| Abstract: | Background/Aims Clinicians commonly face decisions about prevention of coronary heart disease following a new diagnosis of cancer. Such decisions must take into account cancer prognosis, cardiovascular risk status, overall burden of morbidity, and the patient's goals, preferences and values. In cases of favorable cancer prognosis and elevated CHD risk, continued or intensified treatment of risk factors is warranted. In cases of poor cancer prognosis and/or high morbidity burden, a less intensive approach may be appropriate. Methods Study design: Historical cohort analysis. Population: 10,313 persons with a cancer diagnosis between January, 2001 and December, 2008 and a range of SEER 5-year survival categories. We assessed LDL cholesterol (LDL) control, blood pressure control, and hemoglobin A1c control each as a function of morbidity burden (using Charlson score), cancer 5-year survival, and the interaction between them in specific at-risk sub-populations. We used linear mixed models with random intercept for each patient and splines at cancer diagnosis and 6- and 12- months post cancer diagnosis to model each outcome occurring less than 2 years prior and 5 years post cancer diagnosis. Results Better LDL goal attainment was associated with higher morbidity in sub-populations characterized by need for cholesterol treatment. For persons with a diagnosis of hypertension, better blood pressure control was associated with lower morbidity burden. Neither LDL nor blood pressure goal attainment was associated with cancer stage at diagnosis. Both blood pressure and LDL control improved in the 6 months after cancer diagnosis. In persons with diabetes, attainment of hemoglobin A1c goal was not associated with either morbidity burden or cancer stage. Discussion In these sub-cohorts characterized by indications for cardiovascular risk factor control, control of risk factors was a function of morbidity, but not cancer stage. This raises the possibility that guideline-driven care of cardiovascular risk factors is neither intensified in the face of good cancer prognoses nor decreased in the face of poor cancer prognoses. These findings should be further explored with attention to detailed patient and clinician factors in order to make appropriate recommendations for patient-centered care delivery in complex patient populations. |
