Association between plasma lipid levels during acute coronary syndrome and long-term malignancy risk. The ABC-4* study on heart disease

Abstract

Background Emerging evidence suggests that patients with coronary artery disease carry an increased risk of developing malignancy, with deleterious effects on long-term prognosis. Our aim was to ascertain whether baseline plasma lipid levels during acute coronary syndrome (ACS) are associated with malignancy in long-term. Methods This study included 589 patients admitted with ACS to three centers and discharged alive. Plasma lipid levels were assessed on the first morning after admission. Patients were followed for 17 years or until death. Results Five hundred seventy-one patients were free from malignancy at enrollment, of them 99 (17.3%) developed the disease during follow-up and 75 (13.1%) died due to it. Compared to patients without malignancy, those with malignancy showed lower plasma levels of total cholesterol (TC), low-density lipoprotein (LDL), and triglycerides (TG). The groups showed similar statin use rates at any time in follow-up. The incidence rate of neoplasia and neoplastic mortality was higher in patients with baseline TC or LDL values ≤ median; they showed 85 and 72% increased incidence rate of developing malignancy and 133 and 122% increased incidence rate of neoplastic death respectively. No differences were observed relative to HDL and TG levels. In survival analysis using Cox regression with parsimonious models, patients with baseline TC or LDL values > median, respectively, showed risks of 0.6(95% CI 0.4–0.9; p = 0.01) and 0.6(95%CI 0.4–0.9; p = 0.02) for malignancy onset, and 0.5(95% CI 0.3–0.8; p = 0.005) and 0.5(95% CI 0.3–0.8; p = 0.004) for neoplastic death. Similar results were obtained using competitive risk analysis with parsimonious models. Conclusions This long-term prospective study of an unselected real-world patient sample showed that neoplasia onset and mortality are independently associated with low plasma TC and LDL levels at admission for ACS.

Risk of malignancy long after acute coronary syndrome in selected urban and rural areas and comparison with smoking risk: the ABC-7* study on Heart Disease

“…To the best of our knowledge, the present study is the first to report on the geographic distribution of malignancy in this specific population, ACS patients, with a very long follow-up and very few dropouts. In agreement with the medical knowledge, we found an association between malignancy risk and other important variables, such as age and smoking, but we also found an inverse association between malignancy risk in both urban and rural areas and serum cholesterol as in previous reports [ 32 , 33 ].…”

Baseline plasma lipid levels in patients with acute coronary syndrome: Association with 20‐year mortality. The ABC‐5a* Study on Heart Disease

“…Our different prognostic results support the assumption of the presence of other modifiable risk factors, other than cholesterol levels, that deliberates this risk in the majority of patients and may explain why patients develop myocardial infarction despite a low LDL level 19,39 or why a considerable proportion of major adverse events are still not prevented by aggressive lipid‐lowering treatment 46 . We also observed during the long‐term follow‐up that non‐cardiac death was more prevalent, and an inverse association with plasma lipid levels was observed in concordance with previous reports 5,47,48 . This observation is clinically relevant if we consider that the non‐cardiac mortality rate after acute coronary syndrome has progressively increased in recent years 49,50 .…”

Plasma lipid levels during ACS: Association with 20-year mortality: The ABC-5* Study on Heart Disease

“…We also observed that non-CD was more prevalent, 8 and an inverse association with plasma lipid levels was observed in concordance with previous reports. 4,9,10 We could assume that the improvement in cardiovascular treatment tends to reduce cardiovascular mortality, allowing non-cardiac disorders and their complications to prevail. The median age of our cohort at the time of admission was approximately 67 (58–74) years, and it is understandable that the prognostic role of plasma lipids changes with the aging of the population.…”