Cardioprotective medications are underutilized in patients at high risk of cardiovascular disease (CVD) who have a history of cancer, according to results of a cross-sectional observational study. These findings were published in the Journal of the American College of Cardiology (JACC): Cardiooncology.
Although rates of CVD have been shown to be higher in the population of patients with cancer compared with the general population, inconsistent results have been observed across previous studies examining the use of cardioprotective medications, such as antiplatelet agents, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and beta blockers, in patients with a history of cancer.
“While a major focus of cardio-oncology research has been on cancer therapy–induced cardiotoxicity, optimization of cardiac care in patients with [a cancer history] has not been widely addressed,” the authors of this study noted.
The aim of this study was to compare cardioprotective medication use in patients with and without a history of cancer in a cohort at high-risk of CVD admitted to the cardiology unit of a large, tertiary, regional hospital in New South Wales, Australia, between July 2018 and January 2019.
Of the 320 patients included in the study, all had an indication for cardioprotective medications, and 69 patients had a history of cancer, with the date of cancer diagnosis, on average, preceding the date of the index hospital admission by 11 years. Furthermore, only 11 patients in the latter subgroup were undergoing active treatment for cancer.
Of note, compared with patients without a history of cancer (15.9%), those with a cancer history were significantly more likely to have a diagnosis of heart failure (30.4%; P =.009).
On multivariable analyses adjusted for potential confounding factors including age, sex, body mass index (BMI), hypertension, dyslipidemia, smoking status, diabetes mellitus, and CVD, patients with a history of cancer were significantly less likely to be receiving treatment with a statin (odds ratio [OR], 0.41; 95% CI, 0.22-0.77; P =.006) or antiplatelet therapy (OR, 0.53; 95% CI, 0.29-1.00; P =.049) compared with those without a cancer history. Furthermore, patients with a history of cancer were also significantly less likely to have a current prescription for either a statin or antiplatelet therapy.
However, neither current use of an ACE inhibitor, ARB therapy, or beta blockers, or the likelihood of having a current prescription for these medications, differed significantly in these 2 subgroups of patients.
“Given that [cancer history] is associated with an increased CVD risk, we believe that this issue is of substantial public health importance,” the study authors stated.
They further noted that this study “highlights practice and policy gaps and the need to develop strategies to improve guideline-directed cardioprotective therapies in cancer patients and survivors.”
Untaro R, Chen D, Kelly C, et al. Suboptimal use of cardioprotective medications in patients with a history of cancer [published online June 2, 2020]. JACC: CardioOncology. doi: 10.1016/j.jaccao.2020.05.010