Increased morbidity and high mortality of cancer is the important global human health problem. Cancer formation is complicated and there are variable factors in cancer etiology. It has been evidenced that inherent genetic factor, smoking, alcohol consumption, radiation exposure, environmental pollutants contact and infectious agents are considered to be the potential risk for cancer development. In addition, geographic difference and socioeconomic status have been reported as important factors and used in cancer development and survive estimation. Recent reports have enhanced infection-associated cancers could be linked to geographic factor and socioeconomic development.

Infective endocarditis (IE) is a peculiar disease caused by microorganisms with clinical valvular endothelial damage. Although it is relative rare disease, the incidence rate of IE is various and dependent on different population with their different basic characteristics. Clinically, IE is not a disease with uniform presentation and the various manifestations make the diagnosis indistinct. Durack et al. using echocardiography for IE diagnosis grades the disease as certain, probable, and possible. The criteria have been used for IE diagnosis till now. Cancer process is slow and may take many years. In cancer patients without clinical manifestation, compromised immunity could be vulnerable to IE. Early observational studies demonstrated IE by some individual microorganisms could be linked to specific cancer occurrence as colorectal neoplasm.

Till now, cancer prevention is intractable. Despite there is no definite medication in prevention of cancer development at present time, many studies demonstrated the use of cardiovascular drugs as aspirin and statin were associated with lowering colorectal cancer risks. The relationship between IE and cancer had been reported, however, IE survivors with concomitant use of cardiovascular medication may impact on the results. In addition, IE is a complicated and serious infection disease and has a high mortality rate in both in-hospital and long-term follow-up. This makes the categorical relationship between IE and cancer more difficult to clarify.

The aim of this study was to use the nationwide population-based database to explore the incidence of long-term cancer risk in IE survivor. We also tried to evaluate the associated risk factors in cancer development. To reduce the effects of potential confounders from baseline characteristics, we conducted a propensity score-matching study. To minimize death effect in IE patients, we used death as competing risk in regression analysis in the study.

The study was based on data from the NHIRD released by the National Health Research Institute (NHRI). The National Health Insurance (NHI) program was begun in 1995 and provided comprehensive health care for all Taiwan inhabitants. Enrollment in the NHI program is mandatory and there are presently more than 23 million enrollees, representing approximately 99% of Taiwan’s population. The NHIRD includes the entire registry and claims data from the NHI system, ranging from demographic data to detailed orders from ambulatory and inpatient care.

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Regards,

Mary Wilson

Editorial office

Current Research: Cardiology

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