International Journal of Clinical Oncology

, Volume 24, Issue 2, pp 196–210 | Cite as

Burden of cardiovascular disease in Japanese cancer patients and survivors: a single cancer-center study in Niigata City

  • Yuji OkuraEmail author
  • Tsugumi Takayama
  • Kazuyuki Ozaki
  • Hiroshi Tanaka
  • Hiroshi Seki
  • Tatsuya Takenouchi
  • Nobuaki Sato
  • Tohru Minamino
Original Article



Cardiovascular disease (CVD) and cancer are major causes of death in Japan. As most CVDs are chronic and often aggravate, long-term follow-up is necessary. Although some cancer patients and survivors have CVD, its prognostic significance and prevalence are unknown. Therefore, we conducted a retrospective study at our center to determine the prevalence of cancer patients with CVD.


In 2015, our 10-year (2005–2014) cancer registry was summarized. Comorbidities including left ventricular dysfunction, atrial fibrillation (AF), ischemic heart disease, aortic stenosis, venous thromboembolism (VTE), and elevation of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) were examined.


In total, 26,235 de novo cancer patients were registered and 16,130 survived until January 1, 2015. The 5-year survival rate was 64.0% for all cancer patients and 44.2% for cancer patients with CVD. Cox proportional hazards analysis adjusting for age, cancer stage, and body mass index revealed that AF [hazard ratio (HR) 1.219, male; P = 0.038], VTE (HR 1.517, male; P = 0.003 and HR 2.089, female; P < 0.001), and NT-proBNP elevation (HR 1.861, female; P = 0.002) were significantly associated with death. The CVD prevalence among cancer survivors in 2015 was 8.7% vs 3.5% for males vs females. AF was the most common CVD (prevalence: male, 4.0%; female, 1.0%). The prevalence of most CVD in adults increased progressively with age, with male predominance (12.1% for male and 7.5% for female patients in the 80 s age group).


One in 10 elderly cancer survivors has serious CVD. AF, VTE, and heart failure were critical comorbidities. Cardiologists and cancer-care providers should recognize CVD presence and monitor patients closely, providing medications or interventions concurrently with cancer therapy.


Atrial fibrillation Venous thromboembolism N-terminal prohormone of brain natriuretic peptide Heart failure 



We are indebted to Chika Sekine and Tomomi Fujita (cancer registry) for their superb assistance with the datasets; Sumika Ishigaki, Satoko Sakakibara, Chika Yumoto, Megumi Kira, Keiko Henmi (echocardiography laboratory) for performing electrocardiography, echocardiography, and vascular echo; Naho Sasaki and Masaki Yoshino (Department of Pharmacy) for pharmacological information; Dr. Yoshinobu Okada for treating cancer patients with CVD.

Compliance with ethical standards

Conflict of interest

No author has any conflict of interest.


  1. 1.
    Edwards BK, Noone AM, Mariotto AB et al (2014) Annual Report to the Nation on the status of cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 120:1290–1314CrossRefGoogle Scholar
  2. 2.
    Mortality by cause of death (2018) Statistics Bureau, Ministry of internal affairs and communications. Accessed July 2018
  3. 3.
    Eyre H, Kahn R, Robertson RM et al (2004) Preventing cancer, cardiovascular disease, and diabetes: a common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation 109:3244–3255CrossRefGoogle Scholar
  4. 4.
    American Cancer Society Cancer Facts & Figs (2017) American Cancer Society, Atlanta. Accessed July 2018
  5. 5.
    Goff DC Jr, Lloyd-Jones DM, Bennett G, American College of Cardiology/American Heart Association Task Force on Practice Guidelines et al (2014) 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 129:S74–S75CrossRefGoogle Scholar
  6. 6.
    Timp JF, Braekkan SK, Versteeg HH et al (2013) Epidemiology of cancer-associated venous thrombosis. Blood 122:1712–1723CrossRefGoogle Scholar
  7. 7.
    Floyd JD, Nguyen DT, Lobins RL et al (2005) Cardiotoxicity of cancer therapy. J Clin Oncol 23:7685–7696CrossRefGoogle Scholar
  8. 8.
    Ten years survival of cancer patients in hospital group of Japanese Association of Clinical Cancer Centers (2016) Press release published by National Cancer Center Japan in January 26. Accessed July 2018 (Japanese)
  9. 9.
    Paulus WJ, Tschöpe C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28:2539–2550CrossRefGoogle Scholar
  10. 10.
    Tsutsui H, Isobe M, Ito H, JCS Joint Working Group et al (2017) Guidelines for diagnosis and treatment of acute and chronic heart failure (JCS 2017/JHFS 2017). Accessed July 2018 (Japanese)
  11. 11.
    Okita Y, Okada K, Otsuji Y, JCS Joint Working Group et al (2012) Guidelines for surgical and interventional treatment of valvular heart disease (JCS 2012). Accessed January 2018 (Japanese)
  12. 12.
    Januzzi JL, van Kimmenade R, Lainchbury J et al (2006) NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: an international pooled analysis of 1256 patients: the International Collaborative of NT-proBNP Study. Eur Heart J 27:330–337CrossRefGoogle Scholar
  13. 13.
    Takayama T, Okura Y, Okada Y et al (2015) Characteristics of neoplastic cardiac tamponade and prognosis after pericardio-centesis: a single-center study of 113 consecutive cancer patients. Int J Clin Oncol 20:872–877CrossRefGoogle Scholar
  14. 14.
    Okura Y, Ishigaki S, Sakakibara S, et al. (2018) Prognosis of cancer patients with aortic stenosis under optimal cancer therapies and conservative cardiac treatments: a single cancer center study with 92 consecutive patients. Int heart J. (in press) Google Scholar
  15. 15.
    Okura Y, Ohno Y, Suzuki K et al (2007) Characterization of outpatients with systolic dysfunction in a Japanese community by total enumeration. Circ J 71:1004–1012CrossRefGoogle Scholar
  16. 16.
    Okura Y, Ohno Y, Ramadan MM et al (2007) Characterization of outpatients with isolated diastolic dysfunction and evaluation of the burden in a Japanese community: Sado Heart Failure Study. Circ J 71:1013–1021CrossRefGoogle Scholar
  17. 17.
    Adderley NJ, Nirantharakumar K, Marshall T (2018) Risk of stroke and transient ischaemic attack in patients with a diagnosis of resolved atrial fibrillation: retrospective cohort studies. BMJ 361:k1717. Google Scholar
  18. 18.
    Inoue H, Fujiki A, Origasa H et al (2009) Prevalence of atrial fibrillation in the general population of Japan: an analysis based on periodic health examination. Int J Cardiol 137:102–107CrossRefGoogle Scholar
  19. 19.
    Akao M, Chun YH, Wada H et al (2013) Current status of clinical background of patients with atrial fibrillation in a community-based survey: the Fushimi AF Registry. J Cardiol 61:260–266CrossRefGoogle Scholar
  20. 20.
    Benjamin EJ, Blaha MJ, Chiuve SE, American Heart Association Statistics Committee and Stroke Statistics Subcommittee et al (2017) Heart disease and stroke statistics-2017 update: a report from the American Heart Association. Circulation 135:e146–e603. CrossRefGoogle Scholar
  21. 21.
    Ueshima H, Sekikawa A, Miura K et al (2008) Cardiovascular disease and risk factors in Asia. A selected review. Circulation 118:2702–2709CrossRefGoogle Scholar
  22. 22.
    Kitamura A, Sato S, Naito Y et al (2001) Trends in the incidence of cardiovascular diseases and risk factors among urban and rural Japanese males. Nihon Koshu Eisei Zasshi 48:378–394 (in Japanese) Google Scholar
  23. 23.
    Osnabrugge RL, Mylotte D, Head SJ et al (2013) Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta-analysis and modeling study. J Am Coll Cardiol 62:1002–1012CrossRefGoogle Scholar
  24. 24.
    Tei C, Amano K, Ueno K, JCS Joint Working Group et al (2010). guidelines for gender-specific cardiovascular disease (JCS2010). Circ J 74(Suppl. II). Accessed January 2018 (Japanese)
  25. 25.
    Lyman GH (2011) Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis. Cancer 117:1334–1349CrossRefGoogle Scholar
  26. 26.
    Chew HK, Wun T, Harvey D et al (2006) Incidence of venous thromboembolism and its effect on survival among patients with common cancers. Arch Intern Med 166:458–464CrossRefGoogle Scholar
  27. 27.
    Nakamura M, Miyata T, Ozeki Y et al (2014) Current venous thromboembolism management and outcomes in Japan. Circ J 78:708–717CrossRefGoogle Scholar
  28. 28.
    Sakuma M, Nakamura M, Yamada N et al (2009) Venous thromboembolism-deep vein thrombosis with pulmonary embolism, deep vein thrombosis alone, pulmonary embolism alone. Circ J 73:305–309CrossRefGoogle Scholar
  29. 29.
    Chen HH, Colucci WS (2017) Natriuretic peptide measurement in non-heart failure settings. (December 29, 2017)
  30. 30.
    York MK, Gupta DK, Reynolds CF et al (2018) B-type natriuretic peptide levels and mortality in patients with and without heart failure. J Am Coll Cardiol 71:2079–2088CrossRefGoogle Scholar
  31. 31.
    Christ M, Laule-Kilian K, Hochholzer W et al (2006) Gender-specific risk stratification with B-type natriuretic peptide levels in patients with acute dyspnea: insights from the B-type natriuretic peptide for acute shortness of breath evaluation study. J Am Coll Cardiol 48:1808–1812CrossRefGoogle Scholar
  32. 32.
    Sobue T, Saika K (2015) The 42nd scientific meeting perspectives of internal medicine; considerations to treatment and care of cancer by internists in the era of increasing cancer mortality 2. Fruits of basic research on Cancer; 1) Cancer epidemiology–trends of cancer statistics based on cancer registry]. Nihon Naika Gakkai Zasshi 104:417–425 (Japanese) CrossRefGoogle Scholar
  33. 33.
    Hori M, Matsuda T, Shibata A et al (2015) Cancer incidence and incidence rates in Japan in 2009: a study of 32 population-based cancer registries for the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 45:884–891CrossRefGoogle Scholar
  34. 34.
    Cancer mortality in each prefecture in Japan (2018) Cancer registry and statistics. Cancer Information Service, National Cancer Center, Japan. /dl/index.html#survival. Accessed July 2018
  35. 35.
    Matsuda A, Katano K (2012) Cancer mortality in each prefecture. In: Sobue T (ed) Gan Toukei Hakusho 2012. Shinohara shuppan shinsha, Tokyo, pp 15–42 (Japanese) Google Scholar

Copyright information

© Japan Society of Clinical Oncology 2018

Authors and Affiliations

  1. 1.Departments of Onco-cardiologyNiigata Cancer Center HospitalNiigataJapan
  2. 2.Departments of Respiratory MedicineNiigata Cancer Center HospitalNiigataJapan
  3. 3.Departments of Diagnostic RadiologyNiigata Cancer Center HospitalNiigataJapan
  4. 4.Departments of DermatologyNiigata Cancer Center HospitalNiigataJapan
  5. 5.Departments of Breast OncologyNiigata Cancer Center HospitalNiigataJapan
  6. 6.Department of Cardiovascular Biology and MedicineNiigata University Graduate School of Medical and Dental SciencesNiigataJapan

Personalised recommendations