Pre-existing cardiometabolic comorbidities and survival of middle-aged and elderly non-small cell lung cancer patients

BACKGROUND Both lung cancer and cardiometabolic diseases are leading causes of death in China,and they share some common risk factors.However,the prevalence and long-term effect of pre-existing cardiometabolic comorbidities(CMCs)on the survival of middle-aged and elderly lung cancer patients are still not clear.METHODS We consecutively recruited 3477 non-small cell lung cancer(NSCLC)patients between January 2011 and December 2018 from four cancer specialty hospitals in China.Univariable and multivariable adjusted Cox proportional hazard models were conducted to evaluate the risk factors associated with mortality.Hazard ratio(HR)for mortality and corresponding 95%CI were calculated.RESULTS The prevalence of CMCs was 30.0%in middle-aged NSCLC patients and 45.5%in elderly NSCLC patients.Log-rank analysis presented statistically significant differences in median survival time between patients with CMCs and without CMCs in both the middle-aged group(21.0 months vs.32.0 months,P<0.01)and the elderly group(13.0 months vs.17.0 months,P=0.01).Heart failure(HR=1.754,95%CI:1.436–2.144,P<0.001)and venous thrombus embolism(HR=2.196,95%CI:1.691–2.853,P<0.001)were independent risk factors for the survival of middle-aged NSCLC patients,while heart failure(HR=1.709,95%CI:1.371–2.130,P<0.001)continued to decrease overall survival in the elderly group.Hyperlipidemia may be a protective factor for survival in middle-aged group(HR=0.741,95%CI:0.566–0.971,P=0.030).CONCLUSIONS Our findings demonstrate for the first time the prevalence and prognostic value of pre-existing CMCs in Chinese middle-aged and elderly NSCLC patients.

Impacts of smoking status on the clinical outcomes of coronary non-target lesions in patients with coronary heart disease:a single-center angiographic study

Background:Coronary atherosclerotic plaque could go through rapid progression and induce adverse cardiac events.This study aimed to evaluate the impacts of smoking status on clinical outcomes of coronary non-target lesions.Methods:Consecutive patients with coronary heart disease who underwent two serial coronary angiographies were included.All coronary non-target lesions were recorded at first coronary angiography and analyzed using quantitative coronary angiography at both procedures.Patients were grouped into non-smokers,quitters,and smokers according to their smoking status.Clinical outcomes including rapid lesion progression,lesion re-vascularization,and myocardial infarction were recorded at second coronary angiography.Multivariable Cox regression analysis was used to investigate the association between smoking status and clinical outcomes.Results:A total of 1255 patients and 1670 lesions were included.Smokers were younger and more likely to be male compared with nonsmokers.Increase in percent diameter stenosis was significantly lower(2.7[0.6,7.1]%vs.3.5[0.9,8.9]%)and 3.4[1.1,7.7]%,P=0.020)in quitters than those in smokers and non-smokers.Quitters tended to have a decreased incidence of rapid lesions progression(15.8%[76/482]vs.21.6%[74/342]and 20.6%[89/431],P=0.062),lesion re-vascularization(13.1%[63/482]vs.15.5%[53/432]and 15.5%[67/431],P=0.448),lesion-related myocardial infarction(0.8%[4/482]vs.2.6%[9/342]and 1.4%[6/431],P=0.110)and all-cause myocardial infarction(1.9%[9/482]vs.4.1%[14/342]and 2.3%[10/431],P=0.128)compared with smokers and non-smokers.In multivariable analysis,smoking status was not an independent predictor for rapid lesion progression,lesion re-vascularization,and lesion-related myocardial infarction except that a higher risk of all-cause myocardial infarction was observed in smokers than non-smokers(hazards ratio:3.00,95%confidence interval:1.04-8.62,P=0.042).Conclusion:Smoking cessation mitigates the increase in percent diameter stenosis of coronary non-target lesions,meanwhile,smokers are associated with increased risk for all-cause myocardial infarction compared with non-smokers.