Incidental coronary calcium in cancer patients treated with anthracycline and/or trastuzumab

Author:

Hooks Matthew1,Sandhu Gurmandeep2,Maganti Tejaswini2,Chen Ko-Hsuan Amy2,Wang Michelle2,Cullen Ryan1,Velangi Pratik S12,Gu Christina3,Wiederin Jason4,Connett John5,Brown Roland5,Blaes Anne6ORCID,Shenoy Chetan2ORCID,Nijjar Prabhjot S2ORCID

Affiliation:

1. Department of Medicine, University of Minnesota Medical School , Minneapolis, MN 55455 , USA

2. Cardiovascular Division, Department of Medicine, University of Minnesota Medical School , 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455 , USA

3. University of Minnesota Medical School , Minneapolis, MN 55455 , USA

4. Department of Medicine, Hennepin County Medical Center , Minneapolis, MN 55415 , USA

5. Biostatistics, Epidemiology and Research Design (BERD), University of Minnesota , Minneapolis, MN 55455 , USA

6. Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School , Minneapolis, MN 55455 , USA

Abstract

Abstract Aims Cancer patients are at increased risk of cardiovascular disease (CVD) after treatment with potentially cardiotoxic treatments. Many cancer patients undergo non-gated chest computed tomography (NCCT) for cancer staging prior to treatment. We aimed to assess whether coronary artery calcification on NCCT predicts CVD risk in cancer patients. Methods and results Six hundred and three patients (mean age: 61.3 years, 30.8% male) with either breast cancer, lymphoma, or sarcoma were identified retrospectively. Primary endpoint was a major adverse cardiac event (MACE) composite including non-fatal myocardial infarction, new heart failure (HF) diagnosis, HF hospitalization, and cardiac death, with Fine-Gray analysis for non-cardiac death as competing risk. Secondary endpoints included a coronary composite and a HF composite. Coronary artery calcification was present in 194 (32.2%) and clinically reported in 85 (43.8%) patients. At a median follow-up of 5.3 years, 256 (42.5%) patients died of non-cardiac causes. Coronary artery calcification presence or extent was not an independent predictor of MACE [sub-distribution hazards ratio (SHR) 1.28; 0.73–2.27]. Coronary artery calcification extent was a significant predictor of the coronary composite outcome (SHR per two-fold increase 1.14; 1.01–1.28), but not of the HF composite outcome (SHR per two-fold increase 1.04; 0.95–1.14). Conclusion Coronary artery calcification detected incidentally on NCCT scans in cancer patients is prevalent and often not reported. Coronary artery calcification presence or extent did not independently predict MACE. Coronary artery calcification extent was independently associated with increased risk of CAD events but not HF events.

Funder

NIH

University of Minnesota Clinical

Translational Science Institute

University of Minnesota Medical School Faculty Research Award

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Epidemiology

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