High CVD risk confers greater odds of cancer
PHILADELPHIA — People at high risk for CVD, as assessed by risk factors, 10-year atherosclerotic CVD risk score and biomarkers, also have elevated risk for cancer, according to research presented at the American Heart Association Scientific Sessions.
“Our team is committed to understanding the risk factors that predispose to heart disease, particularly heart failure. While exploring these links, we discovered that many patients with heart disease were dying of noncardiovascular causes,” Emily Lau, MD, cardiovascular fellow at Massachusetts General Hospital, told Healio. “When we probed further, we discovered that the rate of cancer deaths seemed to be higher in patients with heart disease compared to those without heart disease. That’s what first sparked our interest.”
Lau and colleagues analyzed 12,712 participants (mean age, 51 years; 55% women) from the Framingham Heart Study who were free from cancer and CVD at baseline. During a median follow-up of 14.6 years, 1,670 participants developed cancer other than nonmelanoma skin cancer (19% gastrointestinal, 18% breast, 16% prostate, 11% lung).
According to the findings, CV risk factors including age, sex, hypertension and smoking status were all linked to elevated risk for cancer (P < .05 for all).
“Many previous studies have postulated that cancer and heart disease share some of the same risk factors such as obesity, advanced age and hypertension,” Lau said in an interview. “Our study corroborates that assertion.”
When the participants were stratified by estimated 10-year ASCVD risk, those with the highest CVD risk (> 20%) had a more than threefold risk for future cancer compared with those at the lowest CVD risk (< 5%; HR = 3.53; 95% CI, 2.84-3.94), Lau and colleagues found.
The researchers also determined that B-type natriuretic peptide level in the highest tertile was associated with future cancer risk compared with BNP level in the lowest tertile (HR = 1.62; 95% CI, 1.04-2.51). There was no relationship between high-sensitivity troponin I level and cancer risk (P = .11).
In addition, participants who had a CVD event during the study period also had elevated risk for developing cancer. The HR for any CVD event was 7.8 (95% CI, 6.44-9.44), the HR for HF was 5.73 (95% CI, 4.26-7.7), the HR for MI was 8.53 (95% CI, 6.36-11.4) and the HR for atrial fibrillation was 6.89 (95% CI = 5.47-8.68), Lau and colleagues found.
“While we cannot conclude cause and effect since our study is an observational study, it does make us wonder: Does the development of heart disease increase your cancer risk? And what is the mechanism?” Lau told Healio. “Ultimately, I think our study helps to further our understanding about the relationship between cancer and cardiovascular disease — two very important conditions facing our patients today.”
Working to improve modifiable CVD risk factors could also improve cancer risk, she said.
“Our study suggests that for individuals at high risk for CVD, it is important to consider cancer risk at the same time,” Lau said. “We found that hypertension and diabetes were two modifiable cardiovascular risk factors that were associated with increased risk of cancer and cancer death, respectively. Aggressively treating hypertension and diabetes may also impact cancer risk in addition to heart disease risk.” – by Erik Swain
Lau E, et al. Presentation Mo3058. Cancer: Surveillance, Trends and Outcomes. Presented at: American Heart Association Scientific Sessions; Nov. 16-18, 2019; Philadelphia.
Disclosure: Lau reports no relevant financial disclosures.