Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history

Akyea, Ralph K.; Iyen, Barbara; Georgiopoulos, Georgios; Kai, Joe; Qureshi, Nadeem; Ntaios, George

Abstract

Background: Up to 10% of patients with ischaemic stroke have comorbid cancer and stroke in these patients is thought to have a poor short-term prognosis. There is little known about the long-term cardiovascular morbidity and mortality outcomes after incident ischaemic stroke in patients with recent cancer history.

Objective: To assess the risk of subsequent cardiovascular morbidity and mortality outcomes in patients with an incident ischaemic stroke and recent cancer history.

Methods: Patients aged ≥18 years with an incident ischaemic stroke between 1998 and 2017, with any diagnosis of cancer within 12 months before the stroke event, and no prior history of serious vascular event were identified from UK Clinical Practice Research Datalink (CPRD GOLD) linked to Hospital Episode Statistics (HES) data. To minimize selection bias, these patients were propensity-score matched with patients with incident ischaemic stroke and no history of cancer. Propensity-score matching was done using covariates such as demographic data, vascular risk factors, comorbid conditions, and prescribed medication. Multivariable models (Competing risks and Cox regression) were used to determine the risk of subsequent major adverse cardiovascular event (MACE) outcomes and all-cause mortality.

Results: Our cohort included 22,460 patients with a median age of 75 (IQR 64–83) years and a follow-up of 12.3 (IQR 7.2–16.7) years. Recent cancer was identified in 1,149 patients (5.1%) at the time of incident ischaemic stroke. The patients with recent cancer history had a lower risk of composite MACE (sub-distribution hazard ratio (SHR) 0.83 [95% CI: 0.75–0.92]) and recurrent stroke (SHR 0.85 95% CI:0.75–0.96]) and a higher risk of all-cause mortality (hazard ratio 1.67 [95% CI:1.47–1.91]). The risk of coronary heart disease, peripheral vascular disease, heart failure, and CVD-related death outcomes did not differ significantly between the groups.

Conclusions: After incident ischaemic stroke, patients with recent cancer history have a lower risk of composite MACE and recurrent stroke outcomes but a higher risk of all-cause mortality when compared with patients without a prior history of cancer.

Citation

Akyea, R. K., Iyen, B., Georgiopoulos, G., Kai, J., Qureshi, N., & Ntaios, G. (2023). Cardiovascular outcomes and mortality after incident ischaemic stroke in patients with a recent cancer history. European Journal of Internal Medicine, 109, 50-57. https://doi.org/10.1016/j.ejim.2022.12.006

• Journal Article Type: Article
• Acceptance Date: Dec 14, 2022
• Online Publication Date: Dec 21, 2022
• Publication Date: 2023-03
• Deposit Date: Dec 15, 2022
• Publicly Available Date: Dec 21, 2022
• Journal: European Journal of Internal Medicine
• Print ISSN: 0953-6205
• Electronic ISSN: 1879-0828
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 109
• Pages: 50-57
• DOI: https://doi.org/10.1016/j.ejim.2022.12.006
• Keywords: Internal Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/14890756
• Publisher URL: https://www.ejinme.com/article/S0953-6205(22)00436-8/fulltext