Pre-diabetes is associated with increases cardiac event in cancer patients treated with anthracyclines

Type of funding sources: Public hospital(s). Main funding source(s): University of Hong Kong, Queen Mary Hospital

To evaluate the association between pre-diabetes and cardiovascular events in patients treated with anthracyclines containing chemotherapy (ACT).

Patients treated with ACT between 2000 and 2019 were divided into diabetes, pre-diabetes, and normoglycemia groups based on the baseline glycemic status. Primary outcome was the major adverse cardiovascular composite events (MACE) of heart failure hospitalization and cardiovascular death. Kaplan-Meier, multivariable COX regression, and Fine and Gray model analysis were applied.

Among 12649 patients treated with ACT, 3997 (31.6%, median age 61 years old) had pre-diabetes and 5622 (44.45%, median age 67 years old) had diabetes at baseline. Over a median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in normoglycemia group, 358 (9.0%) in pre-diabetes group, and 728 (12.9%) in diabetes group. Compared with normoglycemia group, both pre-diabetes (adjusted HR=1.20, 95%CI 1.01-1.43) and diabetes (adjusted HR=1.46, 95% CI 1.24-1.70) were significantly associated with an increased risk of MACE. Further analysis showed that there were 475 (18%) progressed to overt diabetes in the pre-diabetes group after 2 years of the index date and were at greater risk of MACE (Adjusted HR=1.76, 95% CI 1.31-2.36).

Pre-diabetes was significantly associated with an increased risk of MACE in patients treated with ACTs. Among, those who progressed to diabetes after 2 years demonstrated an increased risk of MACE. Findings support that pre-diabetes as a risk factor for cardiovascular events might optimize management.