Abstract 14482: Not Only Cardiovascular but Also Cancer Mortality is Increased in Patients With Different Manifestations of Vascular Disease
Objective: To evaluate causes of death and years of life lost (YLL) in patients with stable vascular disease.
Methods: Cause-specific standardized mortality ratios (SMRs) were calculated for patients with coronary artery disease (CAD, n=2681), cerebrovascular disease (CVD, n=955), peripheral artery disease (PAD, n=697), abdominal aortic aneurysm (AAA, n=186) or polyvascular disease (n=884) included in the prospective SMART-cohort. YLL were calculated and compared to the general Dutch population. Determinants for cause-specific mortality were evaluated using competing risks models.
Results: During a median follow-up of 5.5 years, 791 patients (15%) died, which was higher than expected (SMR 1.49, 95% CI 1.38 - 1.61). Besides an increased risk of cardiovascular mortality (SMR 2.74, 95%CI 2.48 - 3.02), patients with vascular disease also had a higher risk of dying from cancer (SMR 1.20, 95%CI 1.03 - 1.38). Risk levels were not increased in patients with CAD, whereas patients with PAD and polyvascular disease had the highest risk of both cardiovascular (SMR 3.28, 95%CI 2.52 - 4.21 and 4.89, 95%CI 4.18 - 5.68, respectively) and cancer mortality (SMR 1.88, 95%CI 1.34 - 2.58 and 1.38, 95%CI 1.02 - 1.82). Presence of an AAA also increased the risk of nonvascular, noncancer mortality. Average excess YLL are displayed in the figure. Determinants for all causes of death were current smoking, BMI <20 kg/m2 and impaired renal function, whereas diabetes and metabolic syndrome increased risk of cardiovascular-, but not of cancer mortality.
Conclusions: Patients with vascular disease are at increased risk of early death not only from cardiovascular disease, but also from cancer. Particularly patients with PAD, AAA and polyvascular disease are also at high risk of nonvascular mortality. These results underline the necessity to target both mutual and cause-specific risk factors to reduce all-cause mortality, especially in relatively young patients with manifest vascular disease.
- Coronary artery disease
- Cerebrovascular disorders
- Peripheral arterial disease
- Abdominal aortic aneurysm
- © 2013 by American Heart Association, Inc.