prevalence of Cardiovascular Risk Factors in Head and Neck Cancers

New research suggests a high prevalence of uncontrolled cardiovascular (CV) risk factors among patients with head and neck cancers.

These uncontrolled CV risk factors are associated with a “substantial” increased risk of stroke, myocardial infarction (MI), and death, researchers found. They reported these findings in JAMA Otolaryngology-Head & Neck Surgery.

In this retrospective study, researchers examined data from 35,857 US veterans in the Veterans Health Administration database who were diagnosed with head and neck squamous cell carcinoma (HNSCC) between 2000 and 2020.

The median age of the cohort was 63 years. Most patients were men (98.9%) and White (82.0%). The most common sites of disease were the oropharynx (36.2%), larynx (35.5%), and oral cavity (19.6%).

Nearly half of patients (47.8%) had at least 1 uncontrolled CV risk factor. Uncontrolled CV risk factors were more likely among Black patients (relative risk [RR], 1.06; 95% CI, 1.03-1.09) and patients aged 65 years or older (RR, 1.07; 95% CI, 1.04-1.09).

At 10 years, the cumulative incidence of stroke among patients without a history of stroke was 12.5%. The cumulative incidence of MI at 10 years among patients without a history of MI was 8.3%.

Patients with uncontrolled CV risk factors had a higher risk of stroke (cause-specific hazard ratio [csHR], 1.09; 95% CI, 1.02-1.17) and MI (csHR, 1.19; 95% CI, 1.10-1.29).

The greatest risk factors for stroke were carotid artery stenosis (csHR, 22.18; 95% CI, 19.10-25.75), hypertension (csHR, 1.39; 95% CI, 1.29-1.50), kidney disease (csHR, 1.31; 95% CI, 1.12-1.53), and coronary artery disease (csHR, 1.24; 95% CI, 1.14-1.34).

For MI, the factors that carried the greatest risk included coronary artery disease (csHR, 4.04; 95% CI, 3.72-4.39), atrial fibrillation (csHR, 1.51; 95% CI, 1.19-1.93), and kidney disease (csHR, 1.50; 95% CI, 1.30-1.74).

In a multivariable analysis, the risk of all-cause death was increased by 47% in patients who had a stroke and by 71% in patients who had an MI.

“The results of this cohort study suggest that, in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial,” the researchers concluded. “These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Sun L, Brody R, Candelieri D, et al. Risk of cardiovascular events among patients with head and neck cancer. JAMA Otolaryngal Head Neck Surg. Published online June 22, 2023. doi:10.1001/jamaoto.2023.1342