Dr. Ameen, ENT Specialist in Kuala Lumpur

Sun L, Brody R, Candelieri D, et al. Risk of Cardiovascular Events Among Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg. Published online June 22, 2023. doi:10.1001/jamaoto.2023.1342

Abstract

Importance  Cardiovascular (CV) disease is a substantial cause of morbidity and mortality in cancer due to shared risk factors and exposure to potentially cardiotoxic cancer therapy. However, our understanding of CV risk in patients with head and neck squamous cell carcinoma (HNSCC) is limited.

Objective  To define CV risk profiles, incident stroke, myocardial infarction (MI), and mortality in patients with HNSCC.

Design, Setting, Participants  This retrospective, population-based cohort study included 35 897 US veterans with newly diagnosed HNSCC from January 1, 2000, to December 31, 2020. Data were analyzed from May 2022 to January 2023.

Exposures  Demographic, cancer-specific, and treatment characteristics

Main Outcomes  Prevalence of CV risk factors, medication use, and control at HNSCC diagnosis; cumulative incidence of stroke and MI; and all-cause death.

Results  Of 35 857 US veterans with HNSCC (median [IQR] age, 63 [58-69] years; 176 [0.5%] American Indian or Alaska Native, 57 [0.2%] Asian, 5321 [16.6%] Black, 207 [0.6%] Native Hawaiian or Other Pacific Islander, and 26 277 [82.0%] White individuals), there were high rates of former or current smoking (16 341 [83%]), hypertension (24 023 [67%]), diabetes (7988 [22%]), and hyperlipidemia (18 421 [51%]). Although most patients were taking risk-lowering medications, 15 941 (47%) had at least 1 uncontrolled CV risk factor. Black race was associated with increased risk of having uncontrolled CV risk factor(s) (relative risk, 1.06; 95% CI, 1.03-1.09), and patients with larynx cancer had higher rates of prevalent and uncontrolled risk factors compared with other cancer subsites. Considering death as a competing risk, the 10-year cumulative incidence of stroke and MI was 12.5% and 8.3%, respectively. In cause-specific hazards models, hypertension, diabetes, carotid artery stenosis, coronary artery disease, and presence of uncontrolled CV risk factor(s) were significantly associated with stroke and MI. In extended Cox models, incident stroke and MI were associated with a 47% (95% CI, 41%-54%) and 71% (95% CI, 63%-81%) increased risk of all-cause death, respectively.

Conclusion  The results of this cohort study suggest that in HNSCC, the burden of suboptimally controlled CV risk factors and incident risk of stroke and MI are substantial. Modifiable CV risk factors are associated with risk of adverse CV events, and these events are associated with a higher risk of death. These findings identify populations at risk and potentially underscore the importance of modifiable CV risk factor control and motivate strategies to reduce CV risk in HNSCC survivorship care.

Komen saya: Cardiovascular risk factors atau nama lain, risiko penyakit jantung seperti darah tinggi, kencing manis, kolesterol, berat yang berlebihan, kurang bersenam dan merokok adalah risiko2 yang boleh dikawal jika kita tahu dan sedar masalah itu, dan tahu bagaimana untuk mengatasinya. Lagi2 dalam kes-kes kanser Head and Neck, risiko kematian lagi tinggi! Kajian di atas menunjukkan ‘the obvious’.

Nasihat saya, kurangkan portion makanan (setengah dari biasa), makan makanan yang berkhasiat, tinggalkan makanan berlemak/berminyak/processed food, buat intermittent fasting yang mudah, dan senaman at least 30minit sehari untuk kurangkan risiko sakit jantung 🙂 Insyallah badan dan minda bertambah sihat 🙂