Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Apr 24, 2024; 15(4): 548-553
Published online Apr 24, 2024. doi: 10.5306/wjco.v15.i4.548
Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors: A decade-apart study of two nationwide cohorts
Rupak Desai, Avilash Mondal, Vivek Patel, Sandeep Singh, Shaylika Chauhan, Akhil Jain
Rupak Desai, Independent Researcher, Atlanta, GA 30079, United States
Avilash Mondal, Vivek Patel, Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA 19152, United States
Sandeep Singh, Department of Clinical Epidemiology, Biostatistics and Bio-informatics, Amsterdam UMC, Amsterdam 7057, Netherlands
Shaylika Chauhan, Department of Internal Medicine, Geisinger Health System, Wikes-Barre, PA 18702, United States
Akhil Jain, Division of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX 77079, United States
Author contributions: Desai R, Singh S and Chauhan S conceptualized the methodology of manuscript; Desai R and Mondal A collected resources to write the manuscript; Desai R, Patel V, Singh S, Chauhan S and Jain A reviewed and edited the manuscript; Desai R analyzed the manuscript with software; Desai R, Mondal A, Singh S, Chauhan S and Jain A visualized the results; Singh S, Chauhan S and Jain A supervised the manuscripts. All authors have read and approved the final manuscript.
Institutional review board statement: As the datasets are publicly available and de-identified, they were exempt from institutional review board approval.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at drshaylikachauhan@gmail.com. Participants consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shaylika Chauhan, MD, FACP, Clinical Assistant Professor (Honorary), Department of Internal Medicine, Geisinger Health System, 1000 E Mountain Blvd, Wikes-Barre, PA 18702, United States. drshaylikachauhan@gmail.com
Received: December 26, 2023
Peer-review started: December 26, 2023
First decision: January 15, 2024
Revised: March 18, 2024
Accepted: March 21, 2024
Article in press: March 21, 2024
Published online: April 24, 2024
Abstract
BACKGROUND

Over the years, strides in colon cancer detection and treatment have boosted survival rates; yet, post-colon cancer survival entails cardiovascular disease (CVD) risks. Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.

AIM

To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.

METHODS

We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample, studying two colon cancer survivor groups for CVD risk factors, mortality rates, and major adverse events like pulmonary embolism, arrhythmia, cardiac arrest, and stroke, adjusting for confounders via multivariable regression analysis.

RESULTS

Of total colon cancer survivors hospitalized in 2007 (n = 177542) and 2017 (n = 178325), the 2017 cohort often consisted of younger (76 vs 77 years), male, African-American, and Hispanic patients admitted non-electively vs the 2007 cohort. Furthermore, the 2017 cohort had higher rates of smoking, alcohol abuse, drug abuse, coagulopathy, liver disease, weight loss, and renal failure. Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities, including hypertension, hyperlipidemia, diabetes, obesity, peripheral vascular disease, congestive heart failure, and at least one traditional CVD (P < 0.001) vs the 2007 cohort. On adjusted multivariable analysis, the 2017 cohort had a significantly higher risk of pulmonary embolism (PE) (OR: 1.47, 95%CI: 1.37-1.48), arrhythmia (OR: 1.41, 95%CI: 1.38-1.43), atrial fibrillation/flutter (OR: 1.61, 95%CI: 1.58-1.64), cardiac arrest including ventricular tachyarrhythmia (OR: 1.63, 95%CI: 1.46-1.82), and stroke (OR: 1.28, 95%CI: 1.22-1.34) with comparable all-cause mortality and fewer routine discharges (48.4% vs 55.0%) (P < 0.001) vs the 2007 cohort.

CONCLUSION

Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events (stroke 28%, PE 47%, arrhythmia 41%, and cardiac arrest 63%). It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Keywords: Colon cancer, Colorectal cancer, Cardiovascular diseases, Cardiovascular disease risk, Cardiac events, Stroke

Core Tip: Colon cancer survivors hospitalized 10 years apart in the United States showed an increased cardiovascular disease risk with an increased risk of acute cardiovascular events (stroke 28%, pulmonary embolism 47%, arrhythmia 41%, and cardiac arrest 63%). Increased screening in this cohort is important.