Carotid intima thickness and cardiovascular risk assessment in patients treated for head and neck cancer

Abstract

Cardiovascular disease (CVD) is the leading cause of non–cancer-related morbidity and mortality among patients treated for head and neck cancer (HNC). However, the extent to which these patients are screened for CVD remains unclear, and the long-term impact of different anticancer treatment modalities for HNC on the CVD risk is also not well established. A validated marker of subclinical atherosclerosis such as the carotid intima–media thickness (cIMT) might be useful to predict CVD in these patients. The aim of this study was to assess cIMT and cardiovascular risk factors in patients treated for HNC more than two years after treatment completion. This is a single-centre, cross-sectional observational study, in which patients ≥18 years old who had completed treatment for HNC (surgery or radiotherapy, post-operative radio(chemo)therapy, or radio(chemo)therapy) at least two years prior underwent an outpatient cardiovascular risk assessment. Primary endpoint was the maximum cIMT, measured in μm on both sides by means of ultrasound. Secondary endpoints included associations of cIMT with low-density lipoprotein cholesterol, systolic blood pressure, use of lipid-lowering drugs, and use of antihypertensives via linear regression, as well as the proportion of patients who required modifications in medication for cardiovascular risk management. Differences between two independent groups were analysed using independent-samples t-tests, and comparisons among more than two groups were performed using one-way ANOVA. From December 2022 to December 2025, 112 patients were included with a median time after treatment completion of 32.5 months (IQR 26.0-46.2). Compared to their expected cIMT based on their sex and age reference population, patients had a significantly higher cIMT (cIMT observed 927 μm, expected 679 μm; mean difference (MD) 248 μm; 95% CI: 213 to 282 μm; p<0.001). No significant differences in cIMT were found between the different HNC treatment modalities (p=0.453). After correction for age, sex, smoking, diabetes and alcohol use, both LDL-cholesterol (B= 32.8 μm per mmol/L; 95% CI: -7.53 to 73.2; p= 0.110) and systolic blood pressure (B: 1.68 μm per mmHg; 95% CI: -0.23 to 3.59; p= 0.097) tended to associate with cIMT. Patients treated with lipid-lowering drugs (MD: -44.3 μm; 95%CI: -108 to 19.1 μm; p=0.169) or antihypertensive medication (MD: -103 μm; 95%CI: -79.4 to 59.2 μm; p=0.773) did not have a lower cIMT than patients without these treatments. Lipid-lowering therapy was initiated in 41% of previously untreated patients and antihypertensive therapy in 14%. Patients treated for head and neck cancer exhibited a substantially increased cIMT, suggesting elevated vascular risk. Preventive therapy was frequently initiated, highlighting the importance for systematic cardiovascular risk assessment in these patients.