Previous studies on cardiovascular disease (CVD) death risk in cancer patients mostly focused on overall cancer, age subgroups and single cancers. To assess the CVD death risk in non-metastatic cancer patients at 21 cancer sites. A total of 1,672,561 non-metastatic cancer patients from Surveillance, Epidemiology, and End Results (SEER) datebase (1975–2018) were included in this population-based study, with a median follow-up of 12·7 years. The risk of CVD deaths was assessed using proportions, competing-risk regression, absolute excess risks (AERs), and standardized mortality ratios (SMRs). In patients with localized cancers, the proportion of CVD death and cumulative mortality from CVD in the high-competing risk group (14 of 21 unique cancers) surpassed that of primary neoplasm after cancer diagnosis. The SMRs and AERs of CVD were found higher in patients with non-metastatic cancer than the general US population (SMR 1·96 [95 %CI, 1·95-1·97]–19·85[95 %CI, 16·69-23·44]; AER 5·77–210·48), heart disease (SMR 1·94[95 %CI, 1·93-1·95]–19·25[95 %CI, 15·76-23·29]; AER 4·36–159·10) and cerebrovascular disease (SMR 2·05[95 %CI, 2·02-2·08]–24·71[95 %CI, 16·28-35·96]; AER 1·01–37·44) deaths. In the high-competing risk group, CVD-related SMR in patients with localized stage cancer increased with survival time but followed a reverse-dipper pattern in the low-competing risk group (7 of 21 cancers). The high-competing risk group had higher CVD-related death risks than the low-competing risk group. The CVD death risk in patients with non-metastatic cancer varied by cancer stage, site and survival time. The risk of CVD mortality is higher in 14 out of 21 localized cancers (high-competing cancers). Targeted strategies for CVD management in non-metastatic cancer patients are needed.

中文翻译：

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21种非转移性癌症患者的长期和短期心血管疾病死亡率

此前关于癌症患者心血管疾病（CVD）死亡风险的研究主要集中在整体癌症、年龄亚组和单一癌症上。评估 21 个癌症部位非转移性癌症患者的 CVD 死亡风险。这项基于人群的研究纳入了来自监测、流行病学和最终结果 (SEER) 数据库 (1975-2018) 的总共 1,672,561 名非转移性癌症患者，中位随访时间为 12·7 年。使用比例、竞争风险回归、绝对超额风险（AER）和标准化死亡率（SMR）评估CVD死亡风险。在局部癌症患者中，高竞争风险组（21 种独特癌症中的 14 种）中 CVD 死亡比例和 CVD 累积死亡率在癌症诊断后超过了原发性肿瘤。研究发现，非转移性癌症患者的 CVD 的 SMR 和 AER 高于美国普通人群（SMR 1·96 [95 % CI，1·95-1·97]–19·85 [95 % CI，16· 69-23·44]；AER 5·77–210·48)，心脏病（SMR 1·94[95 % CI, 1·93-1·95]–19·25[95 % CI, 15·76- 23·29]；AER 4·36–159·10) 和脑血管疾病 (SMR 2·05[95 % CI, 2·02-2·08]–24·71[95 % CI, 16·28-35· 96]；AER 1·01–37·44）死亡。在高竞争风险组中，局部期癌症患者的 CVD 相关 SMR 随着生存时间的延长而增加，但在低竞争风险组（21 种癌症中的 7 种）中则遵循相反的下降模式。高竞争风险组的CVD相关死亡风险高于低竞争风险组。非转移性癌症患者的 CVD 死亡风险因癌症分期、部位和生存时间而异。 21 种局部癌症（高竞争性癌症）中，有 14 种的 CVD 死亡风险较高。非转移性癌症患者需要有针对性的 CVD 管理策略。