Incidence and risk factors of cardiovascular mortality in patients with gastrointestinal adenocarcinoma

Abstract

Background Gastrointestinal (GI) cancers are common and fatal. Improved cancer-directed therapies, with thier substantial role in improving cancer-specific survival, may increase non-cancer mortality−including cardiovascular mortality−in these patients. Aim To identify the risk factors of cardiovascular mortality in GI adenocarcinoma patients. Methods Data of GI adenocarcinoma patients were gathered from the Surveillance, Epidemiology, and End Results database. We used Pearson’s chi-square test to assess the relationships between categorical variables. We used the Kaplan-Meyer test in the univariate analysis and Cox regression test for the multivariate analysis. Results Among 556,350 included patients, 275,118 (49.6%) died due to adenocarcinoma, 64,079 (11.5%) died due to cardiovascular causes, and 83,161 (14.9%) died due to other causes. Higher rates of cardiovascular mortality were found in patients ≥ 50 years (HR, 8.476; 95% CI, 7.91–9.083), separated (HR, 1.27; 95% CI, 1.184–1.361) and widowed (HR, 1.867; 95% CI, 1.812–1.924), patients with gastric (HR, 1.18; 95% CI, 1.1–1.265) or colorectal AC (HR, 1.123; 95% CI, 1.053–1.198), and patients not undergone surgery (HR, 2.04; 95% CI, 1.958–2.126). Lower risk patients include females (HR, 0.729; 95% CI, 0.717–0.742), blacks (HR, 0.95; 95% CI, 0.924–0.978), married (HR, 0.77; 95% CI, 0.749–0.792), divorced (HR, 0.841; 95% CI, 0.807–0.877), patients with pancreatic AC (HR, 0.83; 95% CI, 0.757–0.91), and patients treated with chemotherapy (HR, 0.416; 95% CI, 0.406–0.427). Conclusions Risk factors for cardiovascular mortality in GI adenocarcinoma include advanced age, males, whites, separated and widowed, gastric or colorectal adenocarcinoma, advanced grade or advanced stage of the disease, no chemotherapy, and no surgery. Married and divorced, and patients with pancreatic adenocarcinoma have a lower risk.