关键词: 癌症, 动脉僵硬度, 心血管疾病, 死亡率

Abstract: Objective Cancer survivors have a higher risk of cardiovascular disease (CVD) than second malignancies. It is of great clinical significance to prevent the occurrence of cardiovascular diseases in advance by identifying potential risk factors. The estimated pulse wave velocity (ePWV) can reflect the degree of arterial stiffness and is an independent alternative indicator of cardiovascular events. Its simple calculation method provides a feasibility for cardiovascular risk stratification in cancer patients. Our main aim was to determine the relationship ePWV and cardiovascular disease-related mortality in cancer patients. Methods We conducted a prospective cohort study using the data of 4862 cancer patients in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, and followed up the cohort, including age, gender, race, body mass index, chest circumference, basic heart rate, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure, diabetes status, cardiovascular disease history, smoking, drinking status.With ePWV as a variable, the quartile method was used for grouping. All the subjects were divided into four groups according to the value of the index, which were recorded as Q1, Q2, Q3 and Q4 groups. The differences between different subgroups were visually displayed by forest map. Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the association between ePWV and cardiovascular and all-cause mortality in cancer patients. Draw a receiver operating characteristic (ROC) curve for the predictive value of ePWV on cancer patient mortality, and calculate the area under the ROC curve (AUC). Results During the median follow-up period of 11.8 years, 830 all-cause deaths, 572 cancer-related deaths and 376 cardiovascular disease-related deaths were recorded. In the unadjusted model, for every 1m/s increase in ePWV, the risk of all-cause and cardiovascular-related death increased by 33 % and 50 %, respectively. Elevated ePWV was independently associated with all-cause mortality, with hazard ratios [95%CI] of 1.00, 1.57 (1.07, 2.30), 2.03 (1.21, 3.41) and 2.34 (1.19, 4.58) in quartiles 1-4, respectively. Elevated ePWV was also independently associated with cardiovascular-related mortality. The hazard ratios [95%CI] of the 1-4 quartiles were 1.00, 2.84 (1.14, 7.06), 3.75 (1.27, 11.08) and 5.90 (1.62, 21.53), respectively. The correlation between ePWV and all-cause and cardiovascular-related mortality in cancer patients was significant, with adjusted HR [95%CI] of 1.5 (1.45-1.55) and 1.83 (1.69-1.99), respectively. The ROC curve showed that the area under the curve of ePWV predicting the risk of death in cancer patients was 0.753. Conclusion We have validated for the first time in cancer patients that elevated ePWV is positively correlated with all-cause mortality and cardiovascular related mortality risk, highlighting the importance of mitigating ePWV progression in clinical practice.

Key words: cancer, arterial stiffness, cardiovascular disease, mortality rate