ePWV对癌症患者全因和心血管相关死亡率的预测价值研究

BackgroundCurrentlythe landscape of cancer treatment has undergone significant transformationswith numerous cancer patients now surviving in a chronic disease paradigm over extended periods. Research indicates that a substantial number of cancer survivors succumb to non-tumor factorswith cardiovascular diseaseCVD being a prominent cause among them. Neverthelessthe potential CVD risks associated with cancer treatment are frequently overlookedresulting in inadequate early intervention and protective measures.The estimated pulse wave velocityePWV can reflect the degree of arterial stiffness and is an independent predictor of cardiovascular events. The simple calculation method provides feasibility for cardiovascular risk stratification in cancer patients. ObjectiveTo assess the influencing factors of ePWV for all-cause mortality and cardiovascular disease mortality in a cohort of cancer patients. MethodsA retrospective cohort design was used. The cohort included 4 632 cancer patients who attended the National Health and Nutrition Examination SurveyNHANES database from 1999 to 2018. Baseline data were collectedincluding agegenderracebody mass indexBMIchest circumference baseline heart ratetotal cholesterolTChigh-density lipoprotein cholesterolHDL-Csystolic blood pressureSBP diastolic blood pressureDBPdiabetes statushistory of cardiovascular diseasesmoking and drinking status. Follow-up to July 2023. With ePWV as the variablethe quartile method was used for grouping. All the subjects were divided into 4 groupswhich were recorded as Q1Q2Q3 and Q4 groups. The baseline levels of the 4 groups were comparedand the Kaplan-Meier survival curves related to all-cause mortality and cardiovascular disease mortality of the patients were plotted. Cox proportional hazard regression model were used to explore the relationship of ePWV and mortality in cancer patients. The receiver operating characteristicROC curve of the predictive value of ePWV for death in cancer patients was drawnand the area under the ROC curveAUC was calculated. ResultsA total of 4 632 patientswith an average age of60.71.01 yearswere enrolledcomprising 2 426 females52.37% and 2 206 males47.63%. There were 1 158 cases25.0 % in Q1-Q4 groups. Significant differences were observed among the four groups in terms of agegenderraceBMIchest circumferencebaseline heart rateTCHDL-CSBPDBPdiabetes historycardiovascular disease historysmoking statusand alcohol consumption statusP<0.05. During the follow-up period83017.9 % of 4632 cancer patients died of all-cause and 3768.1 % died of cardiovascular disease.There were significant differences in all-cause mortality and cardiovascular disease mortality among the four groupsP<0.001. Kaplan-Meier survival analysis revealed statistically significant differences in the survival curves related to all-cause mortality and CVD mortality among 4 groups2 =587.11P<0.0012 =322.97P<0.001. The results of multivariate Cox regression analysis indicated thatcompared with patients in Q1those in Q2Q3and Q4 had an increased risk of all-cause mortalityQ2HR=1.3095%CI=1.23-1.38P=0.045Q3HR=1.4695%CI=1.01-2.13P=0.047Q4HR=1.2495%CI=1.04-1.49P=0.017. Additionallypatients in Q3 and Q4 exhibited an elevated risk of CVD mortalityQ3HR=1.2895%CI=1.05~1.56P=0.013Q4HR=2.7395%CI=1.67-4.48P=0.026ROC curve showed that the AUC values of Q1Q2Q3 and Q4 quartile groups were 0.5140.6240.598 and 0.772respectively. ConclusionFor the first timeit was verified that elevated ePWV was positively correlated with the risk of all-cause and cardiovascular disease mortality in cancer patients. ePWV may be a predictor of the risk of death in this population.