Abstract 4141925: Impact of Chemotherapy Exposure on New-Onset Cardiovascular Disease Risk in Cancer Survivors

Background: Five-year survivors of cancer are at excess risk of non-cancer competing morbidity and mortality including cardiovascular disease (CVD). However, whether excess risk differs based on exposure to specific chemotherapy treatments is unclear. We compared risk of CVD among 5-year cancer survivors with or without prior chemotherapy exposure. Methods: Using a retrospective cohort design, we identified 25,535 pan-cancer survivors with ≥5 years follow-up at MSKCC. New onset CVD events (i.e., heart failure [HF], myocardial infarction [MI], stroke) were ascertained based upon administrative billing codes. Cumulative incidence rates (CIR) were estimated, accounting for the competing risk of death, and differences between groups with and without chemotherapy treatment were evaluated using Gray’s test. Multivariable Fine and Gray proportional hazard models estimated sub-distribution hazard ratios (sHR) and 95%CIs for survivors treated with versus without chemotherapy. Subgroups of survivors treated with an individual class of chemotherapy were also examined. Results: Median follow-up was 116.2 (IQR, 80.6-162.0) months (Table). Compared to survivors with no chemotherapy exposure, survivors with prior chemotherapy treatment had higher CIR of HF (7.62% vs. 2.77%, P<0.01) and stroke (5.44% vs. 3.06%, P<0.01), but not MI (3.92% vs 3.49%, P=0.20). In multivariable models, survivors who received chemotherapy had higher risk of HF (sHR: 4.08; 95% CI: 3.47-4.80), MI (sHR: 1.61; 95% CI: 1.36-1.91), and stroke (sHR: 2.64; 95% CI: 2.20-3.15). Risks of CVD varied based upon type of chemotherapy received (Figure 1). Conclusion: Cancer survivors who received chemotherapy had higher risks of CVD compared with survivors without chemotherapy exposure, with variation based upon type of chemotherapy. These findings underscore the need for aggressive CVD risk factor modification and prevention in cancer survivors, especially those who received chemotherapy associated with increased CVD risk.