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.

研究背景 本研究旨在探讨癌症病史与各类心血管疾病事件发生率的关联，并明确癌症病史是否会调节传统心血管危险因素与新发心血管疾病之间的关系。
研究方法 本项回顾性队列研究采用JMDC理赔数据库（JMDC Claims Database），共纳入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。
研究结果 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显著升高（风险比（Hazard Ratio, HR）=1.26，95%置信区间（95% Confidence Interval, 95% CI）=1.22~1.29）。其中，心肌梗死、心绞痛、脑卒中、心力衰竭及心房颤动对应的风险比分别为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、高血压及糖尿病）即使在有癌症病史的人群中，仍与新发复合心血管疾病相关，但此类传统危险因素的总人群归因分值在有癌症病史的人群中更低。
研究结论 有癌症病史的人群（尤其是需接受癌症化疗者）发生心血管疾病的风险更高。传统危险因素在有或无癌症病史人群的心血管疾病发生进程中均具有重要作用。但在有癌症病史的人群中，传统危险因素的总人群归因分值有所降低。