Cardiovascular outcomes in individuals with ovarian cancer: A retrospective cohort study

To examine the association between ovarian cancer and subsequent risk of cardiovascular disease (CVD).

This retrospective cohort study used deidentified claims data from the Optum Labs Data Warehouse with linked Surveillance, Epidemiology, and End Results (SEER) data. Female patients aged ≥18 with ovarian cancer (2010-2021) who underwent bilateral oophorectomy were propensity score-matched to non-cancer controls who had bilateral oophorectomy for benign indications based on age, cardiovascular risk factors, comorbidities, and oophorectomy year. Outcome measure was incident major adverse cardiovascular events (MACE), a composite of angina, acute myocardial infarction, heart failure, stroke, transient ischemic attack, cardiac arrest, or cardiovascular procedures. Time to first MACE was compared between ovarian cancer and non-cancer patients using Gray's tests and Fine-Gray sub-distribution hazard models accounting for death as a competing risk.

A total of 1148 ovarian cancer patients were matched to 2284 non-cancer controls. Median (interquartile range) follow-up was 29 (13-54) months for ovarian cancer patients and 40 (17-70) months for controls. One-, two-, three-, and five-year MACE risks were higher in ovarian cancer patients (7.7%, 12.0%, 17.1%, 24.8%) compared to controls (5.3%, 9.1%, 12.9%, 18.6%). Ovarian cancer was associated with increased MACE risk (hazard ratio [HR] 1.33, 95% confidence interval [CI] 1.14-1.56), with a more pronounced association in patients <55 years (HR 1.95, 95% CI 1.01-3.58) than ≥55 years (HR 1.30, 95% CI 1.09-1.53).

Ovarian cancer is associated with increased CVD risk, particularly among younger patients, calling for mechanistic studies elucidating this relationship.