People with risk factors for cardiovascular diseases (determined by traditional risk, 10-year artherosclerotic cardiovascular disease risk score, and biomarkers) were also at higher risk for developing cancer compared to people with lower cardiovascular disease risk, according to research presented by Lau et al at the American Heart Association’s Scientific Sessions 2019 (Abstract 12269).

“It’s a double whammy. Heart disease and cancer are the two leading causes of death in the United States. We now recognize that they are intimately linked. This tells us that we, as physicians, should be aggressive in trying to reduce cardiovascular risk factors not only to prevent heart disease, but also to consider cancer risk at the same time,” said lead study author Emily Lau, MD, a cardiology fellow at Massachusetts General Hospital. 

"This tells us that we, as physicians, should be aggressive in trying to reduce cardiovascular risk factors not only to prevent heart disease, but also to consider cancer risk at the same time.”

— Emily Lau, MD

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Methods

Using data from the Framingham Heart Study, researchers evaluated data from 12,712 participants (mean age = 51 years) without cardiovascular disease or cancer at the start of the study. The American Heart Association/American College of Cardiology’s Atherosclerotic Cardiovascular Disease (ASCVD) Risk Estimator (a tool to help predict a person’s risk of developing heart disease within 10 years) and biomarkers were used to measure cardiovascular risk.

Results

During the study period of nearly 15 years, 1,670 cancer cases occurred (19% gastrointestinal, 18% breast, 16% prostate, 11% lung).

The researchers found that cardiovascular risk factors—including age, sex, high blood pressure, and smoking status—were independently associated with cancer. Patients with a 10-year ASCVD risk of 20% or higher were more than three times as likely as those with a 10-year ASCVD risk of 5% or lower to develop any type of cancer.

People who developed cardiovascular disease (defined as a heart attack, heart failure, or atrial fibrillation) during the study period had more than a sevenfold increased risk for subsequent cancer compared to those who did not experience any cardiac event. Additionally, patients with high levels of brain natriuretic peptide (BNP)—a biomarker frequently elevated in heart failure—were more likely to develop cancer during the 15-year follow-up period than participants with low levels of BNP.

“I think it's interesting that BNP, a cardiac marker linked to heart failure risk, was associated with the risk of cancer in the future. Currently we use BNP to determine if a person has developed heart failure from chemotherapy drugs used to treat cancer,” explained Tochi M. Okwuosa, DO, Vice Chair, American Heart Association Council on Clinical Cardiology and Genomics and Precision Medicine Cardio-Oncology Subcommittee, and Associate Professor at Rush University, Chicago. “This is the first study that has shown that BNP that's elevated at baseline is associated with the future risk of cancer.”

“Cancer and cardiovascular disease share many of the same risk factors, such as tobacco use, poor nutrition, and lack of physical activity. The next step is to identify the biologic mechanisms driving the link between cardiovascular disease and cancer,” said Dr. Lau. She noted this was an observational study, so it doesn’t prove cause and effect, but it does shed light on the connection between heart disease and cancer.

Disclosures: The National Institutes of Health funded the study. For full disclosures of the study authors, visit ahajournals.org.