Supplementary Material for: Association of Cancer and Its Interaction with Conventional Risk Factors on Cardiovascular Disease Risk

Introduction We sought to examine the association of cancer history with the incidence of individual cardiovascular disease events and to clarify whether the history of cancer modifies the relationship between conventional cardiovascular risk factors and incident cardiovascular disease.
Methods This retrospective cohort study used the JMDC Claims Database, including 3,531,683 individuals. The primary endpoint was the composite cardiovascular disease outcome, which included myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation.
Results During a follow-up, 144,162 composite endpoints were recorded. Individuals with a history of cancer had a higher risk of developing composite cardiovascular disease events (HR 1.26, 95% CI 1.22-1.29). The HRs for myocardial infarction, angina pectoris, stroke, heart failure, and atrial fibrillation were 1.11 (95% CI 0.98-1.27), 1.15 (95% CI 1.10-1.20), 1.11 (95% CI 1.05-1.18), 1.39 (95% CI 1.34-1.44), and 1.22 (95% CI 1.13-1.32), respectively. Individuals who required chemotherapy for cancer had a higher risk of developing cardiovascular disease. Although conventional risk factors (e.g., overweight/obesity, hypertension, and diabetes) were associated with incident composite cardiovascular disease even in individuals with a history of cancer, the total population-attributable fractions of conventional risk factors were less in individuals with a history of cancer.
Conclusion Individuals with a history of cancer (particularly those requiring chemotherapy) have a higher risk of cardiovascular disease. Traditional risk factors are important in the development of cardiovascular disease in individuals with and without a history of cancer. In individuals with a history of cancer, however, the total population-attributable fractions of conventional risk factors decreased.

引言 本研究旨在探讨癌症病史与各心血管疾病事件发生风险的关联，并明确癌症病史是否会改变传统心血管危险因素与新发心血管疾病之间的关系。
方法 本回顾性队列研究使用JMDC索赔数据库（JMDC Claims Database），纳入3531683名研究对象。本研究的主要终点为复合心血管疾病结局，涵盖心肌梗死、心绞痛、脑卒中、心力衰竭及心房颤动。
结果 随访期间共记录到144162例复合终点事件。有癌症病史的研究对象发生复合心血管疾病事件的风险更高（风险比HR=1.26，95%置信区间CI：1.22~1.29）。针对心肌梗死、心绞痛、脑卒中、心力衰竭及心房颤动的风险比分别为1.11（95%CI：0.98~1.27）、1.15（95%CI：1.10~1.20）、1.11（95%CI：1.05~1.18）、1.39（95%CI：1.34~1.44）及1.22（95%CI：1.13~1.32）。需要接受癌症化疗的患者发生心血管疾病的风险更高。尽管传统心血管危险因素（如超重/肥胖、高血压、糖尿病）即便在癌症病史人群中也与复合心血管疾病的新发风险相关，但癌症病史人群中传统危险因素的总人群归因分值更低。
结论 有癌症病史的人群（尤其是需要接受化疗的患者）发生心血管疾病的风险更高。传统危险因素无论在有还是无癌症病史的人群中，均对心血管疾病的发生具有重要作用。但在癌症病史人群中，传统危险因素的总人群归因分值有所降低。