In a retrospective cohort study reported in JACC: CardioOncology, Caitlin F. Bell, MD, of the Division of Cardiovascular Medicine, Stanford University School of Medicine, and colleagues found that persons with a diagnosis of cardiovascular disease (CVD) were more likely to have a subsequent incident cancer diagnosis than persons with no CVD diagnosis.1 Risk was elevated among persons with atherosclerotic CVD.
“…CVD and cancer share several risk factors. Individuals with CVD have an increased risk of developing cancer compared with those without CVD.”— Caitlin F. Bell, MD
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As stated by the investigators: “…CVD and cancer share several risk factors. Although preclinical models show that various types of CVD can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk.”
The study used claims data from the 2009–2019 IBM MarketScan research databases. A total of 27,195,088 individuals with no cancer diagnosis and a minimum of 36 months of follow-up data were identified. Of these individuals, 5,681,601 had a diagnosis of CVD, and 21,513,487 did not.
Risk of Subsequent Cancer Diagnosis
Individuals with CVD were significantly more likely to receive a subsequent cancer diagnosis than were those without CVD (hazard ratio [HR] =1.13, 95% confidence interval [CI] = 1.12–1.13, P < .001). A greater risk of subsequent cancer was observed among individuals with a diagnosis of atherosclerotic CVD (n = 2,235,574) vs those with no CVD (HR = 1.20, 95% CI = 1.19–1.21, P < .001); a smaller increase in risk was observed for nonatherosclerotic CVD (n = 3,446,027) vs no CVD (HR = 1.08, 95% CI = 1.07–1.08, P < .001). Atherosclerotic CVD was also associated with a greater risk of subsequent cancer vs nonatherosclerotic CVD (HR= 1.11, 95% CI = 1.11–1.12, P < .001).
Atherosclerotic CVD vs No CVD
Diagnosis of atherosclerotic CVD was associated with a significantly increased risk of 15 of 20 evaluated malignancies vs no CVD. These malignancies included lung (HR = 2.76), liver (HR = 2.11), brain (HR = 2.07), “other” hematologic (apart from leukemia and lymphoma; HR = 1.66), neuroendocrine (HR = 1.60), renal (HR = 1.53), pancreas (HR = 1.42), and lymphoma (HR = 1.40), as well as bladder, colon, head and neck, leukemia, rectal, thyroid, and soft-tissue malignancies (HRs = 1.38–1.19). No significantly increased risk was observed for prostate cancer, and significantly reduced risks were observed for melanoma (HR = 0.96), ovarian (HR = 0.85), breast (HR = 0.72), and uterine (HR = 0.64) malignancies.
Nonatherosclerotic CVD vs No CVD
Nonatherosclerotic CVD was associated with a significantly increased risk of 15 malignancies vs no CVD. These malignancies included brain (HR = 2.07), liver (HR = 1.75), lung (HR = 1.73), neuroendocrine (HR = 1.50), renal (HR = 1.38), thyroid (HR = 1.32), “other” hematologic (HR = 1.32), and lymphoma (HR = 1.27), as well as pancreas, bladder, head and neck, leukemia, rectal, soft-tissue, and colon malignancies (HRs = 1.26–1.09). No increased risk was observed for ovarian cancer, and significantly reduced risks were observed for melanoma (HR = 0.92), prostate (HR = 0.89), breast (HR = 0.86), and uterine (HR = 0.86) malignancies.
Atherosclerotic vs Nonatherosclerotic CVD
Compared with individuals who were diagnosed with nonatherosclerotic CVD, those who had atherosclerotic CVD had a significantly higher risk of 15 malignancies. These malignancies included lung (HR = 1.60), “other” hematologic (HR = 1.27), colon (HR = 1.23), liver (HR = 1.20), bladder (HR = 1.19), head and neck (HR = 1.15), prostate (HR = 1.13), and pancreas (HR = 1.13), as well as kidney, lymphoma, rectum, leukemia, neuroendocrine, soft-tissue, and melanoma malignancies (HRs = 1.11–1.04). No increased risk was observed for brain malignancies, and significantly reduced risks were observed for thyroid (HR = 0.90), ovarian (HR = 0.88), breast (HR = 0.84), and uterine (HR = 0.75) malignancies.
The investigators concluded: “Individuals with CVD have an increased risk of developing cancer compared with those without CVD. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.”
DISCLOSURE: The study was supported by the National Institutes of Health and others. For full disclosures of the study authors, visit sciencedirect.com.
1. Bell CF, Lei X, Haas A, et al: Risk of cancer after diagnosis of cardiovascular disease. JACC CardioOncol 5:431-440, 2023.