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Nature Sub-Journal: Cancer survivors have these changes in four blood lipids, be careful of myocardial infarction and stroke!

 Last Update: 2021-11-13
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Due to early detection and improved treatment, the life span of cancer patients has been extended

This study aims to examine the circulating lipid concentrations of patients with myocardial infarction or stroke in combination with national registration data, and to compare the lipid profiles of patients with and without a history of cancer at the time of diagnosis of myocardial infarction or stroke, including high-density lipoprotein cholesterol (HDL-C).

Compare the lipid profile of patients with and without a history of cancer at the time of diagnosis of myocardial infarction or stroke, including high-density lipoprotein cholesterol (HDL-C), triglycerides, total cholesterol and most importantly LDL-C concentration; high-density lipoprotein Cholesterol (HDL-C), triglycerides, total cholesterol and the most important LDL-C concentration; determine whether the relationship between LDL-C concentration between previous cancer and no cancer at the time of myocardial infarction is related to the relationship between the LDL-C concentration at the time of stroke, previous cancer and The relationship between LDL-C concentration is different between cancer-free patients ; to determine whether patients with previous cancer have a worse prognosis after myocardial infarction and stroke after myocardial infarction and stroke; fourth, evaluate the preventive treatment of previous lipid-lowering therapy (LLT) in patients with previous cancer Impact

We identified 78,721 people who had MI incidents between January 1, 2007 and December 31, 2017

The median duration from cancer diagnosis to myocardial infarction was 2251 days (6 years and 61 days)

During the same time period, we identified 62,871 stroke patients

Similar to the myocardial infarction cohort, the previous cancer group was older and had a higher proportion of women (Table 2)

Figure 2 shows the relationship between the cumulative incidence of myocardial infarction and stroke patients and the LDL-C concentration in the previous cancer state

Especially for patients with myocardial infarction with a history of hyperlipidemia, Figure 3 shows the cumulative incidence of myocardial infarction in the previous cancer group and the cancer-free group, stratified by whether the patients received LLT before the occurrence of myocardial infarction

The geometric mean LDL-C concentration at the time of myocardial infarction in the previous cancer group was 21% lower than that in the cancer-free group [unadjusted ratio 0.

The geometric mean LDL-C concentration at the time of myocardial infarction in the previous cancer group was 21% lower than that in the cancer-free group [unadjusted ratio 0.
79, 95% CI 0.
78-0.
80] (Figure 4)
.
The geometric mean LDL-C concentration at the time of myocardial infarction in the previous cancer group was 21% lower than that in the cancer-free group.
After adjusting for age, gender, body mass index, previous hypertension treatment, previous diabetes treatment and previous LLT treatment, the LDL-C concentration in the previous cancer group The geometric mean was still 13% lower than the cancer-free group (adjusted ratio 0.
87, 95% CI 0.
85-0.
89)
.
After adjusting for age, gender, body mass index, previous hypertension treatment, previous diabetes treatment, and previous LLT treatment, the geometric mean LDL-C concentration of the previous cancer group was still 13% lower than that of the cancer-free group

There was no significant difference in triglyceride concentration, but after correction, the geometric mean of HDL-C and total cholesterol concentrations in the previous cancer group were significantly reduced (Figure 4)
.
Compared with those patients who had been treated with LLT before the MI event (adjusted ratio 0.
92, 95% CI 0.
90-0.
94), if LLT was not treated before the MI event, the LDL between the previous cancer group and the cancer-free group The geometric mean of the C concentration has a greater difference (corrected ratio 0.
83, 95%CI 0.
79-0.
87) (Figure 4)
.

There was no significant difference in triglyceride concentration, but after correction, the geometric mean of HDL-C and total cholesterol concentrations in the previous cancer group were significantly reduced (Figure 4)
.
After correction, the geometric mean of HDL-C and total cholesterol concentrations in the previous cancer group were significantly lower than those of patients who had been treated with LLT before the MI event (corrected ratio 0.
92, 95%CI 0.
90-0.
94), if Without LLT treatment before the MI event, the geometric mean difference of LDL-C concentration between the previous cancer group and the cancer-free group was greater (corrected ratio 0.
83, 95% CI 0.
79-0.
87) (Figure 4)
.
Compared with those patients who had been treated with LLT before the MI event (adjusted ratio 0.
92, 95% CI, if LLT treatment was not performed before the MI event, the geometric mean of LDL-C concentration between the previous cancer group and the cancer-free group Bigger difference

At the time of stroke, the geometric mean of LDL-C concentrations in the previous cancer group was 11% lower (unadjusted ratio 0.
89, 95% CI 0.
87-0.
90), and still 7% lower after adjustment (adjusted ratio 0.
93, 95% CI 0.
91-0.
95) )
.
There was no significant difference in triglyceride or HDL-C concentration, but total cholesterol in the previous cancer group was again significantly lower than in the cancer-free group ( Figure 4)
.
At the time of stroke, the geometric mean of LDL-C concentrations in the previous cancer group was 11% lower (unadjusted ratio 0.
89, 95% CI 0.
87-0.
90), and still 7% lower after adjustment (adjusted ratio 0.
93, 95% CI 0.
91-0.
95) )
.
At the time of stroke, the geometric mean of LDL-C concentration in the previous cancer group was 11% lowerand still 7% lower after adjustment.
There was no significant difference in triglyceride or HDL-C concentration, but total cholesterol was again significantly lower in the previous cancer group The cancer-free group ( Figure 4)
.
The total cholesterol in the previous cancer group was again significantly lower than the cancer-free group (

3.
LDL-C concentration in MI and stroke patients with a previous history of cancer

3.
LDL-C concentration in MI and stroke patients with a history of cancer 3.
LDL-C concentration in MI and stroke patients with a history of cancer

Table 3 shows the median LDL-C concentration associated with cancer characteristics at the time of myocardial infarction and stroke
.
According to gender, cancer stage, and length of time for cancer diagnosis, LDL-C has no clinically significant difference
.
Among all cancer subtypes, the median LDL-C concentration of patients with myocardial infarction is lower than that of stroke patients
.
Among patients with myocardial infarction, cancers involving the hepatobiliary system and pancreas have the lowest median LDL-C concentrations
.
Among stroke patients, cancers involving malignancies of the hepatobiliary system, pancreas, upper digestive tract and hematological system have the lowest median LDL-C concentrations
.
Except for stroke patients who received radiotherapy, there was no significant difference in the LDL-C concentration of different cancer treatments
.

Table 3 shows the median LDL-C concentration associated with cancer characteristics at the time of myocardial infarction and stroke
.
According to gender, cancer stage, and length of time for cancer diagnosis, LDL-C has no clinically significant difference
.
Among all cancer subtypes, the median LDL-C concentration of patients with myocardial infarction is lower than that of stroke patients
.
Among patients with myocardial infarction, cancers involving the hepatobiliary system and pancreas have the lowest median LDL-C concentrations
.
Among stroke patients, cancers involving malignancies of the hepatobiliary system, pancreas, upper digestive tract and hematological system have the lowest median LDL-C concentrations
.
Among patients with myocardial infarction, cancers involving the hepatobiliary system and pancreas have the lowest median LDL-C concentrations
.
Among stroke patients, cancers involving malignancies of the hepatobiliary system, pancreas, upper digestive tract and hematological system have the lowest median LDL-C concentrations
.
Except for stroke patients who received radiotherapy, there was no significant difference in the LDL-C concentration of different cancer treatments
.

4.
Mortality after myocardial infarction and stroke

4.
Mortality after myocardial infarction and stroke 4.
Mortality after myocardial infarction and stroke 4.
Mortality after myocardial infarction and stroke

The adjusted risk of all-cause mortality after myocardial infarction and stroke in the previous cancer group was higher than that in the cancer-free group (Table 4)
.
The correlation between past cancer and mortality after myocardial infarction is significant.
The relative risk of mortality from myocardial infarction after previous cancer is about 50% higher, regardless of whether the patient has LLT before myocardial infarction
.
The correlation between past cancer and post-stroke mortality is more significant, and the relative risk of stroke mortality after past cancer is 95% higher
.
The correlation between past cancer and mortality after myocardial infarction is significant.
The relative risk of mortality from myocardial infarction after previous cancer is about 50% higher, regardless of whether the patient has LLT before myocardial infarction
.
The correlation between past cancer and post-stroke mortality is more significant, and the relative risk of stroke mortality after past cancer is 95% higher
.
Although LLT treatment before MI is not associated with a reduction in mortality after MI, in a stratified study of past cancers and past LLT, patients with past cancer who did not receive LLT treatment before MI had the highest post-MI mortality (adjusted p<0.
001 )
.
The highest post-MI mortality in cancer patients who were not treated with LLT before MI was p<0.
001

In summary, this study reports the differences in plasma LDL-C concentrations for MI and stroke in the national cancer patient population
.
After comparing more than 40,000 MI or stroke patients over a 10-year period, it was found that at the time of myocardial infarction, the corrected geometric mean LDL-C concentration of patients with previous cancer was 13% lower than that of patients without cancer.
At the time of stroke, previous cancers The corrected geometric mean LDL-C concentration of patients was 7% lower than that of patients without cancer
.
The difference in LDL-C concentration between the previous cancer and cancer-free groups was most obvious in MI patients who did not receive LLT before the MI event
.
Past cancer has a 48% higher mortality rate after MI and a 95% higher mortality rate after stroke.
However, LLT treatment before MI is not associated with a reduction in mortality after MI
.
At the time of myocardial infarction, the corrected geometric mean LDL-C concentration of patients with previous cancer was 13% lower than that of patients without cancer.
At the time of stroke, the corrected geometric mean LDL-C concentration of patients with previous cancer was lower than that of patients without cancer.
7%
.
The difference in LDL-C concentration between the previous cancer and cancer-free groups was most obvious in MI patients who did not receive LLT before the MI event
.
Past cancer has a 48% higher mortality rate after MI and a 95% higher mortality rate after stroke.
However, LLT treatment before MI is not associated with a reduction in mortality after MI
.

In summary, past cancers are associated with lower LDL-C at the time of myocardial infarction or stroke
.
The difference in LDL-C concentration between the previous cancer group and the cancer-free group was greater in patients with myocardial infarction than in stroke patients, and the difference in LDL-C concentration between the two groups was reduced when LLT treatment was performed before myocardial infarction occurred
.
LDL-C concentration is low when myocardial infarction or stroke occurs, and past cancers are associated with poor survival after myocardial infarction and stroke
.
Previous cancer patients who did not undergo LLT before myocardial infarction had the greatest risk of death after myocardial infarction
.
In the future, we need further research to better determine the LDL-C control goals and the role and intensity of LLT in preventing myocardial infarction and stroke in cancer survivors
.

In summary, past cancers are associated with lower LDL-C at the time of myocardial infarction or stroke
.
Past cancers are associated with lower LDL-C at the time of myocardial infarction or stroke
.
The difference in LDL-C concentration between the previous cancer group and the cancer-free group was greater in patients with myocardial infarction than in stroke patients, and the difference in LDL-C concentration between the two groups was reduced when LLT treatment was performed before myocardial infarction occurred
.
LDL-C concentration is low when myocardial infarction or stroke occurs, and past cancers are associated with poor survival after myocardial infarction and stroke
.
Previous cancer patients who did not undergo LLT before myocardial infarction had the greatest risk of death after myocardial infarction
.
In the future, we need further research to better determine the LDL-C control goals and the role and intensity of LLT in preventing myocardial infarction and stroke in cancer survivors
.
The difference in LDL-C concentration between the previous cancer group and the cancer-free group was greater in patients with myocardial infarction than in stroke patients, and the difference in LDL-C concentration between the two groups was reduced when LLT treatment was performed before myocardial infarction occurred
.
LDL-C concentration is low when myocardial infarction or stroke occurs, and past cancers are associated with poor survival after myocardial infarction and stroke
.
Previous cancer patients who did not undergo LLT before myocardial infarction had the greatest risk of death after myocardial infarction
.
In the future, we need further research to better determine the LDL-C control goals and the role and intensity of LLT in preventing myocardial infarction and stroke in cancer survivors
.

Original source:

ChiehYang Koo, et al.
Lipid profiles and outcomes of patients with prior cancer and subsequent myocardial infarction or stroke.

Scientifc Reports | (2021) 11:21167 | https://doi.
org/10.
1038/s41598-021-00666-z

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