Association of premature atherosclerotic cardiovascular disease with higher risk of cancer: a behavioral risk factor surveillance system study

Abstract

Aim The aim of this study was to investigate a possible association between atherosclerotic cardiovascular disease (ASCVD) and risk of cancer in young adults. Methods We utilized data from the Behavioral Risk Factor Surveillance System, a nationally representative US telephone-based survey to identify participants in the age group of 18–55 years who reported a history of ASCVD. These patients were defined as having premature ASCVD. Weighted multivariable logistic regression models were used to study the association between premature ASCVD and cancer including various cancer subtypes. Results Between 2016 and 2019, we identified 28 522 (3.3%) participants with a history of premature ASCVD. Compared with patients without premature ASCVD, individuals with premature ASCVD were more likely to be Black adults, have lower income, lower levels of education, reside in states without Medicaid expansion, have hypertension, diabetes mellitus, chronic kidney disease, obesity, and had delays in seeking medical care. Individuals with premature ASCVD were more likely to have been diagnosed with any form of cancer (13.7% vs 3.9%), and this association remained consistent in multivariable models (odds ratio, 95% confidence interval: 2.08 [1.72–2.50], P < 0.01); this association was significant for head and neck (21.08[4.86–91.43], P < 0.01), genitourinary (18.64 [3.69–94.24], P < 0.01), and breast cancer (3.96 [1.51–10.35], P < 0.01). Furthermore, this association was consistent when results were stratified based on gender and race, and in sensitivity analysis using propensity score matching. Conclusion Premature ASCVD is associated with a higher risk of cancer. These data have important implications for the design of strategies to prevent ASCVD and cancer in young adults.

Trends in Prevalence, Risk-Factors Controls and Medications in ASCVD Among US Adults, 1999-2018

“…This definition has been widely reported. 12-16 Very-high-risk ASCVD was defined as multiple major ASCVD events or 1 major ASCVD event and multiple high-risk conditions. 17 Major ASCVD events include recent angina or coronary heart disease (within 1 year), history of myocardial infarction, and history of stroke.…”

“…First, analyses were based on self-reported ASCVD, which might cause misclassification or underestimation; however, it has been reported that self-reported coronary heart disease, myocardial infarction, and stroke is reliable 40 . Second, ASCVD in our study did not include transient ischemic attack or peripheral artery disease, but this definition has also been widely used [12][13][14][15][16] and reflects CVD that causes major global mortality 12 . Third, NHANES did not capture dosages of statins, therefore it's unable to determine the trends of high-intensity statins use, one of the major topics in ASCVD.…”

Cancer and Postradiotherapy Cardiotoxicity: How to Face Damage in Women’s Hearts?

“…Possible reasons are an increase in the prevalence of traditional CVD risk factors in younger adults, rising unemployment and poverty, lack of affordable health insurance and limited access to healthcare, higher prevalence of risky behaviours (tobacco, alcohol and drug use) being more evident in people living in the most vulnerable areas. 52,53 Regarding sex, Khan et al showed a rise in mortality related to CVD and cancer in young and middle-aged women in the US. 54 In the ARIC study, it has been reported there is a higher incidence of traditional risk factorshypertension, diabetes, and stroke -in women.…”

Evolving data on cardiovascular complications in cancer

“…Navi et al found the 6-month cumulative incidence of MI to be 2.0% in patients with cancer, opposed to 0.7% in age-matched controls without cancer [25]. Reversely, premature atherosclerotic CVD is associated with an increased risk of cancer in young adults [56]. Growing scientific evidence suggests that cancer and coronary artery disease (CAD) are not independent entities but are connected through shared risk factors and pathological mechanisms [11,57,58].…”

“…Coronary calcification (CAC) scores were associated with cancer risk in both sexes, with a stronger association for lung and colorectal cancer as compared to sex linked cancers [14]. Interestingly, premature atherosclerosis was independently associated with higher risk of cancer in one study, suggesting that not only the vascular risk factors but perhaps also the chronic inflammation linked to atherosclerosis is a driver of carcinogenesis [15]. Although the influence of confounders cannot be eliminated, the association between atherosclerosis (the net result of diverse thrombo-inflammatory triggers) and incident cancer may point to relevant joint players.…”