In a study reported in JACC: CardioOncology, Emily S. Lau, MD, and colleagues found that the presence of cardiovascular disease risk factors was significantly associated with an increased risk of future cancer, although no increased risk was observed among individuals who had a history of cardiovascular disease events or developed cardiovascular disease events during follow-up.

Emily S. Lau, MD

Study Details

The study involved data from prospective follow-up of participants in the Framingham Heart Study and PREVEND study with no history of cancer at baseline. Histology-proven cancer cases were identified through surveillance of routine examinations; health updates; hospital admissions; or from death records through December 31, 2016. Multivariate models were used to analyze potential association baseline traditional cardiovascular disease risk factors, 10-year atherosclerotic (ASCVD) risk score, established cardiovascular disease biomarkers (including high-sensitivity cardiac troponin and natriuretic peptide), prevalent cardiovascular disease, and the American Heart Association (AHA) Life’s Simple 7 cardiovascular health score with future occurrence of cancer.

For analysis of cardiovascular disease risk factors, the population consisted of 20,305 participants with no baseline major cardiovascular disease or atrial fibrillation. Analysis of prevalent cardiovascular disease included 1,020 participants with a history of major cardiovascular disease at baseline.

Association of Traditional Cardiovascular Disease Risk Factors and Biomarkers With Cancer Risk

 Among the 20,305 participants:

• Mean age was 50 ± 14 years
• 54% were women
• 33% were former and 29% current smokers
• 4% had diabetes
• 15% used antihypertensive medications
• 4% had hyperlipidemia requiring statin therapy. 

Over a median follow-up of 15.0 years (quartile 1–3 = 13.3–15.0 years), 2,548 incident cancer cases were observed. The most common cancer types included gastrointestinal (20%), lung (11%), prostate (16%), and breast (18%) cancers.

Among traditional cardiovascular disease risk factors, increasing age (hazard ratio [HR] = 2.12, P < .001, per 1 standard deviation [SD] increase), male sex (HR = 1.39, P < .001), former smoker status (HR = 1.30, P < .001), and current smoker status (HR = 1.74, P < .001) were significantly associated with an increased risk of cancer. No significant associations were observed for systolic blood pressure, hypertension treatment, diabetes, body mass index, total cholesterol/high-density lipoprotein cholesterol ratio, or statin use.

Ten-year ASCVD risk categories are defined as low (< 5%), borderline (5%–7.5%), intermediate (7.5%–20%), and high (> 20%). Higher 10-year ASCVD risk scores were significantly associated with increased risk of cancer, with a hazard ratio of 1.16 per 5% increase in risk (P < .001). Compared with low risk, hazard ratios were 1.88, 2.70, and 3.71 for borderline, intermediate, and high risk, respectively (all P < .001).

Increasing natriuretic peptide concentration was associated with increased cancer risk (P = .02 for trend) both when comparing the highest vs lowest tertile (HR = 1.40, P = .035) and when analyzed as a continuous variable (HR = 1.26, P < .001, per 1 SD increase). No significant association was observed for high-sensitivity cardiac troponin (P = .47 for trend) when comparing highest vs lowest tertile (P = .37) or as a continuous variable (P = .07).

Associations With Prevalent Cardiovascular Disease, Interim Cardiovascular Disease Events, and AHA Health Score

Among the 1,020 participants with prevalent cardiovascular disease at baseline, no significant association with subsequent cancer risk was observed overall (HR = 0.96, P = .61), among 793 with prior myocardial infarction (HR = 1.03, P = .71) or among 116 with heart failure (HR = 0.66, P = .15). Among the total of 1,454 participants who developed cardiovascular disease events during follow-up, no association with cancer risk was observed overall (HR = 0.99, P = .91) or among 687 with myocardial infarction (HR = 0.99, P = .95) or 681 with heart failure (HR = 1.07, P = .59).

The AHA Life’s Simple 7 cardiovascular health score was associated with subsequent cancer risk. Scores range from 0 to 14, with scores of 0 to 6 indicating poor; 7 to 9, average; and 10 to 14, optimal cardiovascular health. Optimal cardiovascular health was associated with an age- and sex-adjusted hazard ratio of 0.94 (P = .01) per one-point increase in score. Compared with participants with poor cardiovascular health, those with average and optimal cardiovascular health were less likely to develop cancer (overall P < .001).

The investigators concluded, “Cardiovascular disease risk, as captured by traditional cardiovascular disease risk factors, 10-year ASCVD risk score, and natriuretic peptide concentrations are associated with increased risk of future cancer. Conversely, a heart-healthy lifestyle is associated with a lower risk of future cancer. These data suggest that the association between cardiovascular disease and future cancer is attributable to shared risk factors.”

Jennifer E. Ho, MD, of Massachusetts General Hospital, is the corresponding author for the JACC:CardioOncology article.

Disclosures: The study was supported by grants from the National Institutes of Health. For full disclosures of the study authors, visit jacc.org.