Risk and predictors of subsequent cancers of patients with newly-diagnosed atrial fibrillation — A nationwide population-based study
Section snippets
Background
Atrial fibrillation (AF) is a disease of the elderly, with an increasing prevalence and incidence with age. AF not only increases the risk of stroke, but also increased the risk of death by 1.5 fold in males and 1.9-fold in females in the Framingham Heart Study [1]. Although cardiovascular diseases represented the most common cause of mortality among AF patients, cancer also accounted for approximately 11% of all deaths in patients with AF in a recent pooled analysis of 4 randomized trials of
Methods
The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.
Results
The baseline characteristics of study population are shown in Table 1. The mean age of AF patients was 70.8 ± 13.1 years, and 55.2% were men. Hypertension is the most common comorbidity which is prevalent among 68.5% of patients. Overall, the cohort was observed for 1385,140 person-years with a median follow-up of 3.1 years.
Main findings
To our knowledge, this is the largest observational cohort of AF patients in which the absolute and relative risk of cancer and its predictors were investigated. Our principal findings are as follows: (i) AF patients had an increased risk of almost every kind of cancer, which was consistently observed in males and females; (ii) the increased risk of cancer was highest within 1 year and persisted beyond 10 years after AF was diagnosed; and (iii) several clinical factors were identified to be
Conclusion
In the nationwide cohort study, we show that the risk of cancer was higher for AF patients compared to that of general population. The relative risk was higher early after an AF diagnosis but persisted in the long term. Age, male gender, hypertension, diabetes, chronic obstructive pulmonary diseases and liver cirrhosis are independent risk factors of cancer among AF patients. Prompt and detailed examinations may be considered for incident AF patients with multiple risk factors to early detect
Acknowledgments
- 1.
This work was supported in part by grants from the Ministry of Science and Technology (MOST 107-2314-B-075-062-MY3), Research Foundation of Cardiovascular Medicine and Szu-Yuan Research Foundation of Internal Medicine, Taipei, Taiwan.
- 2.
This study is based in part on data from the National Health Insurance Research Database provided by the Bureau of National Health Insurance, Department of Health and managed by National Health Research Institutes. The interpretation and conclusions contained
Declaration of Competing Interest
None.
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2021, Progress in Cardiovascular DiseasesCitation Excerpt :Also the incidence of cancer increased in the first year after AF diagnosis7 and persisted up to 10 years from the diagnosis as showed by Hung et al. in a previous retrospective study.43 The association between cancer and AF is not surprising, given that these two conditions share risk factors, such as male sex, aging, smoking, obesity, chronic obstructive pulmonary disease, alcohol abuse, liver cirrhosis, hypertension and diabetes41,48,49: indeed, these were risk factors for new-onset cancer, with the risk of cancer increasing with the number of factors present (HR 1.40, 95%CI 1.28–1.53 for 1 factor, and HR 5.14, 95%CI 4.03–6.06 for patients with all risk factors).43 There are several mechanisms potentially linking AF and cancer (Fig. 1), including systemic inflammation which seems to represent a common milieu for these two conditions.
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