Distribution Of Cardiovascular Comorbidities In Cancer Patients With Potential Indications For VEGF Inhibitors

Background: Many studies have found that the application of vascular endothelial growth factor(VEGF)signaling pathway inhibitors can increase the risk of cardiovascular diseases(CVDs)in cancer patients.However,the distribution of cardiovascular comorbidities in cancer patients at baseline before initiation of chemotherapy is rarely reported.The purpose of this study was to investigate the distribution of cardiovascular disease complications in cancer patients with potential VEGF inhibitor indications before anticancer therapy,and to provide evidence for drug use in such patients.Methods: A total of 4148 newly diagnosed cancer patients registered from 1January 2013 to 31 December 2017 were included,including 3286 patients with colorectal cancer,862 patients with renal cell carcinoma,excluding patients who was not diagnosed with cancer newly or ever had cancer treatment,And excluded patients who were not suitable for the use of VEGF inhibitors.Baseline data,cardiovascular complications and risk factors were collected for statistical analysis.Results: Renal cell carcinoma and colorectal cancer patients carry a high burden of CVD-related comorbidities before the application of VEGF inhibitors,mainly for hypertension(HTN),Coronary heart disease(CHD),Atrial fibrillation(AF)and heart failure(HF).The highest prevalence was hypertension,and the prevalence of HTN in renal cell carcinoma was significantly higher than colorectal cancer(33.2% vs.29.0%,p=0.016).However,the prevalence rates of CHD,AF and HF were not significantlydifferent between the two groups..In terms of risk factors associated with cardiovascular disease,the prevalence of lipid metabolic disorders was significant,accounting for more than 50%,with the largest proportion of patients with abnormal HDL cholesterol.The other risk factors were smoking,diabetes,and alcohol.In this study,cancer patients with grade III hypertension account 72.7% out of the total hypertension cases.Whereas,cancer patients diagnosed with grade I and II HTN accounts for 4.1 and 23.2%,respectively.Out of the total cancer patients with HTN,the prevalence of high-risk level was found to be 33.3%,very high-risk level was 43.2%,moderate risk and low risk present a smaller percentage of hypertension prevalence(23.5% and 0%).Both in the renal cell carcinoma and colorectal cancer patients,the average age(73.18±10.27 vs.66.32±12.41;p< 0.001),combined with HF(6.6% vs.1.2%;P<0.001),CHD(20.3% vs.3.0%;P<0.001),AF(9.7% vs.2.4%;P< 0.001)and the proportion of patients with diabetes(34.1% vs.9.5%;P< 0.001)in the HTN group were significantly higher than those in the uncombined HTN group.Similarly,the proportion of dyslipidemia(57.7% vs.21.7%;P<0.5),uric acid(54.4% vs.41.8%;P<0.001)and creatinine(116.34 ±144.28 vs.87.76± 77.93;p<0.001)levels in the HTN group was also higher than the other.Age and sex-adjusted binary logistic regression showed that colorectal cancer patients with CHD(OR:5.392;95% CI: 3.759-7.734)or AF(OR:3.797;95% CI: 2.373-6.076)had a higher risk of having HTN.Renal cell carcinoma patients with CHD(OR: 2.627;95% CI: 1.272-5.428)or HF(OR:7.418;95% CI: 1.301-42.282)had a higher risk of having HTN.Among the patients with HTN,27% did not take antihypertensive drugs regularly,and33.5% did not reach the target blood pressure.Of the patients who did not reach the target range of normal blood pressure,32.7% did not meet systolic blood pressure standards and 5.9% did not meet diastolic blood pressure standards.Conclusions: Cancer patients were associated with a high risk of cardiovascular diseases before the application of VEGF antagonists,including HTN,CHD,AF,and HF.HTN was the most common comorbidity.Compared with patients without HTN,merger of HTN cancer patients with more other cardiovascular disease and related risk factors of cardiovascular disease,however,a considerable number of HTN patients do not meet the recommended standard for blood pressure control,this may limit the use of VEGF inhibitors in the future and the therapeutic effect,while that for cancer patients with cardiovascular risk assessment and management of importance remain to be improved.