Atrial Fib, Elevated Lipids, Renal Disease Raise Stroke Risk in Cancer Patients

Janelle Blankenship, PharmD, for Medscape

February 24, 2022

The study covered in this summary was published on ResearchSquare.com as a preprint and has not yet been peer reviewed.

Key Takeaways

  • Cancer patients with a diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA) were more likely than those without AIS/TIA to have new-onset or baseline atrial fibrillation (AF).

  • Patients with cancer and AIS/TIA had higher mortality than those without AIS/TIA.

  • Independent risk factors for the development of AIS/TIA in cancer patients include new-onset or baseline AF, history of ischemic stroke, dyslipidemia, renal disease, and active cancer treatment.

  • A high CHA2DS2-VASc score (≥2 in males and ≥3 in females) in cancer patients was also associated with a significantly increased risk of developing AIS/TIA, regardless of AF status.

Why This Matters

  • Cancer and AF are known to be independent risk factors for stroke. However, the risk for stroke in patients with concurrent cancer and AF has been unclear. This study demonstrated an increased likelihood of developing AIS/TIA in patients with cancer and AF.

  • This study identified various other risk factors for stroke in patients with cancer.

  • The utility of the CHA2DS2-VASc score for predicting stroke risk in cancer patients has been unknown because patients with active cancer had been excluded from trials that validated the stroke-prediction score. This study showed an association between high CHA2DS2-VASc scores and risk for stroke, regardless of AF status.

Study Design

  • This case-control study involved 136 patients at the King Hussein Cancer Center (Amman, Jordan) who had cancer and developed AIS/TIA between 2014 and 2019. These patients were matched in a 1:1 ratio with control patients who had similar cancer sites and were of similar age and sex but did not develop AIS/TIA.

  • Univariate analyses were performed to evaluate the association between patients' clinical characteristics and AIS/TIA diagnosis.

  • Logistic regression models were built to further assess the effect of the variables that had a P value < .2 in the univariate analyses and to examine the association between CHA2DS2-VASc score and a diagnosis of AIS/TIA.

Key Results

  • New-onset or baseline AF was present in 14% of patients diagnosed with AIS/TIA and in 4% of patients without AIS/TIA (odds ratio [OR], 4.25; 95% CI, 1.39 - 17.36).

  • At the conclusion of the study, 76% of patients with AIS/TIA had died, compared with 33% of the control patients (OR, 9.4; 95% CI, 3.74 - 23.64; P < .001).

  • The highest risk for AIS/TIA was seen in patients with previous ischemic stroke (OR, 9.18; 95% CI, 2.66 - 31.74; P < .001) and AF (OR, 7.93; 95% CI, 1.6 - 39.18; P = .01). The likelihood of having AIS/TIA was significantly increased in patients with renal disease (OR, 4.25; 95% CI, 1.55 - 11.63; P = .005), those with dyslipidemia (OR, 3.78; 95% CI, 1.32 - 10.82; P = .01), and those receiving active cancer treatment (OR, 3.11; 95% CI, 1.46 - 6.62; P = .003).

  • Regardless of AF status, high CHA2DS2-VASc scores (≥2 in males and ≥3 in females) were associated with an increased risk for stroke. High CHA2DS2-VASc scores were reported in 71% of patients who had AIS/TIA and in 52% of control subjects (OR, 3.08; 95% CI, 1.61 - 5.91; P < .001).

Limitations

  • Because of the use of retrospective chart review, this study relied on data from electronic medical records that were not intended to be used for clinical research.

  • This study included a relatively small patient sample, because patients were enrolled only if they had a definitive diagnosis of AIS/TIA.

  • Future prospective studies are needed to confirm the results of this study and to establish a method for determining stroke risk that is specific for cancer patients.

Study Disclosures

  • The authors declared no competing interests or relevant financial relationships.

This is a summary of a preprint research study, Atrial Fibrillation in Cancer Patients who Develop Stroke, written by Ismail Hamam from King Hussein Cancer Center, Amman, Jordan, and colleagues. Preprints from researchsquare.com are provided to you by Medscape. This study has not yet been peer-reviewed. The full text of the study can be found on ResearchSquare.com.

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