In a retrospective cohort study reported in JACC: CardioOncology, Bell et al found individuals with a diagnosis of cardiovascular disease were more likely to have a subsequent cancer diagnosis than individuals with no cardiovascular disease diagnosis. Risk was elevated among persons with atherosclerotic cardiovascular disease.

As stated by the investigators, “Cardiovascular disease and cancer share several risk factors. Although preclinical models show that various types of cardiovascular disease can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk.”

Study Details

The study used claims data from 2009 to 2019 pulled from the 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, 5,681,601 had a diagnosis of cardiovascular disease and 21,513,487 did not.

Risk of Subsequent Cancer Diagnosis    

Individuals with cardiovascular disease were significantly more likely to receive a subsequent cancer diagnosis vs those without cardiovascular disease (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 cardiovascular disease (n = 2,235,574) vs those with no cardiovascular disease (HR = 1.20, 95% CI = 1.19–1.21, P  < .001); a smaller increase in risk was observed for nonatherosclerotic cardiovascular disease vs no cardiovascular disease (HR = 1.08, 95% CI = 1.07–1.08, P < .001). Atherosclerotic cardiovascular disease was also associated with a greater risk of subsequent cancer vs nonatherosclerotic cardiovascular disease (HR = 1.11, 95% CI = 1.11–1.12, P < .001).

Diagnosis of atherosclerotic cardiovascular disease was associated with a significantly increased risk of 15 of 20 evaluated cancers vs no cardiovascular disease, including lung (HR = 2.76), liver (HR = 2.11), brain (HR = 2.07), hematologic other than leukemia and lymphoma (HR = 1.66), and neuroendocrine malignancies (HR = 1.60). No significantly increased risk was observed for prostate, ovarian, breast, or uterine cancers, or melanoma.

Nonatherosclerotic cardiovascular disease was associated with a significantly increased risk of 15 cancers vs no cardiovascular disease, including brain (HR = 2.07), liver (HR = 1.75), lung (HR = 1.73), neuroendocrine (HR = 1.50), and renal malignancies (HR = 1.38). No increased risk was observed for prostate, ovarian, breast, or uterine cancers, or melanoma.

Compared with individuals with nonatherosclerotic cardiovascular disease, those with atherosclerotic cardiovascular disease had a significantly higher risk of 14 cancers, including lung, bladder, colon, head and neck, liver, prostate, pancreatic, kidney, and hematologic malignancies, and a significantly lower risk for breast, ovarian, and uterine cancers.

The investigators concluded, “Individuals with cardiovascular disease have an increased risk of developing cancer compared with those without cardiovascular disease. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.”

Kevin T. Nead, MD, MPhil, of The University of Texas MD Anderson Cancer Center, and Nicholas J. Leeper, MD, of Stanford University School of Medicine and Stanford Cardiovascular Institute, are the corresponding authors for the JACC: CardioOncology article.

Disclosure: The study was supported by the National Institutes of Health and others. For full disclosures of the study authors, visit jacc.org.