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

Abstract

Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient’s residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54 % were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17 % and 24 % (p = 0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95 % confidence interval [CI] 1.7–7.1; p = 0.001), with little change from north to south provinces (OR 1.5;95 % CI 1.0-2.2; p = 0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95 % CI 1.2–3.5; p = 0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95 % CI 1.5–6.2; p = 0.02), but not among provinces (HR 1.3;95 % CI 1.0–2.0; p = 0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95 % CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Conclusions The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

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

“…The higher cancer mortality in residents of the northern rural area in our study may be caused by differences in cancer incidence, as we have previously reported a higher incidence of cancer in the same area (14). Jansen et al have also attributed the higher cancer mortality in the more deprived areas in their study to a disparity in cancer incidence (36).…”

“…We recently reported that ACS patients have a higher longterm risk of cancer than the general population (4). Among lifelong ACS patients, we also documented a significant difference in the incidence and prevalence of malignancy across different parts of the Veneto region, with the northern rural area having the greatest risk (14). 3 | Cox regression and Fine-Gray competing risk regression analysis of non-neoplastic and neoplastic mortality risk over 22 years of follow-up after ACS with the interaction for risks between the six geographic areas after excluding patients who had malignancy and were still alive (n = 519).…”

“…We recently reported that ACS patients have a higher long-term risk of cancer than the general population ( 4 ). Among lifelong ACS patients, we also documented a significant difference in the incidence and prevalence of malignancy across different parts of the Veneto region, with the northern rural area having the greatest risk ( 14 ).…”

“…As previously described in detail ( 14 ), the ABC study includes patients admitted to hospitals in the following cities in Italy’s Veneto region: Conegliano-Vittorio Veneto in Treviso province (northern), Bassano in Vicenza province (central), and Adria-Cavarzere in Rovigo province (southern). Residency was categorized as urban or rural in each province (six geographic areas) using the Rural Development Programme (Programma di Sviluppo Rurale [PSR] 2014-2020) classification of municipalities, which categorises municipalities based on their rural or urban nature ( 17 ).…”

“…Our group also reported a higher incidence of cancer and neoplastic mortality in patients’ post-MI compared to the general population ( 4 ). We have observed that cancer risk in patients long after ACS significantly differs based on the geographic distribution in six urban and rural areas in the Veneto region in northern Italy, with the highest observed risk in northern rural areas ( 14 ).…”