Cardiovascular-specific mortality among multiple myeloma patients: a population-based study

Introduction: Multiple myeloma (MM) survival has greatly improved in recent decades. MM is usually diagnosed at a median age of 66-70 years. MM patients do not necessarily die from primary cancer, so cardiovascular health may be a key factor threatening long-term survival. This study was designed to explore the cardiovascular disease mortality (CVM) trends in MM patients and compare them with those in the general population. Methods: In total, 88,328 MM patients from the Surveillance, Epidemiology, and End Results (SEER) database (1975-2016) were included. Standardized mortality ratios (SMRs) were used to assess CVM risk. Results: The CVM risk was significantly higher in MM patients than in the general population (SMR, 1.84 (95% CI, 1.78-1.89)). MM patients had the highest CVM SMR, at 2.62 (95% CI, 2.49-2.75), in the first year after diagnosis, and it decreased over the follow-up period. Over the study period, the incidence of CVM continued to decrease in MM patients diagnosed at age 65-74 (APC, -1.2% (95% CI, -1.9% to -0.4%)) and >= 75 years (APC, -1.9% (95% CI, -2.6% to -1.2%)) but not younger. CVM was the second-most common cause of death in patients >= 75 years. In only MM case analyses, male sex, Black race, older age at diagnosis, and earlier year of diagnosis were poor prognostic factors for heart-specific mortality. Conclusion: The CVM risk in MM patients was significantly higher than that in the general population. To improve survival, cardiovascular health should receive attention upon diagnosis.