Retrospective cohort study of real-world cancer-associated arterial thromboembolism burden

Arterial thromboembolism (ATE), including myocardial infarction (MI) and ischemic stroke (iCVD) is increasingly recognized in patients with cancer; however, contemporary population-level data are limited. A retrospective cohort study using the Epic Cosmos database investigated ATE events in cancer patients. Among 1,740,618 patients, the cumulative incidence of ATE was 2.4%, 3.4%, and 4.9% at 1, 2, and 5 years, respectively. Incidence was highest in acute leukemia (5.5%), lung (5.1%), and pancreatic (4.9%), and lowest in prostate (1.5%), uterine (1.5%), breast (0.9%), and testicular (0.5%) cancers. Independent factors associated with ATE onset included cancer-specific characteristics (cancer type, metastatic disease, and systemic therapy), pre-existing cardiovascular disease, cardiovascular risk factors (older age, male sex, diabetes, hypertension, renal disease), and other clinical and laboratory variables. In an analysis adjusted for baseline confounders, time-varying onset of ATE was associated with an approximately 3-fold increase in mortality. The authors conclude that these findings highlight the importance of adapted cardio-oncolgy risk assessment.