Coagulation and inflammation in long-term cancer survivors: results from the adult population

M. Panova-Noeva; A. Schulz; N. Arnold; M. I. Hermanns; J. H. Prochaska; D. Laubert-Reh; H. M. Spronk; M. Blettner; M. Beutel; N. Pfeiffer; T. Munzel; K. J. Lackner; H. ten Cate; P. S. Wild

doi:10.1111/jth.13975

Coagulation and inflammation in long-term cancer survivors: results from the adult population

M. Panova-Noeva^*, A. Schulz, N. Arnold, M. I. Hermanns, J. H. Prochaska, D. Laubert-Reh, H. M. Spronk, M. Blettner, M. Beutel, N. Pfeiffer, T. Munzel, K. J. Lackner, H. ten Cate, P. S. Wild

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The advances in cancer treatment and detection of early cancer have resulted in a steady increase in the number of of cancer survivors over the years. However, because of the long-term toxic effects of chemotherapy and radiotherapy, the incidence of cardiovascular disease (CVD) is increasing in survivors. Objectives: To investigate traditional cardiovascular risk factors (CVRFs), inflammation and the coagulation profile in long-term cancer survivors (cancer diagnosis >= 5 years) from a large adult population-based study sample. Methods: The presence of cardiovascular risk factors (CVRFs) and laboratory markers were compared in individuals with (n = 723) and without (n = 13626) a long-term history of cancer from the Gutenberg Health Study. Data on coagulation factors, D-dimer and von Willebrand factor (VWF) activity were available for 4974 individuals (n = 244 cancer survivors). Results: In multivariable regression models, a history of cancer was, independently of CVRFs and CVD, associated with higher fibrinogen levels (beta 6.99, 95% confidence interval [CI] 1.16-12.8), VWF activity (beta 5.08, 95% CI 0.02-10.1), and antithrombin activity (beta 1.85, 95% CI 0.44-3.27). Cancer survivors with CVD showed notably higher VWF activity than individuals with CVD without a history of cancer, with a difference in the means of 23.0 (7.9-38.1). Multivariate Cox regression analysis, adjusted for CVRFs, confirmed that a long-term history of cancer is associated with a 72% higher mortality. Increased mortality in cancer survivors was dependent on fibrinogen level and VWF activity level. Conclusion: Cancer survivors showed a worse inflammation and coagulation profile than individuals without a history of cancer. Overall mortality in long-term cancer survivors was increased independently of traditional CVRFs. These results underline the need to further investigate plasma biomarkers as complementary cardiovascular risk predictors in cancer survivors.

Original language	English
Pages (from-to)	699-708
Number of pages	10
Journal	Journal of Thrombosis and Haemostasis
Volume	16
Issue number	4
DOIs	https://doi.org/10.1111/jth.13975
Publication status	Published - 1 Apr 2018

Keywords

cancer
cardiovascular disease
coagulation factors
inflammation
mortality
survivors
VON-WILLEBRAND-FACTOR
CARDIOVASCULAR-DISEASE
PLASMA-FIBRINOGEN
OVARIAN-CANCER
RISK
MORTALITY
ATHEROSCLEROSIS
METAANALYSIS
HEALTH
COHORT

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10.1111/jth.13975

Cite this

Panova-Noeva, M., Schulz, A., Arnold, N., Hermanns, M. I., Prochaska, J. H., Laubert-Reh, D., Spronk, H. M., Blettner, M., Beutel, M., Pfeiffer, N., Munzel, T., Lackner, K. J., ten Cate, H., & Wild, P. S. (2018). Coagulation and inflammation in long-term cancer survivors: results from the adult population. Journal of Thrombosis and Haemostasis, 16(4), 699-708. https://doi.org/10.1111/jth.13975

@article{bb98068cdd6442a289e175f8ffbbda8a,

title = "Coagulation and inflammation in long-term cancer survivors: results from the adult population",

abstract = "Background: The advances in cancer treatment and detection of early cancer have resulted in a steady increase in the number of of cancer survivors over the years. However, because of the long-term toxic effects of chemotherapy and radiotherapy, the incidence of cardiovascular disease (CVD) is increasing in survivors. Objectives: To investigate traditional cardiovascular risk factors (CVRFs), inflammation and the coagulation profile in long-term cancer survivors (cancer diagnosis >= 5 years) from a large adult population-based study sample. Methods: The presence of cardiovascular risk factors (CVRFs) and laboratory markers were compared in individuals with (n = 723) and without (n = 13626) a long-term history of cancer from the Gutenberg Health Study. Data on coagulation factors, D-dimer and von Willebrand factor (VWF) activity were available for 4974 individuals (n = 244 cancer survivors). Results: In multivariable regression models, a history of cancer was, independently of CVRFs and CVD, associated with higher fibrinogen levels (beta 6.99, 95% confidence interval [CI] 1.16-12.8), VWF activity (beta 5.08, 95% CI 0.02-10.1), and antithrombin activity (beta 1.85, 95% CI 0.44-3.27). Cancer survivors with CVD showed notably higher VWF activity than individuals with CVD without a history of cancer, with a difference in the means of 23.0 (7.9-38.1). Multivariate Cox regression analysis, adjusted for CVRFs, confirmed that a long-term history of cancer is associated with a 72% higher mortality. Increased mortality in cancer survivors was dependent on fibrinogen level and VWF activity level. Conclusion: Cancer survivors showed a worse inflammation and coagulation profile than individuals without a history of cancer. Overall mortality in long-term cancer survivors was increased independently of traditional CVRFs. These results underline the need to further investigate plasma biomarkers as complementary cardiovascular risk predictors in cancer survivors.",

keywords = "cancer, cardiovascular disease, coagulation factors, inflammation, mortality, survivors, VON-WILLEBRAND-FACTOR, CARDIOVASCULAR-DISEASE, PLASMA-FIBRINOGEN, OVARIAN-CANCER, RISK, MORTALITY, ATHEROSCLEROSIS, METAANALYSIS, HEALTH, COHORT",

author = "M. Panova-Noeva and A. Schulz and N. Arnold and Hermanns, {M. I.} and Prochaska, {J. H.} and D. Laubert-Reh and Spronk, {H. M.} and M. Blettner and M. Beutel and N. Pfeiffer and T. Munzel and Lackner, {K. J.} and {ten Cate}, H. and Wild, {P. S.}",

year = "2018",

month = apr,

day = "1",

doi = "10.1111/jth.13975",

language = "English",

volume = "16",

pages = "699--708",

journal = "Journal of Thrombosis and Haemostasis",

issn = "1538-7933",

publisher = "Wiley",

number = "4",

}

Panova-Noeva, M, Schulz, A, Arnold, N, Hermanns, MI, Prochaska, JH, Laubert-Reh, D, Spronk, HM, Blettner, M, Beutel, M, Pfeiffer, N, Munzel, T, Lackner, KJ, ten Cate, H & Wild, PS 2018, 'Coagulation and inflammation in long-term cancer survivors: results from the adult population', Journal of Thrombosis and Haemostasis, vol. 16, no. 4, pp. 699-708. https://doi.org/10.1111/jth.13975

TY - JOUR

T1 - Coagulation and inflammation in long-term cancer survivors: results from the adult population

AU - Panova-Noeva, M.

AU - Schulz, A.

AU - Arnold, N.

AU - Hermanns, M. I.

AU - Prochaska, J. H.

AU - Laubert-Reh, D.

AU - Spronk, H. M.

AU - Blettner, M.

AU - Beutel, M.

AU - Pfeiffer, N.

AU - Munzel, T.

AU - Lackner, K. J.

AU - ten Cate, H.

AU - Wild, P. S.

PY - 2018/4/1

Y1 - 2018/4/1

N2 - Background: The advances in cancer treatment and detection of early cancer have resulted in a steady increase in the number of of cancer survivors over the years. However, because of the long-term toxic effects of chemotherapy and radiotherapy, the incidence of cardiovascular disease (CVD) is increasing in survivors. Objectives: To investigate traditional cardiovascular risk factors (CVRFs), inflammation and the coagulation profile in long-term cancer survivors (cancer diagnosis >= 5 years) from a large adult population-based study sample. Methods: The presence of cardiovascular risk factors (CVRFs) and laboratory markers were compared in individuals with (n = 723) and without (n = 13626) a long-term history of cancer from the Gutenberg Health Study. Data on coagulation factors, D-dimer and von Willebrand factor (VWF) activity were available for 4974 individuals (n = 244 cancer survivors). Results: In multivariable regression models, a history of cancer was, independently of CVRFs and CVD, associated with higher fibrinogen levels (beta 6.99, 95% confidence interval [CI] 1.16-12.8), VWF activity (beta 5.08, 95% CI 0.02-10.1), and antithrombin activity (beta 1.85, 95% CI 0.44-3.27). Cancer survivors with CVD showed notably higher VWF activity than individuals with CVD without a history of cancer, with a difference in the means of 23.0 (7.9-38.1). Multivariate Cox regression analysis, adjusted for CVRFs, confirmed that a long-term history of cancer is associated with a 72% higher mortality. Increased mortality in cancer survivors was dependent on fibrinogen level and VWF activity level. Conclusion: Cancer survivors showed a worse inflammation and coagulation profile than individuals without a history of cancer. Overall mortality in long-term cancer survivors was increased independently of traditional CVRFs. These results underline the need to further investigate plasma biomarkers as complementary cardiovascular risk predictors in cancer survivors.

AB - Background: The advances in cancer treatment and detection of early cancer have resulted in a steady increase in the number of of cancer survivors over the years. However, because of the long-term toxic effects of chemotherapy and radiotherapy, the incidence of cardiovascular disease (CVD) is increasing in survivors. Objectives: To investigate traditional cardiovascular risk factors (CVRFs), inflammation and the coagulation profile in long-term cancer survivors (cancer diagnosis >= 5 years) from a large adult population-based study sample. Methods: The presence of cardiovascular risk factors (CVRFs) and laboratory markers were compared in individuals with (n = 723) and without (n = 13626) a long-term history of cancer from the Gutenberg Health Study. Data on coagulation factors, D-dimer and von Willebrand factor (VWF) activity were available for 4974 individuals (n = 244 cancer survivors). Results: In multivariable regression models, a history of cancer was, independently of CVRFs and CVD, associated with higher fibrinogen levels (beta 6.99, 95% confidence interval [CI] 1.16-12.8), VWF activity (beta 5.08, 95% CI 0.02-10.1), and antithrombin activity (beta 1.85, 95% CI 0.44-3.27). Cancer survivors with CVD showed notably higher VWF activity than individuals with CVD without a history of cancer, with a difference in the means of 23.0 (7.9-38.1). Multivariate Cox regression analysis, adjusted for CVRFs, confirmed that a long-term history of cancer is associated with a 72% higher mortality. Increased mortality in cancer survivors was dependent on fibrinogen level and VWF activity level. Conclusion: Cancer survivors showed a worse inflammation and coagulation profile than individuals without a history of cancer. Overall mortality in long-term cancer survivors was increased independently of traditional CVRFs. These results underline the need to further investigate plasma biomarkers as complementary cardiovascular risk predictors in cancer survivors.

KW - cancer

KW - cardiovascular disease

KW - coagulation factors

KW - inflammation

KW - mortality

KW - survivors

KW - VON-WILLEBRAND-FACTOR

KW - CARDIOVASCULAR-DISEASE

KW - PLASMA-FIBRINOGEN

KW - OVARIAN-CANCER

KW - RISK

KW - MORTALITY

KW - ATHEROSCLEROSIS

KW - METAANALYSIS

KW - HEALTH

KW - COHORT

U2 - 10.1111/jth.13975

DO - 10.1111/jth.13975

M3 - Article

C2 - 29431889

SN - 1538-7933

VL - 16

SP - 699

EP - 708

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 4

ER -