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. 2021 Mar;3(1):48-58.
doi: 10.1016/j.jaccao.2020.12.003. Epub 2021 Mar 16.

Cardiovascular Risk Factors are Associated with Future Cancer

Emily S Lau  1 , Samantha M Paniagua  1   2 , Elizabeth Liu  1 , Manol Jovani  3 , Shawn X Li  1 , Katherine Takvorian  1 , Navin Suthahar  4 , Susan Cheng  5 , Greta L Splansky  6 , James L Januzzi Jr  1 , Thomas J Wang  7 , Ramachandran S Vasan  6   8   9 , Bernard Kreger  8 , Martin G Larson  6   10 , Daniel Levy  6   11 , Rudolf A de Boer  4 , Jennifer E Ho  1   2
Affiliations

Cardiovascular Risk Factors are Associated with Future Cancer

Emily S Lau et al. JACC CardioOncol. 2021 Mar.

Abstract

Background: The extent to which co-occurrence of cardiovascular disease (CVD) and cancer is due to shared risk factors or other mechanisms is unknown.

Objectives: We investigated the association of standard CVD risk factors, CVD biomarkers, preexisting CVD, and ideal CV health metrics with the development of future cancer.

Methods: We prospectively followed Framingham Heart Study and PREVEND participants free of cancer at baseline, and ascertained histology-proven cancer. We studied the association of baseline CV risk factors, 10-year atherosclerotic CVD risk score, established CVD biomarkers, prevalent CVD, and AHA Life's Simple 7 CV health score with incident cancer using multivariable Cox models. Analyses of interim CVD events with incident cancer used time-dependent covariates.

Results: Among 20,305 participants (mean age 50 ± 14 years, 54% women), 2,548 incident cancer cases occurred over a median follow-up of 15.0 (13.3-15.0) surveillance years. Traditional CVD risk factors including age, sex, and smoking status were independently associated with cancer (P <0.001 for all). Estimated 10-year atherosclerotic CVD risk was also associated with future cancer (HR 1.16 per 5% increase in risk, 95% CI 1.14-1.17, P<0.001). We found that natriuretic peptides (NP) (tertile 3 vs 1: HR 1.40, 95% CI 1.03-1.91, p=0.035) was associated with incident cancer, but not high sensitivity troponin (hs-cTn) (p=0.47). Prevalent CVD and the development of interim CV events were not associated with higher risk of subsequent cancer. However, ideal CV health was associated with lower future cancer risk (HR 0.95 per 1-point increase in AHA health score, 95% CI 0.92-0.99, p=0.009).

Conclusions: CVD risk as captured by traditional CVD risk factors, 10-year atherosclerotic CVD risk score, and NP concentrations are associated with increased risk of future cancer. Conversely, a heart healthy lifestyle is associated with a reduced risk of future cancer. Our data suggest that the association between CVD and future cancer is attributable to shared risk factors.

Keywords: Lifestyle Risk Factors; Prevention; Risk Factor.

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Conflict of interest statement

Dr. Lau was supported by a grant from the National Institutes of Health (NIH) (5T32HL094301-07). Dr. Ho was supported by grants from NIH (R01-HL134893, R01-HL140224, and K24-HL153669). The Framingham Heart Study was supported by contracts from the National Heart, Lung, and Blood Institute (NO1-HC-25195, HHSN268201500001I, and 75N92019D00031). Dr. Januzzi has been supported by the Hutter Family Professorship; has been a trustee of the American College of Cardiology; has received grant support from Novartis, Applied Therapeutics, and Abbott; has received consulting income from Abbott, Janssen, Novartis, Pfizer, Merck, and Roche Diagnostics; and has participated in clinical endpoint committees/data safety monitoring boards for Abbott, AbbVie, Amgen, Bayer, CVRx, Janssen, and Takeda. Dr. Vasan has been supported in part by the Evans Medical Foundation and the Jay and Louis Coffman Endowment from the Department of Medicine, Boston University School of Medicine. Dr. Ho has received research grants from Gilead Sciences and Bayer; and has received research supplies from EcoNugenics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

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Graphical abstract
Central Illustration
Central Illustration
Risk of Future Cancer by ASCVD Score Incident cancer among subjects classified as atherosclerotic cardiovascular disease (ASCVD) low risk (<5%) (purple), borderline risk (5% to 7.5%) (gray), intermediate risk (7.5% to 20%) (red), and high risk (>20%) (blue) for developing cancer.
Figure 1
Figure 1
Time to Incident Cancer by Categories of the AHA’s Life Simple 7 CVH Score The American Heart Association (AHA) Life Simple 7 cardiovascular health (CVH) score ranged from 0 to 14 and was classified into poor (0 to 6), average (7 to 9), and optimal (10 to 14) scores.
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