Neoplastic disease after acute coronary syndrome: incidence, duration, and features: the ABC-4 ∗ Study on Heart Disease

Berton, Giuseppe; Cordiano, Rocco; Cavuto, Fiorella; Bagato, Francesco; Segafredo, Beatrice; Pasquinucci, Mattia

doi:10.2459/jcm.0000000000000701

Cited by 22 publications

(10 citation statements)

References 31 publications

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“…35,36 Earlier, our group reported a higher risk of cancer among ACS patients in the Veneto region of Italy, approximately three times higher than that observed in the general population. 7 Based on these data and data from other reports, [6][7][8][9][10] it is arguable that coronary artery disease (CAD) is associated with a higher neoplastic risk while HF per se does not seem to promote an increased risk for neoplasia onset and death in ACS patients considering that the median times of HF to cancer diagnosis in most of the prior studies were <3 years, [16][17][18] which may be too short of a period to explain a causal relationship.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, reports have suggested an increased risk of cancer and cancer‐related mortality in patients who survived ACS 6–10 . Both pathologies are linked by inflammation and oxidative stress and share several modifiable risk factors such as smoking, sedentary lifestyle, unhealthy diet, and obesity, possibly reflecting a shared biology 7,11–15 . Yet it is not well understood which patients have this higher risk.…”

Section: Introductionmentioning

confidence: 99%

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Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease

Mahmoud,

Berton,

Cordiano

et al. 2024

ESC Heart Failure

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AimsA higher risk of cancer among patients with heart failure (HF) has been suggested in recent community‐based studies. This study aimed to investigate the impact of HF during hospitalization with acute coronary syndrome (ACS) on the long‐term cancer risk.Methods and resultsThe study included 572 patients admitted with ACS to three Italian hospitals, discharged cancer‐free, and prospectively followed for 24 years or until death. All but three patients completed the follow‐up, which represented 6440 person‐years (mean age: 66 ± 12 years; 70% males). Baseline HF was diagnosed in 192 (34%) patients. A total of 129 (23%) patients developed cancer (103 without HF and 26 with HF), and 107 (19%) patients died due to it (81 without HF and 26 with HF). The incidence rates for cancer onset and cancer death were not different according to HF status. Cox regression analysis revealed no association between HF or left ventricular ejection fraction (LVEF) and cancer risk. In addition, no difference in cancer risk was observed among patients with HF with preserved ejection fraction, HF with mildly reduced ejection fraction, and HF with reduced ejection fraction. In competing risk regression analysis, the risk of cancer onset associated with HF was sub‐hazard ratio (SHR) 0.47 [95% confidence interval (CI): 0.30–0.72; P = 0.001] and SHR 1.02 (95% CI: 1.01–1.04; P = 0.002) with LVEF. Results were the same in the adjusted model. Yet the fully adjusted model showed an attenuated association between cancer death and HF (SHR: 0.63; 95% CI: 0.37–1.05; P = 0.08) and LVEF (SHR: 1.02; 95% CI: 0.99–1.06; P = 0.08). Consistent results were obtained after using propensity score matching analysis that created 192 pairs. A negative interaction between age and HF and a positive interaction between age and LVEF for cancer risk have also been found.ConclusionsAn inverse association between baseline HF and long‐term cancer risk has been observed among the ABC Study on heart disease patients who were followed for 24 years after ACS.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease

Mahmoud,

Berton,

Cordiano

et al. 2024

ESC Heart Failure

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“…The incidence rate was 17.8 cases per 1000 person-years in patients with ACS, which was three times higher than that observed in the general population. Those who developed malignancies after the ACS diagnosis demonstrated a worse prognosis [ 41 ].…”

Section: Cardio-oncology Syndrome Type III (Cos 3; Direct): Cvd Promotes a Pro-oncogenic Environmentmentioning

confidence: 99%

A new classification of cardio-oncology syndromes

et al. 2021

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Increasing evidence suggests a multifaceted relationship exists between cancer and cardiovascular disease (CVD). Here, we introduce a 5-tier classification system to categorize cardio-oncology syndromes (COS) that represent the aspects of the relationship between cancer and CVD. COS Type I is characterized by mechanisms whereby the abrupt onset or progression of cancer can lead to cardiovascular dysfunction. COS Type II includes the mechanisms by which cancer therapies can result in acute or chronic CVD. COS Type III is characterized by the pro-oncogenic environment created by the release of cardiokines and high oxidative stress in patients with cardiovascular dysfunction. COS Type IV is comprised of CVD therapies and diagnostic procedures which have been associated with promoting or unmasking cancer. COS Type V is characterized by factors causing systemic and genetic predisposition to both CVD and cancer. The development of this framework may allow for an increased facilitation of cancer care while optimizing cardiovascular health through focused treatment targeting the COS type.

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“…The diseases are linked by inflammation and oxidative stress, which contribute to the development and progression of both. Modifiable risk factors such as tobacco smoking, a sedentary lifestyle, unhealthy diet, and obesity are reported to be major contributors to the pathogenesis of both diseases, possibly reflecting a shared biology (3)(4)(5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

“…An increased risk of malignancy and cancer death was recently reported after acute coronary syndrome (ACS) (4,(8)(9)(10) and several epidemiological studies presented the higher risk of incident cancer in patients with cardiovascular diseases, especially CAD.…”

Section: Introductionmentioning

confidence: 99%

Differences in Cancer Death Risk Long After ACS Among Selected Urban and Rural Areas in North Italy: The ABC-7a† Study on Heart Disease

et al. 2021

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BackgroundAn increased risk of cancer death has been demonstrated for patients diagnosed with acute coronary syndrome (ACS). We are investigating possible geographic risk disparities.MethodsThis prospective study included 541 ACS patients who were admitted to hospitals and discharged alive in three provinces of Italy’s Veneto region. The patients were classified as residing in urban or rural areas in each province.ResultsWith 3 exceptions, all patients completed the 22-year follow-up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre-existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow-up period, which represented 6232 person-years. No difference in the cancer death risk was found between the urban and rural areas or between southern and northern provinces (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.7–1.7; p = 0.59 and HR 1.1; 95% CI 0.9–1.4; p = 0.29, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 1.9; 95% CI 1.1–3.0; p = 0.01). The fully adjusted Cox regression and Fine-Gray competing risk regression models provided similar results. Interestingly, these results persisted, and even strengthened, after exclusion of the 22 patients who developed malignancy and survived to the end of follow-up. We did not observe an urban/rural difference in non-neoplastic death risk or a significant interaction between the geographic areas.ConclusionOur analysis reveals that the cancer death risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography. The northern rural area has the highest risk. These results highlight the importance of implementing a preventive policy based on area-specific knowledge.

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Neoplastic disease after acute coronary syndrome: incidence, duration, and features: the ABC-4 ∗ Study on Heart Disease

Abstract: The long-term prospective study showed that patients with ACS have a higher incidence of malignancy than the general population. Those who develop neoplasm after being diagnosed with ACS have a worse prognosis than patients with a preexisting neoplasia.

Cited by 22 publications

References 31 publications

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease

A new classification of cardio-oncology syndromes

Differences in Cancer Death Risk Long After ACS Among Selected Urban and Rural Areas in North Italy: The ABC-7a† Study on Heart Disease

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Neoplastic disease after acute coronary syndrome: incidence, duration, and features: the ABC-4 ∗ Study on Heart Disease

Abstract: The long-term prospective study showed that patients with ACS have a higher incidence of malignancy than the general population. Those who develop neoplasm after being diagnosed with ACS have a worse prognosis than patients with a preexisting neoplasia.

Cited by 22 publications

References 31 publications

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9† Study on heart disease

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9† Study on heart disease

A new classification of cardio-oncology syndromes

Differences in Cancer Death Risk Long After ACS Among Selected Urban and Rural Areas in North Italy: The ABC-7a† Study on Heart Disease

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Product

Resources

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Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease

Heart failure during acute coronary syndrome and the long‐term cancer risk: the ABC‐9^† Study on heart disease