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. 2023 Apr 11;5(4):431-440.
doi: 10.1016/j.jaccao.2023.01.010. eCollection 2023 Aug.

Risk of Cancer After Diagnosis of Cardiovascular Disease

Caitlin F Bell  1   2   3 , Xiudong Lei  4 , Allen Haas  4 , Richard A Baylis  2   3 , Hua Gao  2   3 , Lingfeng Luo  2   3 , Sharon H Giordano  4   5 , Mackenzie R Wehner  4   6 , Kevin T Nead  7   8 , Nicholas J Leeper  1   2   3
Affiliations

Risk of Cancer After Diagnosis of Cardiovascular Disease

Caitlin F Bell et al. JACC CardioOncol. .

Abstract

Background: Cardiovascular disease (CVD) and cancer share several risk factors. Although preclinical models show that various types of CVD can accelerate cancer progression, clinical studies have not determined the impact of atherosclerosis on cancer risk.

Objectives: The objective of this study was to determine whether CVD, especially atherosclerotic CVD, is independently associated with incident cancer.

Methods: Using IBM MarketScan claims data from over 130 million individuals, 27 million cancer-free subjects with a minimum of 36 months of follow-up data were identified. Individuals were stratified by presence or absence of CVD, time-varying analysis with multivariable adjustment for cardiovascular risk factors was performed, and cumulative risk of cancer was calculated. Additional analyses were performed according to CVD type (atherosclerotic vs nonatherosclerotic) and cancer subtype.

Results: Among 27,195,088 individuals, those with CVD were 13% more likely to develop cancer than those without CVD (HR: 1.13; 95% CI: 1.12-1.13). Results were more pronounced for individuals with atherosclerotic CVD (aCVD), who had a higher risk of cancer than those without CVD (HR: 1.20; 95% CI: 1.19-1.21). aCVD also conferred a higher risk of cancer compared with those with nonatherosclerotic CVD (HR: 1.11; 95% CI: 1.11-1.12). Cancer subtype analyses showed specific associations of aCVD with several malignancies, including lung, bladder, liver, colon, and other hematologic cancers.

Conclusions: Individuals with CVD have an increased risk of developing cancer compared with those without CVD. This association may be driven in part by the relationship of atherosclerosis with specific cancer subtypes, which persists after controlling for conventional risk factors.

Keywords: atherosclerosis; cardiovascular disease; epidemiology; medical claims; risk prediction.

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Conflict of interest statement

This research was supported, in part, by National Institutes of Health (NIH) grant CCSG P30 CA016672. Dr Bell has received an unrestricted grant from Damon Runyon Cancer Research Foundation PST 33-21 for the conduct of this study. Drs Nead and Wehner are Cancer Prevention and Research Institute of Texas (CPRIT) Scholars in Cancer Research. Dr Nead is supported by CPRIT RR190077, NCI L30CA253796, and NCI K08CA263313. Dr Wehner is supported by CPRIT FP9178 and NCI K08CA263298. Dr Giordano is supported by CPRIT RP160674 and Komen SAC150061. Dr Leeper is supported by NIH R35HL144475 and American Heart Association grant EIA34770065. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Cohort Selection From MarketScan Databases Flow diagram demonstrates sequential inclusion criteria for the study and group separation. aCVD = atherosclerotic cardiovascular disease; CVD = cardiovascular disease; naCVD = nonatherosclerotic cardiovascular disease.
Figure 2
Figure 2
Cumulative Incidence of Cancer According to CVD Group Kaplan-Meier estimates of time from index date to any cancer diagnosis among cohorts (N = 27,195,088 ) according to CVD group: CVD vs no CVD (A) and aCVD vs naCVD or no CVD (B). Index date was set at 24 months after the date of first enrollment. Estimates by group are before time-varying analysis with multivariable adjustment. Number at risk reflects time-varying exposure variable. Abbreviations as in Figure 1.
Figure 3
Figure 3
Forest Plots of the Association of CVD With Cancer Incidences Forest plots of HRs based on inverse probability treatment weighted Cox proportional hazards regression from the patient’s time-dependent propensity score (TDPS) with the weights being TDPS/(1 − TDPS) for CVD adjusted for age, sex, diabetes, hypertension, chronic kidney disease, hyperlipidemia, statin use, health care contacts, region, and insurance type (N = 27,195,088). (A) aCVD vs no CVD, and (B) naCVD vs no CVD. Abbreviations as in Figure 1.
Central Illustration
Central Illustration
Risk of Cancer After Diagnosis of Cardiovascular Disease In this population-based cohort of over 27 million individuals, we determined that cardiovascular disease (CVD) was associated with higher risk of incident cancer. This association was most pronounced for atherosclerotic CVD (aCVD), which appeared to be specifically associated with bladder, colon, lung, and hematologic malignancies, even after accounting for traditional risk factors. naCVD = nonatherosclerotic cardiovascular disease.
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