Coronary artery calcium is associated with increased risk for lung and colorectal cancer in men and women: the Multi-Ethnic Study of Atherosclerosis (MESA)

Abstract

Aims: This study explored the association of coronary artery calcium (CAC) with incident cancer subtypes in the Multi-Ethnic Study of Atherosclerosis (MESA). CAC is an established predictor of cardiovascular disease (CVD), with emerging data also supporting independent predictive value for cancer. The association of CAC with risk for individual cancer subtypes is unknown.

Methods and results: We included 6271 MESA participants, aged 45-84 and without known CVD or self-reported history of cancer. There were 777 incident cancer cases during mean follow-up of 12.9 ± 3.1 years. Lung and colorectal cancer (186 cases) were grouped based on their strong overlap with CVD risk profile; prostate (men) and ovarian, uterine, and breast cancer (women) were considered as sex-specific cancers (in total 250 cases). Incidence rates and Fine and Gray competing risks models were used to assess relative risk of cancer-specific outcomes stratified by CAC groups or Log(CAC+1). The mean age was 61.7 ± 10.2 years, 52.7% were women, and 36.5% were White. Overall, all-cause cancer incidence increased with CAC scores, with rates per 1000 person-years of 13.1 [95% confidence interval (CI): 11.7-14.7] for CAC = 0 and 35.8 (95% CI: 30.2-42.4) for CAC ≥400. Compared with CAC = 0, hazards for those with CAC ≥400 were increased for lung and colorectal cancer in men [subdistribution hazard ratio (SHR): 2.2 (95% CI: 1.1-4.7)] and women [SHR: 2.2 (95% CI: 1.0-4.6)], but not significantly for sex-specific cancers across sexes.

Conclusion: CAC scores were associated with cancer risk in both sexes; however, this was stronger for lung and colorectal when compared with sex-specific cancers. Our data support potential synergistic use of CAC scores in the identification of both CVD and lung and colorectal cancer risk.

Keywords: cancer; cardiovascular disease; coronary arterial calcium; prevention; risk prediction.

Association of coronary artery calcium with cancer subtypes. (Top left) Incidence rates per 1000 person-years for lung and colorectal cancer by sex. (Top right) Incidence rates per 1000 person-years for sex-specific cancers = prostate (men); ovarian, endometrial, and breast cancer (women). (Bottom left) Hazard ratios for development of lung and colorectal cancer and (Bottom right) sex-specific cancers by CAC score group and sex. CAC, coronary artery calcium score; CI, confidence interval.

Figure 1

Incidence rates for all cancers and distinct cancer subtypes by CAC score groups. Incidence rates per 1000 person-years for all cancers and distinct cancer subtypes. Rates increased with CAC score groups. Numbers indicate incidence rates. CAC, coronary artery calcium score.

Figure 2

Incidence rates for lung and colorectal cancer, and sex-specific cancers by CAC score group and sex. Sex-specific cancers = prostate (men); ovarian, endometrial, and breast cancer (women). CAC, coronary artery calcium score.

Figure 3

Subdistribution hazard ratio for lung and colorectal cancer, and sex-specific cancers as a function of age by CAC score group and sex. Graphed subdistribution hazard ratios (SHRs) as a function of age. SHR were adjusted for conventional risk factors (age, sex, race, body mass index, physical activity, income >40K, completed high school, health insurance, pack-years of smoking, healthy diet) for lung and colorectal cancer (A and B) and sex-specific (C and D) cancers. Sex-specific cancers = prostate (men); ovarian, endometrial, and breast cancer (women). SHR are stratified by CAC score group and refer to the CAC = 0 group at age 60 years. With increasing age and CAC score, cancer risk continues to increase exponentially for lung and colorectal cancer, but not for sex-specific cancers. CAC, coronary artery calcium score.